Preterm Infant Flashcards by Aliya Hussain

Define preterm?

Birth that occurs before 37 completed weeks of gestation

How well did you know this?

Not at all

Perfectly

Define term?

Birth between 37 weeks and 42 weeks of gestation

How well did you know this?

Not at all

Perfectly

Define post-term?

Birth that occurs after 42 completed weeks of gestation

ADD IMAGE

How well did you know this?

Not at all

Perfectly

When do the majority of childhood deaths occur?

Over 1/2 of deaths in childhood occur during the 1st year of a child’s life and are strongly influenced by preterm delivery and low birth weight (LBW)

NOTE - many babies that died were born at term

How well did you know this?

Not at all

Perfectly

Risk factors for childhood death?

Maternal age

Smoking

Disadvantages circumstances

How well did you know this?

Not at all

Perfectly

Causes of preterm birth?

Spontaneous preterm labour (major cause)

Multiple pregnancy

Preterm pre-labour rupture of membranes

Pregnancy-assoc. hypertension

Intrauterine growth restriction

Antepartum haemorrhage

Cervical incompetence / uterine malformation

How well did you know this?

Not at all

Perfectly

Late consequences of preterm deliveries?

Increased risk of another premature baby

How well did you know this?

Not at all

Perfectly

Risk factors for preterm birth?

Interval of <6 months between pregnancies

Conceiving via IVF

Smoking, drinking alcohol, using illicit drugs

Poor nutrition

Chronic conditions like hypertension and diabetes

Multiple miscarriages or abortions

How well did you know this?

Not at all

Perfectly

Differences between preterm and term infants?

Become cold even faster

More fragile lungs

Do not breathe effectively

Have fewer reserves

NOTE - pulse oximetry is more useful for these babies

Cord clamping is delayed, if possible (if the baby is in good condition and can be kept warm) for 1 minute, to allow placental transfusion and to avoid anaemia; Fe deficiency increase the risk of infections and is linked to a lower IQ

How well did you know this?

Not at all

Perfectly

Use of assistance vs resuscitation for preterm babies?

Most very preterm babies require help with transitioning to air breathing, i.e: most do not require resuscitation

NOTE - asphyxiated babies generally require more intensive care

How well did you know this?

Not at all

Perfectly

How can preterm babies be kept warm?

Very preterm babies should be kept warm by placing them into a plastic bag immediately; later, they can be placed under a radiant heater

NOTE - if the baby is being placed into a plastic bag, they should not be dried

How well did you know this?

Not at all

Perfectly

Risks assoc. with lung inflation?

Lungs of preterm babies are more fragile than those of term babies

Over-inflation causes damage, leading to inflammation and long-term morbidity

How well did you know this?

Not at all

Perfectly

Common concerns in preterm infants?

Temperature control

Feeding / nutrition

Sepsis

System immaturity / dysfunction:
• RDS
• PDA
• Intraventricular haemorrhage
• NEC

Others:
• Metabolic
• Retinopathy of Prematurity (ROP)

How well did you know this?

Not at all

Perfectly

What is hypothermia?

Low admission temp is an independent risk factor for neonatal death; it increases the severity of all preterm morbidities

How well did you know this?

Not at all

Perfectly

Why is thermal regulation ineffective in preterm babies?

Low BMR (body mass ratio)

Minimal muscular activity

S/c fat insulation is negligible

High ratio of surface area to body mass

How well did you know this?

Not at all

Perfectly

4 methods by which heat is lost?

Radiation
Convection
Conduction
Evaporation

How well did you know this?

Not at all

Perfectly

Methods of achieving temp control in preterm babies?

Study These Flashcards

Wrap or bags

Transwarmer mattress

Skin-to-skin care

Pre-warmed incubator

Why are preterm babies at increased risk of potential nutritional compromise?

Study These Flashcards

Limited nutritional reserves

Immature metabolic pathways

Increased nutrient demands

How many calories do preterm babies require?

Study These Flashcards

Preterm babies have higher nutrition requirements

The very smallest babies require ~120-130 calories per day, which is very difficult to reach with breast milk alone; specific formulas are often used as well

NOTE - usually, mothers are encouraged to express milk / use a breast pump

Gestational correction for plotting of preterm infants?

Study These Flashcards

Adjusts the plot of a measurement to account for the no, of weeks a baby was born early

No. of weeks early = 40 weeks - gestational age

It should continue to be used for:
• 1 year, for infants born 32-36 weeks
• 2 years, for infants born 32 weeks

NOTE - this should not be used for term infants

Types of neonatal sepsis, with regards to time of onset of the disease?

Study These Flashcards

Early onset (EOS) - mainly due to bacteria acquired before and during delivery

Late onset (LOS) - acquired after delivery (nosocomial or community services)

Organisms that cause neonatal sepsis?

Study These Flashcards

Group B Strep.

Gram -ve organisms:
• Klebsiella
• E. coli
• Pseudomonas
• Salmonella

Gram +ve organisms:
• Staph. aureus
• Coagulase -ve Staph.
• Strep. pneumoniae
• Strep. pyogenes

NOTE - INCUBATORS INCREASE INFECTION

Mx of neonatal sepsis?

Study These Flashcards

Prevention - hand washing, vigilant infection screening

Judicial use of antibiotics

Optimum supportive measures

Respiratory complications of prematurity?

Study These Flashcards

Respiratory Distress Syndrome (RDS)

Apnoea of prematurity

Bronchopulmonary dysplasia

Causes of RDS?

AKA hyaline membrane disease Primary causes: • Surfactant deficiency • Structural immaturity ``` Secondary causes (to interventions): • Alveolar damage • Formation of exudate from leaky capillaries • Inflammation • Repair ```

Occurrence of RDS?

Common, mainly occurring in infants born <29 weeks It can occur in term infants but it less common (more likely to be TTN)

Symptoms and signs of RDS?

``` Signs of respiratory distress: • Tachypnoea • Cyanosis • Grunting • Nasal flaring • Intercostal recessions ``` It worsens over minutes to hours, with nadir at 2-4 days and then gradual improvement; this natural history can be modified with

Mx of RDS?

Maternal steroids Surfactant replacement Ventilation (invasive vs non-invasive)

CV concerns in preterm infants?

Patent Ductus Arteriosus (PDA) Systemic hypertension

Issues assoc. with PDA?

Leads to symptoms of CHF O2 requirements are high It exacerbates RDS

What is intraventricular haemorrhage (IVH)?

A form of intracranial haemorrhage that occurs in preterm infants, which begins with bleeding into the germinal matrix (AKA germinal matrix haemorrhage, GMH)

Incidence of IVH?

Inverse relationship between the incidence and gestational age

2 major risk factors for IVH?

1. Prematurity - germinal matrix is still present and cerebral auto-regulation is immature 2. Respiratory Distress Syndrome (RDS) - hypoxia, acidosis and hypotension increase likelihood of having an unstable cerebral circulation

PC of IVH?

Most occur on the 1st day in of life (almost all neonates who develop GMH-IVH present within 72 hours): • Clinically silent • Intermittent deterioration • Catastrophic deterioration

Preventative measure of IVH?

Antenatal steroids Prompt and appropriate sterilisation ``` Avoid: • Haemodynamic instability • Hypoxia • Hypercarbia • Hyperoxia • Hypocarbia ```

Classification of IVH?

Grade 1 & 2: • Neurodevelopmental delay in up to 20% • Mortality 10% Grade 3 & 4: • Neurodevelopmental delay in up to 80% • Mortality 50%

What is necrotising enterocolitis (NEC)?

Widespread necrosis in the small and large intestine

Occurrence of NEC?

Most common neonatal surgical emergency High incidence in the most premature infants Usually occurs after recovery from RDS

Symptoms and signs of NEC?

Early signs: • Lethargy • Gastric residuals Bloody stool Temp instability Apnoea Bradycardia

Other complications of prematurity?

Retinopathy of prematurity (usually 6-8 weeks after delivery) Metabolic complications: • Early - hypoglycaemia and hyponatraemia • Late - osteopaenia of prematurity

Long-term complications of prematurity?

Neurodevelopmental outcomes: • Motor deficits - mild fine or gross motor delay and CP • Sensory deficits - vision and hearing loss • Behavioural and psychological issues Chronic health issues (higher rates compared to children who were born full term) Growth issues (more likely to exhibit poor growth compared to those born full-term) ``` Effects on adult health: • Insulin resistance • Hypertension and vascular changes • Decreased reproduction in adulthood • Preterm women, but not preterm men, have increased risk of preterm offspring ```

Relationship between gestational age at delivery and special educational need?

Increased if preterm and also if post-term The lowest risk is at 41 weeks

Preterm Infant Flashcards

(42 cards)