Preterm Infant

Question 1

Preterm?

Answer 1

A birth that occurs before 37 completed weeks of gestation

Question 2

Term?

Answer 2

A birth between 37 weeks and 42 weeks of gestation

Question 3

Post-term?

Answer 3

A birth that occurs after 42 completed weeks of gestation

Question 4

What % of all pregnancies are preterm?

Answer 4

6-7%

Question 5

Over a half of deaths in childhood occur during the first year of life and are influenced strongly by …

Answer 5

• Preterm delivery

* LBW

Question 6

The number of preterm births globally rises every year due to …

Answer 6

• Increasing maternal age
• Increasing rate in pregnancy related complications
• Greater use of infertility treatments
• More c-sections

Question 7

What is the biggest cause of preterm birth?

Answer 7

Spontaneous

Question 8

Women with a ________ pregnancy are much more likely to give birth early

Answer 8

Multiple

Question 9

> 2 previous preterm deliveries increases the risk of another preterm delivery by __%

Answer 9

70

Question 10

An abnormally shaped _______ can increase the chances of giving birth early

Answer 10

Uterus

Question 11

An interval of less < 6 months between pregnancies increases the risk of giving birth early

Answer 11

TRUE

Question 12

Conceiving through IVF makes you less likely to give birth early

Answer 12

FALSE - more likely to have a preterm brith

Question 13

Smoking, drinking alcohol and using illicit drugs make you more likely to have a ________ birth

Answer 13

Preterm

Question 14

Multiple miscarriages/ abortions make you more likely to have a ________ birth

Answer 14

Preterm

Question 15

** Delay cord clamping if possible in a preterm baby– they have very little amounts of blood !! **

Answer 15

TRUE

Question 16

You must keep preterm babies warm, they get cold very easily

Answer 16

:((((

Question 17

Low admission ___________ is an independent risk factor for neonatal death

Answer 17

Temperature

Question 18

Thermal regulation of the preterm is ineffective due to …

Answer 18

• Low BMR
• Minimal muscular activity
• No SC fat for insulation
• Surface area : body mass ratio is very high

Question 19

By what 4 methods do babies lose heat?

Answer 19

Convection – box prevents this
Radiation – heat inside the box
Evaporation – plastic bag + humidity
Conduction – box with insulated mattress

Question 20

List 4 methods of keeping a baby warm.

Answer 20

• Skin to skin
• Wrap or bags
• Prewarmed incubator
• Transwarmer mattress

Question 21

Why is the an increased risk of nutritional compromise (calorie deficit) in preterm infants?

Answer 21

• Limited nutrient reserves
• Gut immaturity
• Immature metabolic pathways
• Increased nutrient demands

Question 22

What is early onset neonatal sepsis usually due to?

Answer 22

Bacteria acquired before or during labour

Question 23

What is late onset neonatal sepsis usually due to?

Answer 23

Bacteria acquired after delivery

Question 24

What babies are more at risk of infection?

Answer 24

Preterm babies

Question 25

Name the 2 most common early onset neonatal sepsis organisms.

Answer 25

* Group B Streptococcus | * Gram negatives

Question 26

Name the 4 most common late onset neonatal sepsis organisms.

Answer 26

* Coagulase negative staphylococci * Gram negatives * Staph aureus * Group B Streptococcus

Question 27

Why are premature babies more likely to get sepsis?

Answer 27

* Immature immune system. * Intensive care environment. * Indwelling tubes and lines.

Question 28

What commonly used machine in the wards increases a babies risk of infection?

Answer 28

INTUBATORS!!

Question 29

** When a baby gets sick, if they are premature then their bone marrow cannot make WBC’s In sick premature babies, what happens to WBC count?

Answer 29

FALLS

Question 30

What is different about the retina of a preterm baby?

Answer 30

It is not vascularised

Question 31

List the 3 most common resp complications of newborns.

Answer 31

* Respiratory distress syndrome (RDS) – surfactant deficiency * Apnoea of prematurity * Bronchopulmonary dysplasia

Question 32

RDS is common in ________ babies

Answer 32

Preterm

Question 33

What is RDS a problem of?

Answer 33

Hyaline membranes

Question 34

Describe the primary pathology of RDS.

Answer 34

* Surfactant deficiency | * Structural immaturity

Question 35

Describe the secondary pathology of RDS.

Answer 35

* Alveolar damage * Formation of exudate from leaky capillaries * Inflammation * Repair

Question 36

What is the classical x-ray sign in RDS?

Answer 36

Ground glass

Question 37

List the signs of RDS.

Answer 37

* Tachypnoea * Grunting * Intercostal recessions * Nasal flaring * Cyanosis * Worsening over minutes to hours !!

Question 38

Describe the series of events in RDS.

Answer 38

Gradual worsening to a nadir at 2-4 days then gradual improvement

Question 39

Outline the management of RDS.

Answer 39

1. Maternal steroid 2. Surfactant 3. Ventilation – invasive/non-invasive

Question 40

On an x-ray of a baby with severe RDS, what will be practically impossible to see?

Answer 40

Heart border

Question 41

Necrotising enterocolitis is a neonatal ________ __________

Answer 41

Surgical emergency

Question 42

What is necrotising entercolitis?

Answer 42

Necrosis in the small and large intestine !! – multifactorial bowel infection

Question 43

What does a baby always have before getting necrotising entercolitis?

Answer 43

Milk

Question 44

Free gas in the bowel wall gives tramlining appearance What condition is this seen in?

Answer 44

Necrotising enterocolitis

Question 45

Babies who get necrotising enterocolitis are usually recovering from what condition?

Answer 45

RDS

Question 46

What are the early signs of necrotising enterocolitis?

Answer 46

Lethargy and gastric residuals

Question 47

What is seen in the bowel wall of a baby with NE?

Answer 47

Necrotic areas + abscesses

Question 48

List the 4 main signs of NE.

Answer 48

Blood stool, temperature instability, apnoea and bradycardia

Question 49

Who is at risk of PDA (patent ductus arteriosus)?

Answer 49

Preterm babies

Question 50

What are the 3 consequences of failure of the ductus arteriosus to close after birth?

Answer 50

* Leads to symptoms of congestive heart failure * Oxygen requirements are high * Exacerbates RDS

Question 51

Explain the 6 stages of closure of the ductus arteriosus.

Answer 51

1. Baby is born and takes first breath 2. Lungs starts working 3. Pulmonary resistance decreases 4. Pumonary vascular resistance drops and blood flows into the lungs 5. Foramen ovale closes at same time  systemic vascular resistance increases 6. Less blood flows through ductus arteriosus and it closes (+ there is prostaglandin decrease)

Question 52

MACHINE LIKE MURMUR

Answer 52

Patent Ductus Arteriosus

Question 53

What is the most common clinical sign in PDA?

Answer 53

Machine like murmur !!!

Question 54

Outline 3 signs seen in PDA.

Answer 54

* Cardiomegaly * Poor feeding * Increased systolic pressure

Question 55

Describe intraventricular haemorrhage.

Answer 55

* Cardiomegaly * Poor feeding * Increased systolic pressure

Question 56

In 80% of cases, ____ leads to an intraventricular bleed

Answer 56

GMH

Question 57

1st line Ix for intraventricular haemorrhage?

Answer 57

USS

Question 58

How can the risk of bleeding in intraventricular haemorrhage be greatly reduced?

Answer 58

Surfactant

Question 59

How can the risk of bleeding in intraventricular haemorrhage be greatly reduced?

Answer 59

Surfactant

Question 60

Grade 1/2 intraventricular haemorrhage ....

Answer 60

* Neurodevelopmental delay up to 20% | * Mortality 10%

Question 61

Grade 3/4 intraventricular haemorrhage ....

Answer 61

* Neurodevelopmental delay up to 80% | * Mortality 50%

Question 62

How can IVH be prevented?

Answer 62

* Antenatal steroids. * Prompt and appropriate resuscitation. * Avoid haemodynamic instability.

Question 63

What 4 H's should you avoid when trying to prevent IVH?

Answer 63

hypoxia hypercarbia hyperoxia hypocarbia

Question 64

What is there an inverse relationship between in IVH?

Answer 64

Gestational age at birth

Question 65

What are the 2 major risk factors for IVH?

Answer 65

* Prematurity. | * Respiratory distress syndrome.

Question 66

When do most IVH's occur?

Answer 66

In the first day of life. In up to 90% of neonates who will get GMH-IVH, the insult is present by 72 hours.

Question 67

Why does RDS increase the risk of IVH?

Answer 67

Hypoxia, acidosis and hypotension increase the likelihood of the cerebral circulation being unstable.