preterm infant

Question 1

preterm definition

Answer 1

birth that occurs before 37 completed weeks of gestation

Question 2

spectrum of preterm babies

Answer 2

before 22 weeks- fetal loss
23-27 wks- extremely preterm
28-31-very preterm
32-37 wks- preterm

Question 3

smoking ban led to

Answer 3

fall in premature births

Question 4

cause of rising neonatal death

Answer 4

increased maternal age
increasing pregnacy related complications
greater use of infertility treatments
more c-section deliveries before term

Question 5

risk factors foe preterm pregnancy

Answer 5

more than 2 deliveries preterm increases risk by 70%
abnormally shaped uterus increases risk by 19%
9 fold increases in risk if it is a multiple pregnancy
interval shorter than 6 months btwn pregnancies
conceiving through IVF
smoking, drinking and illicit drugs
poor nutrition, chronic conditions and multiple miscarriages or abortions

Question 6

preterm baby issues

Answer 6

need help staying warm 
have fragile lungs 
don't breathe effectively 
have fewer reserves 
delay cord clamping if possible

Question 7

keeping baby warm

Answer 7

plastic bag under radiant heater
skin to skin contact
transwarmer mattress
prewarmed incubator

Question 8

other issues with prematurity

Answer 8

feeding/nutrition 
sepsis
system immaturity/dysfuntion
-RDS(resp. dist. synd.)
-PDA
-IVH(intravent. heamo.)
-NEC(necrotising  enterocolitis)

Question 9

Why is thermal regulation ineffective?

Answer 9

low BMR
minimal muscular activity
low subcut fat
surface area to body mass ratio high

Question 10

hypothermia can lead to

Answer 10

hyoglycemia and hypoxia

Question 11

risk of nutritional compromise due to

Answer 11

limited nutrient reserve
gut immaturity
immature metabolic pathways
increased nutrient demands

Question 12

neonatal sepsis

Answer 12

early onset 
- grp B strep 
- gram neg 
late onset 
- coag neg staph
- gram neg 
- staph aureus

Question 13

risk of sepsis due to

Answer 13

immature immune system
intensive care environment
indwelling tubes and lines

Question 14

respiratory complications of prematurity

Answer 14

RDS
apnoea of prematurity
bronchopulmonary dysplasia

Question 15

respiratory distress syndrome

Answer 15

A disease of hyaline membrane 
Primary pathology
-Surfactant deficiency
-Structural immaturity
Alveolar damage
-Formation of exudate from leaky capillaries
-Inflammation
-Repair
Common in
-75% of infants born before 29 week, 10% in infants born after 32 weeks

Question 16

clinical features of RDS

Answer 16

Respiratory distress
Tachypnoea
       - Grunting
       - Intercostal recessions
        -Nasal flaring
        -Cyanosis
Worsen over minutes to hours

Question 17

management of RDS

Answer 17

give
maternal steroids
surfactant
ventilation(inavasive/noninvasive)

Question 18

intraventricular heamorrage

Answer 18

Grade 1- 4 classification and outcome:
Grade 1 and 2; Neurodevelopmental delay up to 20% Mortality 10%
Grade 3 and 4: Neurodevelopmental delay up to 80% Mortality 50%

Question 19

other complications

Answer 19

Retinopathy of prematurity
usually 6-8 weeks after delivery

Metabolic	
early 
-hypoglycaemia		-hyponatraemia
late
-osteopenia of prematurity

Question 20

summary

Answer 20

Survival rates for extremely preterm infants have improved

Antenatal steroids and surfactant replacement has contributed to improved preterm care

Impairments may have an adverse effect on family life, impact on social, education, and health service resources.
Prematurity : Common problem ~ 6%
The risk of complications increases with decreasing gestational age and birth weight
Organ dysfunction as a result of prematurity
Complications short-term Respiratory, GIT and cardiovascular complications
long-term sequelae neurodevelopmental disabilities such as cerebral palsy