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Preterm Infant Flashcards

1
Q

what is a pre term baby

A

born before 37 weeks completed gestation

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2
Q

what is a post term baby

A

a baby born after 42 completed weeks

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3
Q

what public health effort reduced pre term labours by 10%

A

the smoking ban

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4
Q

when do half of childhood deaths occur

A

within the first year (strongly influenced by pre term delivery and low birth weight)

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5
Q

what are the risk factor for fetal death

A

ethnicity (black and british black, asian or asian black)
poverty
maternal age (teenage and mothers over 40)
pre term
mulitple pregnancies
labour complications

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6
Q

why are preterm births rising in incidence (>1:10)

A

increased maternal age
increased pregnancy complications
fertility treatments
more C sections done before term

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7
Q

what are the most common causes of pre term birth

A 
spontaneous preterm labour 
multiple pregnancy 
PROM
pregnancy associated hypertension 
IUD
antepartum haemorrhage 
cervical incompetence/ uterine malformation
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8
Q

what are the risk factors for pre term deliveries

A 
previous pre term baby 
abnormally shaped uterus 
multiple pregnancies 
interval <6 months between pregnancies 
conceiving through in vitro fertilisation 
smoking, alcohol, drug use 
poor nutrition 
chronic conditions (high BP, diabetes) 
multiple miscarriages/ abortions
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9
Q

what extra management is needed for pre term babies

A

need more help to stay warm (put baby in plastic bag under a radiant heater immediately- while still wet)
more fragile lungs and dont breath effectively, may need resp support
have fewer reserves- need to feed well
delay cord clamping if possible

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10
Q

what are common problems of prematurity

A 
temperature control (important for enzyme activity)
feeding/nutrition 
sepsis 
system immaturity/ dysfunction: 
-respiratory distress syndrome 
-patent ductus arteriosus 
-intraventricular haemorrhage 
-necrotising enterocolitis 
metobolic dysfunction 
retinopathy if prematurity
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11
Q

why is hypothermia in prematurity so bad

A

increases severity of all preterm morbidities
leads to hypoglycaemia and hypoxia as increases metabolism = hypoglycaemia which causes decreases surfactant production and pulmonary constriction, and increased RR= resp distress= hypoxia

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12
Q

why is thermal regulation ineffective in premature babies

A

low BMR
minimal muscular activity
subcutaneous fat insulation is negligible
high SA to body mass

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13
Q

what are the four ways babies loose heat

A

convection, conduction, radiation, evaporation

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14
Q

how is heat maintained in premature babies

A

wrap or bags
skin to skin
transwarmer mattress
PREWARMED incubator

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15
Q

why are pre term babies at more risk of nutritional compromise

A

limited nutrient reserves
gut immaturity
immature metabolic pathways
increased nutrient demands

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16
Q

what nutrition options for premature babies

A

breast milk is best- ask mothers to express and store milk until baby is able to feed normally
can have total parental nutrition if required
can have donor breast milk
rarely formula feeding

17
Q

what are the types of neonatal sepsis

A

early onset sepsis:
-mainly bacterial acquired before and during pregnancy

late onset sepsis:
-acquired after delivery from hospital/community

18
Q

what organisms commonly cause early onset sepsis

A

group B strep

gram -ves

19
Q

what organisms commonly cause late onset sepsis

A

coagulase negative staph (epi)
gram -ves
staph aureus

20
Q

why are the infections risks associated with prematurity

A

immature immune system
intensive care environment
indwelling tubes and lines

21
Q

what management is in place to prevent neonatal infections

A 
hand washing
v vigilant 
screen for infections 
be early to prescribe antibiotics 
supportive measure in place if infections starts
22
Q

what are the resp complications of prematurity

A

respiratory distress syndrome
apnoea of prematurity
bronchopulmonary dysplasia

23
Q

what is respiratory distress syndrome

A

(aka hyaline membrane disease)
when primary pathology (surfactant deficiency and structural immaturity) or secondary pathology result in
alveolar damage:
-formation of exudate from leaky capillaries
-inflammation
-repair

24
Q

how common in resp distress syndrome

A

75% of infants born before 29 week, 10% in infants born after 32 weeks

25
Q

what are the clinical features of respiratory distress syndrome

A 
resp distress 
tachypnoea
grunting 
intercostal recession 
nasal flaring 
cyanosis

worsens over minutes to hours
worst at 2-4 days then gradual improvement

26
Q

what is the management of resp distress syndrome

A

maternal steroid before birth
surfactant replacement
ventilation (invasive or non invasive- CPAP)

27
Q

how do infantile intraventricular haemorrhages present

A 
most present by third day of life 
dimished/ absent moro reflex 
poor muscle tone 
sleepiness 
lethargy 
apnoea

The fontanelle may be tense and bulging with severe IVH.
Neurological depression may progress to coma.
In mild forms there may be no clinical signs, or there may be alternating symptomatic and asymptomatic periods.

28
Q

what are the grade of intraventricular haemorrhage

A

grades 1-4, how contained the blood is within the ventricular system and how dilated they are
Grade 1 and 2 : Neurodevelopmental delay up to 20% Mortality 10%

Grade 3 and 4: Neurodevelopmental delay up to 80%
Mortality 50%

29
Q

how can intraventricular haemorrhage be prevented

A

antenatal steroids

30
Q

what causes necrotising enterocolitis

A

when very premature gut not meant to have milk yet, only liquor, so if feed then gut becomes inflamed and can start to necrose
bacteria can translocate from gut into bloodstream causing sepsis and severe dehydration

31
Q

who is most likely to get retinopathy of prematurity

A

those born <32 weeks
usually happens 6-8 weeks after delivery
(screened until retina properly vascularised)

32
Q

what are the early metabolic complications of prematurity

A

hypoglycaemia

hyponatraemia

33
Q

what are the late metabolic complications of prematurity

A

osteopenia of prematurity

34
Q

how does term relate to educational needs

A

early or later more likely to need more help

35
Q

how common in prematurity

A

~6%

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