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HD > Problems with LBW and prematurity > Flashcards

Problems with LBW and prematurity Flashcards

1
Q

What is considered to be a low-birthweight/very low birthweight/extremely low birthweight?

A

Low birthweight: <2500 g
Very low birthweight: <1500 g
Extremely low birthweight: <1000 g

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2
Q

What is meant by small for gestational age?

A

Birthweight below the 10th centile for gestation

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3
Q

Define foetal growth restriction.

A

Failure to achieve normal rate of foetal growth - can be from uteroplacental insufficiency or from foetal infection

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4
Q

Why might a baby be small for gestation age?

A

Genetics:

  • normal small baby
  • chromosomal disorders (Edwards syndrome = trisomy 18)
  • inherited disorders

Acquired:

  • uteroplacental insufficiency
  • congenital infection
  • smoking
  • maternal chronic illness (renal, sickle cell)
  • multiple pregnancy (twins)
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5
Q

Why does uteroplacental insufficiency occur? How is it detected?

A

Failure of syncytiotrophoblast invasion of the high resistance spiral arteries (fail to transform into low resistance vessels)
Poor placental development with raised resistance in the placental vascular bed

Can be detected using doppler US of the uterine arteries + foetal circulation

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6
Q

During foetal hypoxia, what does increased blood flow to the MCA indicate? Is it a good sign? What artery might there be reduced blood flow in, at the same time?

A

It is a good sign
Indicates that the brain is being spared + prioritised over other organs
Most likely reduced blood flow to the SMA as a result

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7
Q

What problems might a SGA baby face?

A
  1. temperature control (increased surface area:volume; reduced adipose tissue insulation; reduced capacity for thermogenesis)
  2. polycythaemia (response to foetal hypoxia)
  3. poor nutritional status (hypoglycaemia = <2.6 mmol/L, treat with feed/IV dextrose)
  4. increased risk of necrotising enterocolitis
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8
Q

What adult diseases are associated with LBW?

A 
Diabetes
Hypertension
Coronary heart disease
Stroke 
Chronic bronchitis
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9
Q

Why might a baby be born prematurely?

A

Spontaneous:

  • infection/ruptured membranes
  • cervical incompetence
  • polyhydramnios

Intentional:

  • save mother (HTN, haemorrhage)
  • save foetus (placental insufficiency)
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10
Q

What complications can arise with a premature baby?

A
  • temperature control
  • respiratory problems
  • cardiovascular problems
  • nutrition
  • infection
  • neurological
  • LT consequences
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11
Q

What respiratory problems might a premature baby have?

A

Structural immaturity:

  • primitive alveolar development
  • susceptibility to O2 toxicity and barotrauma

Functional immaturity:

  • surfactant deficiency
  • lack of respiratory drive

Susceptibility to infection:

  • immature immune system
  • ineffective cilia
  • instrumentation of airway

Short term clinical issues:

  • Respiratory distress syndrome
  • pneumonia
  • apnoea of prematurity

Long-term clinical issues:
- chronic lung disease in infancy

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12
Q

What are the main components of surfactant?

A

Dipalmitylphosphaditylcholine

Phosphaditylglycerol

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13
Q

What stabilises surfactant?

A

Surfactant protein B

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14
Q

What is the clinical presentation of RDS? How soon does it occur? How is it diagnosed?

A

Clinical presentation:

  • tachypnoea
  • respiratory grunting
  • recession
  • use of accessory muscles

Onset is within 4 hours of birth

Diagnosed with bronchogram –> will show a hazy ‘ground glass’ appearance (surfactant deficiency)

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15
Q

What prevention and treatment options are there for RDS?

A

Prevention:

  • Antenatal steroids (2 12h apart)
  • avoidance of intrauterine hypoxia
  • prophylactic surfactant treatment
  • keep warm - avoid acidosis

Treatment:
- surfactant and respiratory support

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16
Q

What would the lungs/airways system of an infant with chronic lung disease look like?

A
  • inflammation
  • fibrosed
  • emphysema-like appearance
17
Q

What kind of cardiovascular problems occur with prematurity?

A

Persistent pulmonary hypertension of the newborn
Failure to maintain BP
Patent ductus arteriosus

18
Q

How many calories and how many ml of milk does a preterm baby require in order to grow? What must be done if a baby cannot tolerate milk?

A

110-135 kcal/kg/day
160-200 ml/kg/day (milk)

If baby cannot tolerate milk = IV parenteral nutrition

19
Q

What challenges might a preterm baby face in terms of nutrition?

A

Immature sucking = tube feeding
digestive enzymes are present
poor gut motility
may not tolerate enteral feeds

  • if a baby is not fed it can lead to gut mucosa atrophy
  • feeding may precipitate necrotising enterocolitis
20
Q

What is necrotising enterocolitis? What are the risk factors?

A

Acute bacterial/inflammation/necrosis of the bowel with gas formation (pneumotosis)
RFs: prematurity, hypoxia, infection, enteral feeding

21
Q

How does necrotising enterocolitis present? What is the treatment? What are the potential complications?

A

Presentation:

  • Abdominal distension
  • Tenderness
  • Discolouration
  • Blood in stools
  • Collapse

Treatment:
- Stop feed and give antibiotics +/- surgery

Complications:

  • Death (~25%)
  • Short gut secondary to resection/strictures/late obstruction
22
Q

What bacteria most commonly cause infection in newborns?

A

Early infections (<48 hours)

  • Group B beta haemolytic streptococcus
  • E coli

Late infections (>48 hours)

  • Coagulase negative staphylococci
  • Gram negative organisms that colonise the intestine
23
Q

What defences against infection do full-term babies have?

A
  • Transplacental IgG in 3rd trimester
  • IgA + immunologically active cells in colostrum
  • Skin barrier
  • Acquisition of normal flora from mother to baby

*antibiotics and invasive procedures can breach host defences

24
Q

What CNS issues can preterm babies have?

A
  • Susceptibility to periventricular haemorrhage
    (RFs: <34 weeks; RDS; pneumothorax; hypercapnia)
  • Risk of periventricular leucomalacia = ischaemia of periventricular white matter
25
Q

What complications arise with intracerebral bleeding?

A
  • collapse + death
  • loss of brain parenchymal tissue with cyst development
  • blockage of CSF circulation leading to hydrocephalus

HD (26 decks)

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