PROBS RELATED TO PRE- AND POST- MATURITY Flashcards
1
Q
every year, an estimated ___ babies are born preterm
A
15 million
2
Q
preterm birth complicatiosn are the leasing cause of death among children under ___ years of age
A
5
3
Q
___ of these deaths could be prevented with current, cost-effective interventions
A
three-quarters
4
Q
across 184 countires, the rate of preterm birth ranges from ___% of babies born
A
5-18%
5
Q
- live infant born before the end of week 37 of gestation
- weight of less than 2500g at birth
A
preterm infant
6
Q
causes of preterm birth
A
- low socioeconomic level, early termination of pregnancy
- inadequate nutrition
- iatrogenic causes - elective cesarean, inducing labor
7
Q
pregnancy behaviors that may contribute to preterm birth
A
cigarette smoking
working 12 hour shifts
8
Q
preterm baby is small and ___
A
underdeveloped
9
Q
preterm baby’s head is ___
A
disproportionately large (cm greater then chest)
10
Q
preterm baby’s skin is usually ruddy because of little ___
A
subcutaneous fat
11
Q
preterm baby’s ___ are easily noticeable, and high degree of ___ may be present
A
veins
acrocyanosis
12
Q
___ is absent in preterm because it is not formed this early in pregnancy (< 25 weeks ges)
A
vernix
13
Q
___ is usually extensive, covering the back, forearms, forhead, and side of the face
A
lanugo
14
Q
preterm baby’s anterior and posterior ___ are small
A
fontanelles
15
Q
there are no ___ on the soles of the feet
A
creases
16
Q
preterms has varying degrees of ___ because of lack of eye globe depth
A
myopia / nearsightedness
17
Q
the ___ of the ear is immature and allows the ___ to fall forward
A
cartilage
pinna
18
Q
the ___ appear large in relation to the head
A
ears
19
Q
if the preterm infant cries, the cry is weak and ___
A
high-picthed
20
Q
___ and ____ reflexes are absent if below 33 weeks
A
sucking and swallowing
21
Q
____ reflex markedly diminished
A
achilles tendon
22
Q
an infant who has difficulty accomplishing effective breathing may expreince residual ___ ___ as a result of cerebral hypoxia
A
neurologic morbidities
23
Q
process of resuscitation of preterm
A
establish an airway
the lung
initiate and maintain effective ventilation
24
Q
start chest compressions is ___ becomes so severe
A
respiratory depression (<60 bpm)
25
___ should occur if there is an obstruction such as mucus plug
suctioning
26
an infant with no effort at spontaneous respirations after initial steps may require insertion of?
endotracheal tube
27
what medication given to the mother may cause respiratory depression in an infant after birth
morphine, meperidine
28
- a drug to reverse the action of narcotics
- may cause seizure in newborn
naloxone (narcan)
29
resiscitation efforts should focus on ___ and ___ for the persistenty apneic newborn
effective ventilation
airway support
30
___ may be administered IV to stimulate heart action
epinephrine 1:10,000
31
preterms may recieve ___ to replace the natural ___ that has not yet formed in their lungs
surfactant
32
all high-risk infants have difficulty maintaining ___
temp
33
if preterm environment becomes too hot, they are forced to decrease ___ to cool their body
metabolism
34
why is increased metabolism destructive for preterms?
increased metabolism = increased oxygen need = respiratory difficulty = hypoxia
35
- a pause in breathing for 15-20 secs or more
- may happen together with a slow HR
apnea of prematurity
36
- a lung disease that can develop in prematue babies as well as babies who have treatment with a breathing machine
- have a higher risk of lung infections than other babies
bronchopulmonary dysplasia
37
a lack of lung surfactant makes them vulnerable to this
respiratory distress syndrome
38
- can acquire more esily because their immune systems arent fully developed
infections / nenonatal sepsis
39
- develop a normochromic, normocytic anemia
- reticulocyte count is low bc the bone marrow does not increase its production until approximately 32 weeks
anemia of prematurity
40
anemia - infant appears ___ and may be ___ and ____
pale
lethargic and anorectic
41
anemia - may need ___, and supplementation of ___ and ___ provided by preterm formula
blood transfusion
vitamin E and iron
42
occurs bc preterms have both fragile capillaries and immature cerebral vascular development
periventricular/intraventricular hemorrhage
43
an infant experiences ___ distal to the rupture
brain anoxia
44
___ is done after the first few days of life to detetct if a hemorrhage has occured
cranial ultrasound
45
- destruction of brain cells by invasion of indirect bilirubin
- occurs from the high concentration of indirect bilirubin in the blood from excessive breakdown of RBC
kernicterus
46
kernicterus - have less ___ available to bind indirect bilirubin and therefore inactivate its effect
serum albumin
47
if jaundice occurs, what are the interventions?
blood transfusion and phototherapy
48
- acute injury to the small/large intestines that causes nflammation and injury to the bowel lining
- occurs within 2 weeks of birth
- feeding difficulties, abd swelling, hypotension, sepsis
necrotizing enterocolitis
49
when NEC is suspected, infants are treated with ___ and ___
antibiotics
bowel rest
50
- preterms lack surfactant, their lungs are noncompliant, so it is more dificult for them to move blood from the pulmonary artery in the lungs
- lead to pulmonary artery HTN, which may interfere with the closure of the DA
persistent patent ductus arteriosus
51
medications for persistent patent ductus arteriosus
indomethacin and ibuprofen
52
side effect of indomethacin
oliguria
53
- most common eye abnormality
- neovascular retinal disorder, incidence increases with decreasing age and weight
- immaturity with an avascular retina
retionapthy of prematurity
54
an infant must be kept ___ during resuscitation procedures
warm
55
give ___ oxygen during resuscitation
100%
56
preterm experience a high ___ and cannot concentrate urine well because of immature kidney function
insensible water loss
57
normal neuromaturation can be promoted by?
positioning the infant that mimic’s its position in the womb
extreme flexion
hip adduction
avoid neck and trunk extension
58
comfortable breathing, better oxygenation, and more sleep have been noted in infants in the ___ position
prone
59
elements of neurodevelopmental support
- NICU design and lighting
- nursing routines & care plans
- feeding methods
- management of pain
- attention to sensory input, activity, and signs of stress
- involvement of parents
60
preterms fed ___ have lower risk of infections and NEC, have higher cognitive scores, and have lower risk of chronic gastrointestinal diseases and allergies
breast milk
61
most infants have a ___ before a first feeding
chest xray
62
a preterm needs ___ calories per kg of body weight per day
115-140
63
feedings may be as small as ___ ml every ___ hours
1-2 ml
2-3 hours
64
a gag reflex is not intact until ___ weeks gestation
32
65
___ may be given intermittently every few hours or continuously via tubes
gavage feedings
66
infants may be fed by ___ at about 1ml/hr
continuous drip feeding
67
the caloric concentration of formula used for preterms is usually ___
24 cal/oz
68
- born after the 41st week of a pregnancy
- special risk because a placenta appears to function effectively for only 40 weeks
post term infant
69
posterms may be ___ because of poor placental function
lightweight
70
posterms is likelt to have difficulty establishing ___, expecially if meconium aspirations occurd
respirations
71
posterms is unusually ___ and wide eyed with a ___ look
alert
worried look
72
posterm may be thin with ___ and little ___
loose skin
subcutaneous fat
73
posterms cord is thin with little ___
wharton’s jelly
74
posterms have little to no lanugo and vernic but have abundant ___ and long ___
hair and nails
75
posterms skin is ___, ___, and ___
wrinkled, cracked, and peeling
76
posterms should be assessed for ___ bc of rapid use of glycogen stores
hypoglycemia
77
if loss of subcutaneous fat has occured, the infant is at risk for ___
low temp
78
posterm is diagnosed based on
gestational age
79
postmaturity is diagnosed based on
gestational age and physical exam
80
placental insuffiency and cord compression secondary to olugohydramnio
perinatal asphyxia
81
may be severe bc amniotic fluid is decreased and meconium is less dilute
meconium aspiration syndrome
82
occurs after meconium aspiration
persistent pulmonary hypertension
83
management for meconium aspiration
- suctioning
- chest physiotherapy
- supplemental oxygen and respiration support
84
provide ___ to prevent hypoglycemia if not contraindicated by respi status
early feeding
85
avoid the use of ___ in postterm
powders, creams, and lotions
tape
86
- birth weight is below the 10th percentile
- microsomia
- may be born preterm, term or posterm
- IUGR in utero
small of gestational age
87
causes of small for gestational age
- teen pregnancy
- smoking
- inadequate nutrition
88
common cause of IUGR is
placental anomalies
89
other causes for SGA (intrauterine infections)
rubella, toxoplasmosis, chromosomal abnormality
90
how to detect size of baby in utero
sonogram
91
CS birth is the birth method of choice if ___ occurs
hypoxia
92
SGA - overall ___ appearance
wasted
93
SGA’s have small ___, which may cause difficulty regulating glucose, protein, and bilirubin
liver
94
SGA - poor ___ and disproportionate head
skin turgor
95
SGA - hair is ___ and ____
dull and lusterless
96
SGA - abd may be ___
sunken
97
SGA - the cord often appear dry and stained ___
yellow
98
SGA lab findings
- polycythemia
- high hematocrit
- high RBC
- low blood glucose (<40 mg/dl)
99
SGA - later in life there is increased risk of ___, which are thought o be caused by abnormal vascular development
ischemic heart disease
hypertension
stroke
100
- macrosomia
- birth weight above the 90th percentile
large of gestational age
101
LGA is common in mothers who are ___ and have ___
obese
DM
102
other causes of LGA
- transposition of great vessles
- beckwith syndrome
- congenital anomalies (ex: emphalocele)
103
___ is performed to assess the placenta’s ability to sustain the large fetus during labor
non stress test
104
LGA - lung maturity can be assessed by ___
amniocentesis
105
LGA - CS birth may be necessary due to
CPD or shoulder dystocia
106
LGA - mature ___ and ___ scores on gestational age exams (apgar)
reflexes
low scores
107
LGA may have extensive ___ or birth injury such as:
bruising
broken clavicle; erb duchenne paralysis
108
complications of LGA
birth trauma
hypoglycemia
hyperviscosity
hyperbilirubinemia
109
some LGA have difficulty establishing ___ at birth bc of birth trauma
respirations
110
a ___ may occur due to cervical nerve trauma
diaphragmatic paralysis
111
LGA needs to be breastfed immediately to avoid ___
hypoglycemia
112
do not over stimulate infant’s ability to ___ effectively after birth
suck
113
LGA observe closely for signs of
hyperbilirubineamia
polycythemia
hypoglycemia
114
___ is the major cause of LGA
maternal DM
115
large size itself increases risk of ___
birth injury
perinatal asphyxia
116
infants of diabetic mothers are also at risk of ___
respiratory distress syndrome and congenital anomalies
