Sick Preterm Baby

Question 1

What is very preterm defined as?

Answer 1

<32 weeks

Question 2

How were premature births affected by the smoking ban?

Answer 2

fell 10%

Question 3

What is the risk of preterm birth with mulitple pregnnacy?

Answer 3

x9 risk

Question 4

What is the average gestation at birth for twins?

Answer 4

37 weeks

Question 5

What is the average gestation at birth for triplets?

Answer 5

34 weeks

Question 6

What can hypothermia result in?

Answer 6

increased oxygen and energy consumption–hypoxia; metabolic acidosis and hypoglycaemia; apnea; noenatal cold injury; reduced blood coagulability; failure to gain weight; increased mortality

Question 7

What is neonatal cold injury?

Answer 7

redness of the skin from dissociation of haemoglobin

Question 8

Why are newborn babies liable to hypothermia?

Answer 8

large SA realtive to mass; skin is thin; little subcut fat; limitied capacity to generate heat; unable to curl up to reduce skin exposure

Question 9

How are babies under 28 weeks kept warm?

Answer 9

placed in a plastic bag immediately whilst still wet under a radiant heater

Question 10

What happens if you over-inflate a preterm babies lungs?

Answer 10

causes damage leading to inflammation and long-term morbidity; predisposes to bronchopulmonary dysplasia

Question 11

What are the options for keeping a baby warm?

Answer 11

wrap or bags; skin-skin care; transwarmer mattressl prewarmed incubator

Question 12

Why are extremely preterm infants unable to breastfeed immediately?

Answer 12

unable to suck and swallow until 34-35 weeks; initially unable to tolerate milk in enough quantity

Question 13

Why are preterm babies are risk of nutritional compromise?

Answer 13

limited nutrient reserves; immature metabolic pathways; increased nutrient demands

Question 14

What effect does oxygen have on pulmonary vasculature?

Answer 14

potent vasodilator

Question 15

What is gestational corrrection?

Answer 15

adjusts the plot of a measurement to accoutn for the number of weeks a baby was born early

Question 16

How long should gestational correction be continued for infants born between 32 and 36 weeks?

Answer 16

1 year

Question 17

How long should gestational correction be continued for infants born before 32 weeks?

Answer 17

2 years

Question 18

What is the cause of early onset noenatal sepsis?

Answer 18

due to bacteria acquired before and during delivery

Question 19

What is the cause of late onset neonatal sepsis?

Answer 19

acquired after delivery

Question 20

What is the primary problem in respiratory distress syndrome?

Answer 20

surfactant deficiency and structural immaturity

Question 21

What causes the secondary pathology in respiratory distress sundrome?

Answer 21

from treating- ventilation

Question 22

How many calories per kg does a preemie need?

Answer 22

> 100kcal/kg

Question 23

What are the secondary problems in respiratory distress syndrome?

Answer 23

alveolar damage and formation of exudate from leaky capillaires due to damaged fragile lungs

Question 24

How common is RDS in babies born before 29 weeks?

Answer 24

75%

Question 25

What is the natural history of RDS?

Answer 25

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

Question 26

What is the management for RDS?

Answer 26

maternal steroids; surfactant; ventilation

Question 27

What are the CVS concerns in preterm infants?

Answer 27

PDA; systemic hypotension

Question 28

What does PDA lead to?

Answer 28

symptoms of congestive heart failure; babies need lots of oxygen and will exacerbate RDS

Question 29

What is an intraventricular haemorrhage?

Answer 29

form of intracranial haemorrhage that begins with bleeding into the germinal matrix

Question 30

What are the 2 major risk factors for IVH?

Answer 30

prematurity and respiratory distress syndrome

Question 31

When does IVH usually occur?

Answer 31

first day of life

Question 32

Why is prematurity a RF for IVH?

Answer 32

germinal matrix is present but cerebral autoregulation is immature

Question 33

Why does RDS inrease risk of IVH?

Answer 33

hypoxia; acidosis and hypotension make the cerebral circulation more unstable

Question 34

What is the most common neonatal surgical emergency?

Answer 34

necrotizing enterocolitis

Question 35

What happens in NEC?

Answer 35

widespread necrosis in the small and large intestine

Question 36

What is the clinical picture of NEC?

Answer 36

usually after recovering from RDS; lethargy and gastric residuals; bloody stool; temperature instability; apnoea and bradycardia

Question 37

What are the early metabolic comlplications in preterm babies?

Answer 37

hypoglycaemia and hyponatraemia

Question 38

When does retinopathy of prematurity tend to develop?

Answer 38

6-8 weeks after delivery

Question 39

What is a late metabolic complication of prematurity?

Answer 39

osteopenia of prematurity

Question 40

Why do preemies get retinopathy?

Answer 40

the retina isnt well developed or vascularised- get a diabetic retinopathy type picture

Question 41

What effects does being premature have on their adult health?

Answer 41

insulin resistance; hypertension and vascular changes; decreased reproduction- and F more likely to have preemie

Question 42

How common is prematurity?

Answer 42

around 6 %