The Preterm Infant + Neonatal Problems Flashcards by Megan Rose

How is preterm birth defined?

Delivery before 37 weeks gestation

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What are the definitions of extremely preterm, very preterm and moderate/late preterm?

Extremely preterm = < 28 weeks
Very preterm = 28 - 32 weeks
Moderate to late preterm = 32 - 37 weeks

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What are some of the causes of preterm birth?

Spontaneous preterm labour
Multiple pregnancy
Preterm prelabour rupture of membranes
Pregnancy associated hypertension
Cervical incompetence/uterine malformation
Antepartum haemorrhage
Intrauterine growth restriction

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What are the risk factors for preterm delivery?

Previous preterm deliveries
Abnormally shaped uterus
Multiple pregnancies
Interval of < 6 months between pregnancies
IVF
Smoking, alcohol + illicit drugs
Poor nutrition
High BP
Diabetes
Multiple miscarriages or abortions
Infection

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What are some of the common problems in a premature infant?

Temperature control
Feeding/nutrition
Sepsis
System immaturity/dysfunction:
- respiratory distress syndrome
- patent ductus arteriosus
- intraventricular haemorrhage
- necrotising enterocolitis
Others e.g. metabolic, retinopathy of prematurity

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Why is it so important to regulate temperature in preterm infants?

Hypothermis is independent risk factor for neonatal death
Increases severity of all preterm morbidities
More susceptible than term infants due to:
- low BMR
- minimal muscular activity
- minimal subcutaneous fat
- high ratio of surface area to body mass

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How is hypothermia treated/prevented?

Wrap or bags
Skin to skin
Transwarmer mattress
Prewarmed incubator

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Which organisms are likely to be causative in early onset neonatal sepsis?

Bacteria acquired before + during delivery:

group B strep
gram negatives

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Which organisms are likely to be causative in late onset neonatal sepsis?

Acquired after delivery:

coagulase negative staph
gram negatives
staph aureus

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Why are premature babies particularly at risk of infection?

Immature immune system
Intensive care environment
Indwelling tubes and lines

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What are the respiratory complications of prematurity?

Respiratory distress syndrome (RDS)
Apnoea of prematurity
Bronchopulmonary dysplasia

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What causes RDS?

Surfactant deficiency

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What are the clinical features of RDS?

Within minutes-hours from birth
Respiratory distress, RR >60
Grunting
Intercostal recessions
Nasal flaring
Cyanosis

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How can RDS be prevented?

Maternal IM corticosteroids for deliveries < 36 weeks –> increases fetal surfactant production

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What does RDS look like on CXR?

Widespread atelectasis with ground glass appearance

Air bronchogram = air filled trachea + bronchi stand out black against ground glass appearance

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How is RDS managed?

Nasal CPAP

–> if remains distressed, intubate and give surfactant via ET tube

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Apart from RDS, what are the other causes of neonatal respiratory distress?

Transient tachypnoea of the newborn
Meconium aspiration syndrome (MAS)
Bronchopulmonary dysplasia
Milk aspiration
Apnoea of prematurity
PPHN
Pneumonia (GBS)
Pneumothorax

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What is bronchopulmonary dysplasia?

Chronic lung disease resulting from disruption of normal lung development in preterm infants with respiratory problems

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How is bronchopulmonary dysplasia clinically defined?

Need for supplementary oxygen beyond 28 days postnatal or 36 weeks postmenstrual age in absence of other diagnosis requiring oxygen

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How can bronchopulmonary dysplasia be prevented?

Prevent and treat RDS
Minimise ventilation
Caffeine IV if born < 30 weeks
Consider dexamethasone if premature and still ventilated at 8 days (although risk of neurodevelopmental problems)

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What causes transient tachypnoea of the newborn (TTN)?

Delay in resorption of lung liquid

–> C-section and maternal DM are risk factors

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What are the clinical features of TTN and how is it managed?

Respiratory distress at birth
Usually resolves in 24-48 hours
Give oxygen if needed

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What is meconium aspiration syndrome (MAS)?

Study These Flashcards

Occurs when meconium is passed in utero (meconium in liquor) or during birth and is inhaled
- can happen due to fetal maturation (post term baby) or in response to acute hypoxia
Can lead to pneumonitis and obstruction –> collapse or pneumothorax

What might be seen on CXR in MAS?

Study These Flashcards

Patchy atelectasis or consolidation

What is the management and complication of MAS?

Intubate for suction | Can be complex and lead to pulmonary hypertension

How is apnoea of prematurity treated?

IV caffeine

What are the risk factors for intraventricular haemorrhage?

Premature or low birth weight | Associated trauma or asphyxia e.g. RDS

What are the signs of intraventricular haemorrhage?

``` Lethargy Seizures Apnoea Bulging fontanelle (signs may be minimal) ```

Which investigation should be done to look for intraventricular haemorrhage?

Premature + very low birth weight infants: | --> cranial USS monitoring in week 1 and week 6

What is necrotising enterocolitis (NEC)?

Bowel necrosis from unknown cause, typically in premature or low birth weight infants

What are the clinical features of NEC?

``` Abdominal distension or mass Bloody mucous stool Bilious vomit Reduced bowel sounds Shock DIC ```

What might be seen on x-ray of a baby with NEC?

Pneumatosis intestinalis (gas in bowel wall) Gas filled bowel loops "Football sign" Or pneumoperitoneum

How is NEC managed?

Stop feeds Insert NG tube for decompression Give IV antibiotics

What is retinopathy of prematurity (ROP)?

Abnormal vascular growth in retina due to arrest of normal vascular growth --> can lead to retinal detachment and blindness

What are the causes or ROP?

``` Premature birth (<32 weeks) Oxygen therapy ```

How is ROP treated?

Laser therapy

Which metabolic complications might be seen in prematurity?

``` Early: - Hypoglycaemia - Hypocalcaemia - Hyponatraemia Late: - osteopenia of prematurity ```

How is neonatal hypoglycaemia defined?

Normal to have slightly low glucose due to drop off of maternal glucose < 2.6 is pathological

What are the causes of neonatal hypoglycaemia?

``` Maternal diabetes Premature or SGA Infection --> increased glucose use Hypothyroidism Congenital hyperinsuliniam: maternal diabetes, pancreatic islet cell hyperplasia ```

Why does maternal diabetes cause neonatal hypoglycaemia?

Raised glucose during pregnancy --> compensatory fetal raised insulin Raised insulin remains postpartum while maternal glucose stops

What are the clinical features of neonatal hypoglycaemia?

``` Lethargy and altered consciousness Seizures Vomiting Respiratory distress Cyanosis ```

How is neonatal hypoglycaemia managed?

Prevent through adequate feeding soon after birth and then 3 hourly If asymptomatic: ensure adequate feeding, consider NG tube if problems If symptomatic or severe (<1): IV glucose (bolus then infusion)

When is jaundice considered pathological?

< 24 hours | > 2 weeks

At what level is jaundice visible?

> 85 bilirubin

What are the causes of early (<24 hours) neonatal jaundice?

Haemolytic disease | Congenital infection

What causes of haemolytic disease might be the cause of neonatal jaundice?

Rh incompatibility ABO incompatibility G6PD deficiency Spherocytosis

Which congenital infections might cause neonatal jaundice?

``` Group B strep TORCH: TOxoplasmosis Rubella CMV HSV ```

What are the possible causes of high or prolonged (>2 weeks) jaundice?

Breast feeding (failure) jaundice Breast milk jaundice Sepsis (most commonly from UTI) Cephalohaematoma (haemolysis of blood pool) Biliary atresia Specific diseases e.g. hypothyroidism, CF, galactosaemia

What is breast feeding failure jaundice and when does it present?

Poor feeding --> reduced gut motility, allowing more conjugated bilirubin to revert to unconjugated and re-enter the blood as part of the enterohepatic circulation Presents in the first few days

What is breast milk jaundice and when does it present?

An enzyme in breast milk unconjugates the bilirubin, thus increasing enterohepatic circulation Presents as prolonged jaundice

How does biliary atresia present and what are the complications?

Elevated CONJUGATED bilirubin Presents with pale stool and dark urine --> liver failure and death if not treated surgically (phototherapy no use)

What are the signs of neonatal jaundice?

Starts at head and spread down | - Spread below the umbilicus suggests non-physiological jaundice

Which investigations should be done for neonatal jaundice?

``` Serum bilirubin + conjugated fraction FBC Blood film (haemolysis) Reticulocyte count (haemolysis) Blood group Direct antiglobulin (Coombs') test --> +ve in Rh or ABO haemolytic anaemia ``` LFTs (increased in infection) Urine culture TFTs

When should phototherapy be given?

Onset < 24 hours or lasts > 2 weeks | OR bilirubin above treatment line

What is the goal of phototherapy?

To prevent kernicterus

How long should phototherapy continue?

Until bilirubin >50 below the treatment line (because of rebound after stopping treatment)

What is kernicterus?

Unconjugated bilirubin > 360 which deposits in the brain - sleepiness - reduced feeding - irritability - seizure - coma Long term complications: cerebral palsy + deafness

The Preterm Infant + Neonatal Problems Flashcards

(57 cards)