The Small Baby Flashcards
(51 cards)
How do you determine gestational age before and after delivery?
Before- LMP, early USS, SFH/ late USS (much less accurate)After- scoring systems using neuromuscular and physical signs, such as Ballard, Dubrowitz or Finnstrom
What classifies a preterm infant?
What is normal birth weight?
2500-4000g
What classifies LBW, VLBW and ELBW?
LBW 1500-2499g
VLBW 1000-1499g
ELBW
Using weight for GA, what three results can you find?
Preterm
Low birth weight
Appropriate for gestational age
What is symmetrical growth restriction?
The fetus has developed slowly throughout the duration of the pregnancy and was affected from a very early stage
The HC is in proportion to the rest of the body
What is asymmetrical growth restriction?
Fetus has grown normally for the first two trimesters but encounters difficulties in the third
A lack of subcutaneous fat leads to a thin and small body which is out of proportion with the head
SGA babies can be divided into which 2 groups?
Constitutionally small babies
Growth-restricted babies
What are maternal causes of preterm delivery?
Age- 35 Malnutrition Poor SES GPH Infections UTI
What are placental causes of preterm delivery?
Placenta praevia
Abruptio placenta
What are fetal causes of preterm delivery?
Multiple pregnancy
Congenital abnormalities
Congenital infections
List the problems associated with preterm infants
Apnoea. Low Apgar scores. Hypothermia. Respiratory distress. PDA. Anaemia. Poor feeding. Hypoglycaemia. Infections. Intraventricular bleeds. Neonatal jaundice. Necrotising enterocolitis. ROP.
What is the evidence for delayed cord clamping?
Cord pulsation usually continues for several minutes
Neonatal blood volume increases by up to 35%
In preterm infants, with DCC, they require less blood t/f, less inotropes and have less IVH
In term infants, it improves their iron status
What is the current recommendation regarding cord clamping?
Delay clamping for at least 1 min for newborn infants not requiring resus
What is the standard for supplementary oxygen in term infants?
Commence with air
If no improvement in heart rate or oxygenation, increase inspired oxygen
What is the standard for supplementary oxygen in preterm infants?
Titration oxygen (commence with 30-90%, dependent on response) If blended oxygen not available, start with air and only move to 100% oxygen if inadequate response
What are normal oxygen saturations in a newborn at 1,2,3,4,5 and 10 minutes?
1: 60-65%
2: 65-70%
3: 70-75%
4: 75-80%
5: 80-85%
10: 85-95%
What is the normal body temperature for a neonate (axillary temp)?
36.5 - 37
What 4 ways is heat lost?
Convection
Conduction
Radiation
Evaporation
Why is hypothermia a particular problem in preterm infants?
Thin skin. Fast breathing. Large surface area. Less subcutaneous and brown fat. Unable to shiver. Often not feeding well.
List the signs and symptoms of hypothermia
Cold to touch. Peripherally cyanosed. Poor perfusion with delayed capillary refill. Tachypnoea. Hypoglycaemia. Metabolic acidosis. Can be clinically assymptomatic!
How do you treat hypothermia?
Anticipate heat loss and ensure preventative measures immediately after delivery
Dry baby. Head cap. KMC. Incubator +/- heat shield. Treat infections. Manage hypoglycaemia. Administer oxygen. Give energy by feeds or IV fluids.
What occurs with each 1*C decrease in NICU admission temp?
Decrease chance of survival by 10%
Increase risk of late-onset sepsis by 11%
Increase odds of death by 28%
What are the consequences of hypothermia?
Depletion of surfactant. Hypoxia. Hypoglycaemia. Metabolic disorders. Increased caloric usage. Acidosis. Increased neonatal morbidity.
