The Small Baby Flashcards by Michael Nel

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

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What classifies a preterm infant?

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What is normal birth weight?

2500-4000g

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What classifies LBW, VLBW and ELBW?

LBW 1500-2499g
VLBW 1000-1499g
ELBW

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Using weight for GA, what three results can you find?

Preterm
Low birth weight
Appropriate for gestational age

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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

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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

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SGA babies can be divided into which 2 groups?

Constitutionally small babies

Growth-restricted babies

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What are maternal causes of preterm delivery?

Age- 35
Malnutrition
Poor SES
GPH
Infections
UTI

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What are placental causes of preterm delivery?

Placenta praevia

Abruptio placenta

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What are fetal causes of preterm delivery?

Multiple pregnancy
Congenital abnormalities
Congenital infections

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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.

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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

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What is the current recommendation regarding cord clamping?

Delay clamping for at least 1 min for newborn infants not requiring resus

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What is the standard for supplementary oxygen in term infants?

Commence with air

If no improvement in heart rate or oxygenation, increase inspired oxygen

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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

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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%

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What is the normal body temperature for a neonate (axillary temp)?

36.5 - 37

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What 4 ways is heat lost?

Convection
Conduction
Radiation
Evaporation

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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.

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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.

When and how can a LBW feed?

LBW can feed enter ally shortly after birth

How must a VLBW or EBLW be fed?

May require IV fluids for nutrition | Initiate trophic feeds on day 1. Slow progression of enteral feeds until all intake is oral (+/- 5-7 days)

What is normal blood glucose in the neonate?

2.5 - 7.0 mmol/l

Why is hypoglycaemia a common problem in preterms?

Reduced stores- glycogen, fat, protein not built up prior to delivery; feeding usually delayed if ill/distressed; feeding problems common. Increased needs- resp distress increases energy needs; hypothermia competes for energy sources

What are the signs and symptoms of hypoglycaemia in a preterm?

Can be assymptomatic | Irritable. Jittery. Seizures. Lethargic.

What is the long-term, severe complication of hypoglycaemia?

Brain damage

How is hypoglycaemia treated?

Provide energy by feeds or IV fluids | Treat sepsis, resp distress, hypothermia etc

How do you prevent infection in the preterm infant?

Scrupulous hand washing. Alcohol rubs. Limit procedures and indwelling catheters. Give probiotics.

What are common causative organisms in preterm infection?

Nocosomial infections!:Gram - organisms Group B strep Fungal infections

With what signs should you suspect a PDA?

Murmur. Collapsing or bounding pulse. Tachycardia. Respiratory distress. Cardiac failure.

How do you treat a PDA?

Restrict fluid (total 120ml/kg/day). Oxygenate. Treat anaemia. Antifailure treatment when indicated (diuretics). Indomethicin/Brufen but controversial. Surgical ligation.

Do all patients with PDA need treatment?

What is apnea?

Cessation of breathing long enough to cause bradycardia, cyanosis and/or pallor (lasts about 20 seconds)

What are the three groups of causes of apnea?

Obstructive Central Mixed

What causes obstructive apnoea?

Loss of airway patency, caused by mucus secretions, choanal stenosis or choanal atresia

What causes central apnoea?

Immaturity. Maternal sedation. Peri-/intra-ventricular bleeds. Hypoxia. Hypoglycaemia. Hypo- and hyper-thermia. Anaemia. Convulsions.

A mixed cause of apnoea refers to what?

Infection

What is the difference between apnoea and periodic breathing?

Apnoea is cessation of breathing long enough (+/-20secs) to cause bradycardia, cyanosis and/or pallor. Periodic breathing is a normal pattern of irregular breathing seen in most preterm infants that does not have a negative effect on the infant.

Why are preterm infants at risk for IVH?

Immature cerebral vasculature Hypoxia Fluctuations in cerebral perfusion

What are the grades of IVH?

Grade 1- bleeding only in the germinal matrix Grade 2- bleeding in germinal matrix + ventricles Grade 3- ventricles enlarged by blood Grade 4- bleeding into brain tissue around the ventricles

What is the normal HC in a term neonate?

33-37cm (35 average)

What is the normal Hb at birth?

15-22g/dL

How does the Hb change by 6-8/52?

+ / - 7 g/dL

What is the normal blood volume in an infant?

80ml/kg

What causes anaemia in neonates?

Anaemia of prematurity (preterm kidneys don't produce enough EPO). Blood sampling. Infections. Haemolysis. Iron deficiency (in older preterms around 3/12). Bleeding (from cord post delivery or to mother antenatally).

How is anaemia managed?

Very restrictive blood transfusion policies therefore rarely used Recombinant EPO only in exceptional cases, never in preterms (can lead to ROP) Iron supplementation of preterms for 6/12 Blood drawing procedures limited

What developmental problems can be seen in LBW at follow up?

Developmental delay Learning difficulties Blindness Auditory problems