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1: Neonatology: Pre-maturity Flashcards

1
Q

Define prematurity

A

Neonate born prior to 37W

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2
Q

What is the limit of viability

A

22W

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3
Q

According to WHO, what defines extreme pre-maturity

A

<28W

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4
Q

According to WHO, what defines very pre-term

A

28-32W

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5
Q

According to WHO, what defines moderate-late pre-term

A

32-37W

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6
Q

When are majority of pre-maturity complications seen

A

Prior to 32W

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7
Q

What are risk factors for pre-mature delivery

A
  • Previous pre-term delivery
  • PROM
  • Multiple pregnancy
  • Maternal illness
  • Cervical incompetence
  • Intra-uterine bleed: placenta abruption
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8
Q

What are general complications of pre-maturity

A
  • Hypothermia
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9
Q

What are cardiac complications or pre-maturity

A
  • Patent DA

- Anaemia

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10
Q

What are 2 respiratory complications of pre-maturity

A
  • RDS

- Bronchopulmonary dysplasia

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11
Q

What are 2 CNS complications of pre-maturity

A
  • Retinopathy of pre-maturity

- Intra-ventricular haemorrhage

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12
Q

What are 3 GI complications of pre-maturity

A

Necrotising enterocolitis
Poor suck
Poor milk tolerance

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13
Q

What are liver complications of pre-maturity

A

Jaundice

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14
Q

What are immune complications of pre-maturity

A

Immunocompromised

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15
Q

What are 4 late complications of pre-maturity

A

NAI
Neurodevelopment delay
Sudden infant death syndrome
Behavioural problems

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16
Q

What is given antenatally if 23-35W

A

two doses IM corticosteroids 12-24h apart

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17
Q

When should a senior obstetrician be present

A

All deliveries <28W

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18
Q

How long is cord clamping delayed if pre-mature

A

3-minutes

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19
Q

What should a pre-mature baby be placed in after birth

A

Food exchange bag under radiant heater to maintain temperature

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20
Q

If under 27W what is often required

A

Intubation and endotracheal corticosteroids

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21
Q

Why are antenatal corticosteroids given

A

Reduces mortality in pre-mature infants by 40%

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22
Q

What 3 conditions does antenatal corticosteroids decrease risk of

A
  • RDS
  • Intraventricular haemorrhage
  • Necrotising enterocolitis
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23
Q

What % of infants under 23W will have no or minor disability

A

5

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24
Q

What is retinopathy of pre-maturity

A

Disease of retina in pre-mature infants caused by neovascularisation of the retina

25
What are two risk factors for retinopathy of prematurity (ROP)
Pre-mature | Neonatal Ventilation or Oxygen
26
When are infants screened for ROP
30W gestation
27
What time-frame are infants screened for ROP and why
30W gestation, as ROP rarely occurs before 31W
28
What are two risk factors for intraventricular haemorrhage
- Weight <1.5Kg and <32W | - Chorioamnionitis
29
When does intraventricular haemorrhage present
72h
30
How does intraventricular haemorrhage usually present
Asymptomatic
31
If symptoms, how will IV haemorrhage present
- Bulging fontanelle - Lethargy - Irregular respiration
32
How is IV haemorrhage investigated for
Cranial US
33
What is used to manage IV haemorrhage
VP Shunt for hydrocephalus
34
What is necrotising enterocolitis
Haemorrhagic inflammation of bowel wall in pre-mature infants leading to necrosis
35
What tends to cause acute abdomen in pre-mature infants
necrotising enterocolitis
36
What are two main risk-factors of necrotising enterocolitis
cows-milk (6-times risk) | pre-mature
37
What time-frame after birth does necrotising enterocolitis present
2 - 4W
38
What are initial symptoms of necrotising enterocolitis
Bloody diarrhoea Abdominal distention Food intolerance
39
What are late signs of necrotising enterocolitis
Peritonitis Perforation Discolouration flanks
40
What investigation is ordered for necrotising enterocolitis
AUS
41
What are two signs seen on AUS in necrotising colitis
- Riggler sign | - Football sign
42
What is Riggler sign
Air inside and outside bowel wall
43
What is football sign
Outline falciform ligament
44
What are 4 other features of AUS in necrotising enterocolitis
Dilation bowel loops Bowel-wall oedema Intra-mural gas Perforation
45
Explain management of necrotising enterocolitis
Bowel rest: enteral to parenteral nutrition NG tube decompression IV antibiotics Laparoscopy - to remove necrotic bowel
46
What episodes are common in pre-mature neonates
Apneoa, desaturation, bradycardia
47
How are episodes of apnea and desaturation normally managed
Usually self-resolving
48
If not self-limiting how should apnea and desaturation be managed
Methylxanthine (Caffeine) and CPAP | If not effective, mechanical ventillation
49
Why are pre-mature infants at risk of hypothermia
Large surface area to volume ratio - hence loose a lot of heat
50
What are problems of hypothermia
Increase energy goes into maintain body T which can lead to hypoglycaemia and FTT
51
How is hypothermia prevented in pre-mature infants
put in food exchanged bag and under radian heater
52
When can infants suckle and swallow
35W
53
if pre-mature infants cannot swallow what is offered
NG Tube
54
when is parental nutrition used for pre-mature infants
Extremely pre-mature infants
55
why should breast feeding be encouraged
As if gives immunity and prevents necrotising enterocolitis
56
what is the viability threshold in the UK
22-25W or 500-1000g
57
what is the problem with lower gestation
higher risk of mortality and long-term disability
58
if an infant is less than 22W what is their resuscitation status
deemed unsuitable for resuscitation
59
how are 22-25W needing resuscitation managed
consultant obstetrician decision based on presentation and chance of survival

Paediatrics (61 decks)

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