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paediatrics > 1: Neonatology: Pre-maturity > Flashcards

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
Q

What are two risk factors for retinopathy of prematurity (ROP)

A

Pre-mature

Neonatal Ventilation or Oxygen

26
Q

When are infants screened for ROP

A

30W gestation

27
Q

What time-frame are infants screened for ROP and why

A

30W gestation, as ROP rarely occurs before 31W

28
Q

What are two risk factors for intraventricular haemorrhage

A
  • Weight <1.5Kg and <32W

- Chorioamnionitis

29
Q

When does intraventricular haemorrhage present

A

72h

30
Q

How does intraventricular haemorrhage usually present

A

Asymptomatic

31
Q

If symptoms, how will IV haemorrhage present

A
  • Bulging fontanelle
  • Lethargy
  • Irregular respiration
32
Q

How is IV haemorrhage investigated for

A

Cranial US

33
Q

What is used to manage IV haemorrhage

A

VP Shunt for hydrocephalus

34
Q

What is necrotising enterocolitis

A

Haemorrhagic inflammation of bowel wall in pre-mature infants leading to necrosis

35
Q

What tends to cause acute abdomen in pre-mature infants

A

necrotising enterocolitis

36
Q

What are two main risk-factors of necrotising enterocolitis

A

cows-milk (6-times risk)

pre-mature

37
Q

What time-frame after birth does necrotising enterocolitis present

A

2 - 4W

38
Q

What are initial symptoms of necrotising enterocolitis

A

Bloody diarrhoea
Abdominal distention
Food intolerance

39
Q

What are late signs of necrotising enterocolitis

A

Peritonitis
Perforation
Discolouration flanks

40
Q

What investigation is ordered for necrotising enterocolitis

A

AUS

41
Q

What are two signs seen on AUS in necrotising colitis

A
  • Riggler sign

- Football sign

42
Q

What is Riggler sign

A

Air inside and outside bowel wall

43
Q

What is football sign

A

Outline falciform ligament

44
Q

What are 4 other features of AUS in necrotising enterocolitis

A

Dilation bowel loops
Bowel-wall oedema
Intra-mural gas
Perforation

45
Q

Explain management of necrotising enterocolitis

A

Bowel rest: enteral to parenteral nutrition
NG tube decompression
IV antibiotics
Laparoscopy - to remove necrotic bowel

46
Q

What episodes are common in pre-mature neonates

A

Apneoa, desaturation, bradycardia

47
Q

How are episodes of apnea and desaturation normally managed

A

Usually self-resolving

48
Q

If not self-limiting how should apnea and desaturation be managed

A

Methylxanthine (Caffeine) and CPAP

If not effective, mechanical ventillation

49
Q

Why are pre-mature infants at risk of hypothermia

A

Large surface area to volume ratio - hence loose a lot of heat

50
Q

What are problems of hypothermia

A

Increase energy goes into maintain body T which can lead to hypoglycaemia and FTT

51
Q

How is hypothermia prevented in pre-mature infants

A

put in food exchanged bag and under radian heater

52
Q

When can infants suckle and swallow

A

35W

53
Q

if pre-mature infants cannot swallow what is offered

A

NG Tube

54
Q

when is parental nutrition used for pre-mature infants

A

Extremely pre-mature infants

55
Q

why should breast feeding be encouraged

A

As if gives immunity and prevents necrotising enterocolitis

56
Q

what is the viability threshold in the UK

A

22-25W or 500-1000g

57
Q

what is the problem with lower gestation

A

higher risk of mortality and long-term disability

58
Q

if an infant is less than 22W what is their resuscitation status

A

deemed unsuitable for resuscitation

59
Q

how are 22-25W needing resuscitation managed

A

consultant obstetrician decision based on presentation and chance of survival

paediatrics (61 decks)

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