1: Neonatology: Pre-maturity Flashcards
Define prematurity
Neonate born prior to 37W
What is the limit of viability
22W
According to WHO, what defines extreme pre-maturity
<28W
According to WHO, what defines very pre-term
28-32W
According to WHO, what defines moderate-late pre-term
32-37W
When are majority of pre-maturity complications seen
Prior to 32W
What are risk factors for pre-mature delivery
- Previous pre-term delivery
- PROM
- Multiple pregnancy
- Maternal illness
- Cervical incompetence
- Intra-uterine bleed: placenta abruption
What are general complications of pre-maturity
- Hypothermia
What are cardiac complications or pre-maturity
- Patent DA
- Anaemia
What are 2 respiratory complications of pre-maturity
- RDS
- Bronchopulmonary dysplasia
What are 2 CNS complications of pre-maturity
- Retinopathy of pre-maturity
- Intra-ventricular haemorrhage
What are 3 GI complications of pre-maturity
Necrotising enterocolitis
Poor suck
Poor milk tolerance
What are liver complications of pre-maturity
Jaundice
What are immune complications of pre-maturity
Immunocompromised
What are 4 late complications of pre-maturity
NAI
Neurodevelopment delay
Sudden infant death syndrome
Behavioural problems
What is given antenatally if 23-35W
two doses IM corticosteroids 12-24h apart
When should a senior obstetrician be present
All deliveries <28W
How long is cord clamping delayed if pre-mature
3-minutes
What should a pre-mature baby be placed in after birth
Food exchange bag under radiant heater to maintain temperature
If under 27W what is often required
Intubation and endotracheal corticosteroids
Why are antenatal corticosteroids given
Reduces mortality in pre-mature infants by 40%
What 3 conditions does antenatal corticosteroids decrease risk of
- RDS
- Intraventricular haemorrhage
- Necrotising enterocolitis
What % of infants under 23W will have no or minor disability
5
What is retinopathy of pre-maturity
Disease of retina in pre-mature infants caused by neovascularisation of the retina
What are two risk factors for retinopathy of prematurity (ROP)
Pre-mature
Neonatal Ventilation or Oxygen
When are infants screened for ROP
30W gestation
What time-frame are infants screened for ROP and why
30W gestation, as ROP rarely occurs before 31W
What are two risk factors for intraventricular haemorrhage
- Weight <1.5Kg and <32W
- Chorioamnionitis
When does intraventricular haemorrhage present
72h
How does intraventricular haemorrhage usually present
Asymptomatic
If symptoms, how will IV haemorrhage present
- Bulging fontanelle
- Lethargy
- Irregular respiration
How is IV haemorrhage investigated for
Cranial US
What is used to manage IV haemorrhage
VP Shunt for hydrocephalus
What is necrotising enterocolitis
Haemorrhagic inflammation of bowel wall in pre-mature infants leading to necrosis
What tends to cause acute abdomen in pre-mature infants
necrotising enterocolitis
What are two main risk-factors of necrotising enterocolitis
cows-milk (6-times risk)
pre-mature
What time-frame after birth does necrotising enterocolitis present
2 - 4W
What are initial symptoms of necrotising enterocolitis
Bloody diarrhoea
Abdominal distention
Food intolerance
What are late signs of necrotising enterocolitis
Peritonitis
Perforation
Discolouration flanks
What investigation is ordered for necrotising enterocolitis
AUS
What are two signs seen on AUS in necrotising colitis
- Riggler sign
- Football sign
What is Riggler sign
Air inside and outside bowel wall
What is football sign
Outline falciform ligament
What are 4 other features of AUS in necrotising enterocolitis
Dilation bowel loops
Bowel-wall oedema
Intra-mural gas
Perforation
Explain management of necrotising enterocolitis
Bowel rest: enteral to parenteral nutrition
NG tube decompression
IV antibiotics
Laparoscopy - to remove necrotic bowel
What episodes are common in pre-mature neonates
Apneoa, desaturation, bradycardia
How are episodes of apnea and desaturation normally managed
Usually self-resolving
If not self-limiting how should apnea and desaturation be managed
Methylxanthine (Caffeine) and CPAP
If not effective, mechanical ventillation
Why are pre-mature infants at risk of hypothermia
Large surface area to volume ratio - hence loose a lot of heat
What are problems of hypothermia
Increase energy goes into maintain body T which can lead to hypoglycaemia and FTT
How is hypothermia prevented in pre-mature infants
put in food exchanged bag and under radian heater
When can infants suckle and swallow
35W
if pre-mature infants cannot swallow what is offered
NG Tube
when is parental nutrition used for pre-mature infants
Extremely pre-mature infants
why should breast feeding be encouraged
As if gives immunity and prevents necrotising enterocolitis
what is the viability threshold in the UK
22-25W or 500-1000g
what is the problem with lower gestation
higher risk of mortality and long-term disability
if an infant is less than 22W what is their resuscitation status
deemed unsuitable for resuscitation
how are 22-25W needing resuscitation managed
consultant obstetrician decision based on presentation and chance of survival
