18. Premature infants. Diseases of the premature infants.

Question 1

Premature Infant

Definition

Classification according to weight

Answer 1

• Gestationsalter <37 SSW (<=36 + 6 SSW)
• Low Birth Weight Infant: <2500g
• Very Low Birth Weight Infant: <1500g
• Extremely Low Birth Weight Infant: <1000g

Question 2

Risikofaktoren für Frühgeburten

Answer 2

• Fetale Ursachen:
  
  • Tripple I
  • Mehrlingsschwangerschaften
  • Polyhydramnion
• Mütterliche Ursachen:
  
  • Vorrausgegangene Frühgeburten
  • Körperlicher Stress
  • Hypertension (HELLP, Präeclampsie)
  • Nikotinabusus

Question 3

Organbefunde/Komplikationen bei Frühgeburt

Answer 3

• Atemnotsyndrom
• Bronchopulmonäre Dysplasie
• PDA
• Retinopathia praematorum
• NEC (nekrosierende Enterokolitis)
• Hirnblutungen
• Perventrikuläre Leukomalazie
• Apnoen & Bradykardien

Question 4

Respiratory Distress Syndrome of the Newborn

Patho

Symptoms

Answer 4

• AKA Hyaline Membrane Disease
• caused by a surfactantdeficiency:
• type II pneumocytes & adrenal glands (cortisol) not fully funcional, yet
• Symptoms:
  
  • Tachypnoe (>60bpm)
  • Labored breathing
    
    • chest wall recession
    • sternal, subcostal, nasal flaring
    • expiratory grunting
  • Cyanosis

Question 5

Respiratory Distress Syndrome of the Newborn

Prevention

Treatment

Complications

Answer 5

• Give GCS to to the mother (antenatally)
• Supplement surfactant through tracheal tube
• Oxygen therapy
• Respiratory support (CPAP)
  
  • CAVE: bronchopulmonary dyplasia, retinopathy
• Complications:
  
  • Pneumothorax
  • Intracerebral hemorrhage
  • Hyaline membrane disease
  • Bronchopulmonary dysplasia

Question 6

Preterm

Pneumothorax

Other Air Leak Syndromes

Answer 6

• Results from bursting of alveoli
• Can be caused by mechanical ventilation
• Treated with acute decompression (drainage)
• other air leak syndromes:
  
  • Pneumomediastinum
  • Pneumopericardium
  • Pulmonary interstitial emphysema

Question 7

Preterm

Apnea, Bradykardia and Desaturation

Answer 7

• Episodes are very common before 32wks of gest. age
• Bradykardia
  
  • When the infant stops breathing/breathes against closed glottis
  • Exclude Hypoxia, infection, anemia, electrolyte imbalance, hypoglycemia, seizures,HF, aspirations
• Caffeine treatment

Question 8

Preterm infants

Temperature Control

Answer 8

• Preterm are infants more vulnurable to temperature
  
  • higher surface area/mass
  • thin, heat permeable skin
  • little subcutaneous fat
  • transdermal water loss
  • often nursed naked, cannot conserve heat/shiver
• INCUBATOR

Question 9

Preterm Infants

Nutrition

Answer 9

• many cannot swallow
• oro-/nasogastric tube
  
  • give mothers-milk over the tube
  • supplemented with phosphate (protein, calories, calcium)
• < 1kg of birthweight may warrant parenteral nutrition
• Iron supplementation started within a few weeks
  
  • most iron is received during the 3rd trimester

Question 10

Preterm Infants

Infection

Answer 10

• IgG mainly transferred in 3rd trimester
• infection around the cervix is a main cause
• nosocomic infection due to catheter & mech. ventilation
• major cause of death
• contributes to bronchopulmonary dysplasia, brain injury and later disability

Question 11

Necrotizing Enterocolitis

Answer 11

• incidence increases with longer prematurity
• typically seen during first few wks. of life
• bowel of the infant is vulnurable to ischemic injury and bacterial invasion, these are both risk factors
• breast milk: Protective, cows milk: Risk factor
• Early Signs:
  
  • Food intolerance & vomiting (bile?)
  • distended abdomen & (fresh blood instool)
• infant may go into shock and:
  
  • require mech. ventilation & circulatory support
  • require surgery incase of perforation
• 20% mortality
• Long term: May lead to malabsoption after large scale dmg or removal of too much intestine
• X-Ray or translumination of abdomen may show bowel perforation

Question 12

Preterm Brain Injury

Answer 12

• Hemorrhages (20% of VLBW) can be seen by cranial US
• more common afer perinatal asphyxia & severe RDS
• pneumothorax is a significant contributor
  *

Question 13

Retinopathy of Prematurity

Answer 13

• affects the developing blood vessels at the junction of vascularized and non-vascularized retina
• There is vascular proliferation, may progress to retinal detachment, fibrosis, blindness
• in 35% of VLBW infants
• <= 1500g / <32wks. gest. warrants screening by ophtalmologist

Question 14

Bronchopulmonary Dysplasia

Answer 14

• infants still require oxygen at post. gest. age of 36wks.
• lung damage: Thought to be mainly from delay in maturation
  
  • might be due to traume from mech ventilation
• most are weaned onto CPPAP/high-flow nasal cannula
  
  • followed by additional ambient oxygen
  • sometimes for several months
• GCS-therapy may facilitate earlier weaning
  
  • often reduces the infants oxygen requirements (short-term)
  • only used for infants at highest risk and at low-doses
  • due to concerns about normal neurodevelopment