6.3. Neonatology - Born too Small / Too Early

Question 1

What is the Definition of being Born too Small?

Answer 1

2500g (5lb 8oz)

Question 2

What are the Different Categories of being Small for Dates?

Answer 2

1. Small for Gestational Age (SGA)
2. Intra-Uterine Growth Restriction (IUGR) - <10th Centile
3. Hypotrophy - Symmetric / Asymmetric
   Note - Severe IUGR - <0.4th Centile

Question 3

What are the Causes for being Small for Dates?

Answer 3

1. Maternal - Smoking / Blood Pressure
2. Foetal - Chromosomal / Infection
3. Placental - Abruption
4. Twin Pregnancy

Question 4

What are Common Problems with being Small for Dates?

Answer 4

1. Perinatal Hypoxia
2. Hypoglycaemia
3. Hypothermia
4. Polycythaemia
5. Thrombocytopenia
6. Gastrointestinal Problems

Question 5

What are the Common Long-Term Problems for being Small for Dates?

Answer 5

1. Hypertension
2. Reduced Growth
3. Obesity
4. Ischaemic Heart Disease

Question 6

What is the Definition of Preterm?

Answer 6

< 37 weeks

Question 7

What is the Definition of Extremely Preterm?

Answer 7

<28 weeks

Question 8

What is the Definition of Low Birth Weight?

Answer 8

< 2500g (5lb 8oz)

Question 9

What is the Definition of Very Low Birth Weight?

Answer 9

<1500g (3lb 5oz)

Question 10

What is the Definition of Extremely Low Birth Weight?

Answer 10

<1000g (2lb 3oz)

Question 11

What are the Common Respiratory Problems of Preterm Babies?

Answer 11

1. Respiratory Distress Syndrome (RDS)
2. Bronchopulmonary Dysplasia
3. Minor Problems - Apnoea / Irregular Breathing / Desaturation

Question 12

With Regards to Respiratory Distress Syndrome What is the:

1. Prevention?
2. Early Treatment?

Answer 12

1. Antenatal Steroids
2. a) Surfactant (and then as little as possible)
3. b) Non-Invasive Support (CPAP)
4. c) Minimal Ventilation

Question 13

What is the Treatment of Bronchopulmonary Dysplasia?

Answer 13

1. Patience
2. Nutrition / Growth
3. Steroids

Question 14

What is the Treatment of Minor Respiratory Problems?

Answer 14

1. Caffeine

2. N-CPAP

Question 15

What are the Common Brain Problems of Preterm Babies?

Answer 15

1. Intraventricular Haemorrhage (Grades I-IV)
2. Peri-Ventricular Leucomalacia
3. Post-Haemorrhagic Hydrocephalus

Question 16

What is the Treatment of Intraventricular Haemorrhage?

Answer 16

1. Prevention - Antenatal Steroids

2. Symptomatic

Question 17

What is the Common Circulatory Problem of Preterm Babies?

Answer 17

Persistent Ductus Arteriosus

Question 18

What is the (Patho)Physiology of Persistent Ductus Arteriosus?

Answer 18

1. Pressure in the Aorta > Pulmonary Artery causing a Left-Right Shunt
2. Additional Blood goes to Pulmonary Circulation causing:
3. a) Over-Perfusion of Lungs
4. b) Lung Oedema
5. c) Systemic Ischaemia

Question 19

What are the Consequences of Persistent Ductus Arteriosus?

Answer 19

1. Worsening of Respiratory Symptoms
2. Retention of Fluids (Low Renal Perfusion)
3. Gastrointestinal Problems (GE Ischamia)

Question 20

What is the Common Gastrointestinal Problem of Preterm Babies?

Answer 20

Necrotising Entero-Colitis

Question 21

What are the Features of Necrotising Entero-Colitis?

Answer 21

1. Ischaemia and Inflammatory Changes

2. Necrosis of Bowel

Question 22

What is the Treatment of Necrotising Entero-Collitis?

Answer 22

1. Conservative Management sometimes Possible - Antibiotics and Parenteral Nurtrition
2. Surgical Intervention often Required

Question 23

What is the Significance of Nutrition in Preterm Babies?

Answer 23

1. Enormous Nutritional Requirements

2. Triple their size during Hospital Stay

Question 24

What is the Outcome of Prematurity?

Answer 24

1. 1/3 die
2. 1/3 have Moderate / Severe Disability
3. 1/3 have Normal Life / Mild Disability