Born too early too small Flashcards
what is classed as a small baby and why does this occur?
The most common reason why a baby is smaller than average — weighing less than 2.5kg at birth — is prematurity (being born before 37 weeks’ gestation). The earlier the baby is born, the smaller they are likely to be. This is because the baby will have had less time in the womb to grow
what is small for gestational age?
Small for gestational age (SGA) fetuses or newborns are those smaller in size than normal for their gestational age, most commonly defined as a weight below the 10th percentile for the gestational age
what are the causes of small for gestational age (SGA) or small for dates (SFD)?
Maternal
Foetal
Placental
Other
what are maternal causes for small for dates?
smoking - known to cause tailoring of foetal growth, smoking leads to smaller babies
Maternal Pre-Eclamptic Toxemia (PET) - Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn’t get enough blood, your baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction, low birth weight or preterm birth
what are foetal causes for small for dates?
chromosomal (e.g. Edwards Syndrome - trisomy 18)
infection (e.g. CMV)
what are placental causes for small for dates?
Abruption of placenta
what are other causes for small for dates?
twin pregnancy
Many babies with SGA have a condition called ____________________ (IUGR)
intrauterine growth restriction
Intrauterine growth restriction, or IUGR, is when a baby in the womb (a fetus) does not grow as expected. The baby is not as big as would be expected for the stage of the mother’s pregnancy
whata re some common problems with being small for dates?
Perinatal Hypoxia (lack of oxygen to an unborn child during labor and delivery)
Hypoglycaemia
Hypothermia
Polycythaemia (increased red cell production due to hypoxia)
Thrombocytopenia
Gastrointestinal problems (feeds, NEC)
what are long term problems seen in babies that were bron small?
Hypertension
Reduced growth
Obesity
Ischemic heart disease
what is classed as preterm and what is classed as low weight?
what is the Prematurity incidence
5-12%
Common problems of preterm babies - what system can be affected?
Any system…
Respiratory
Circulation
Metabolic / Nutrition
Immune / Infection
Brain
Gastrointestinal
Haematology
Renal
Skin
- Still havnt developed all the function of the organs
what is respiratory distress syndrome in preterms?
Newborn respiratory distress syndrome (NRDS) happens when a baby’s lungs are not fully developed and cannot provide enough oxygen, causing breathing difficulties. It usually affects premature babies
Surfactant deficiency on the lungs
how do you manage repsiraotry distress syndrome?
If thought to be at risk of giving birth before week 34 of pregnancy, treatment for NRDS can begin before birth
You may have a steroid injection before your baby is delivered, second dose is usually given 24 hours after first
The steroids stimulate the development of the baby’s lungs. It’s estimated that the treatment helps prevent NRDS in a third of premature births
treatment after birth - If ,ild symptoms, may only need extra oxygen. It’s usually given through an incubator or tubes into their nose. If symptoms are more severe then baby may be put on vetilator
what is BPD/CLD?
Bronchopulmonary dysplasia (BPD) can affect babies born prematurely, whose lungs have not developed fully in the womb. It’s sometimes called chronic lung disease of prematurity or chronic neonatal lung disease
usually had breathing problems from birth. These usually get better with time
what damaged may BPD reuslt in?
Overstretch by volu-baro-trauma
Atelectasis
Infection via ETT
O2 toxicity
Inflammatory changes
Tissue repair - scarring
what is the treatment of BPD?
If you are at risk of premature labour, you may be given steroids to help mature your baby’s lungs
- patience
- nutrition & growth
what minor repsiratory problems are commonyl seen in preterm babies? and how are they managed?
Apnoea/irregular breathing/desaturations
- caffeine
- N-CPAP (Nasal continuous positive airway pressure (CPAP) therapy is a nonsurgical treatment that provides a steady flow of air to the lungs through the nose)
what is IVH?
Intraventricular hemorrhage (IVH) is bleeding inside or around the ventricles in the brain. The ventricles are the spaces in the brain that contain the cerebral spinal fluid. Bleeding in the brain can put pressure on the nerve cells and damage them. Severe damage to cells can lead to brain injury
most common limiting factor for good long term prognosis
grades I-IV
grade Iv = 75% adverse outcome
what is the prevention and treamtent of IVH?
Prevention - AN steroids (give mum steroids before birth)
Treatment - Sympthomatic
what is PVL?
Periventricular leukomalacia (PVL) is a type of brain injury that is most common in babies born too soon (premature) or at low birthweight. The white matter (leuko) surrounding the ventricles of the brain (periventricular) is deprived of blood and oxygen leading to softening (malacia). The white matter is responsible for transmitting messages from nerve cells in the brain so damage to the white matter can cause problems with movement and other body functions
Injury of white matter in watershed area
Lead to disruption of the connectivity between the cortex and the lower part of our muscles
what is PHH (post haemorrhagic hydrocephalus)?
Major complication of IVH is PHH
Blood products of sludge block draining system of CSF system in the brain and it has no way to go out and leads to increase cranial pressure
When a child is born prematurely, areas inside the brain (called “lateral ventricles”) that contain many small, thin, and fragile blood vessels are easily injured during the stress of shock of birth and the period of intense care afterward. These vessels burst and bleeding starts within those areas.
Unfortunately, the areas where the bleeding occurs are also those where cerebrospinal fluid forms. The blood may plug the drainage holes, causing the fluid to build within the brain, pushing on surrounding brain tissue, causing further brain damage.
In some cases, the posthemorrhagic hydrocephalus will subside on its own. In other cases, medications and sometimes placing of permanent shunts within the brain to drain the fluid may be necessary.
what is PDA?
Patent ductus arteriosus (PDA) is a medical condition in which the ductus arteriosus fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta, which has a higher pressure, to the pulmonary artery
what is the circulation in PDA? and what problems does it cause?
Consequences:
Worsening of respiratory symptoms
+
Retention of fluids (low renal perfusion)
Gastrointestinal problems (GE ischemia)
what is Necrotising entero-colitis (NEC) and what does it cause?
Necrotising Enterocolitis (NEC) is an inflammation of the bowel (intestines) that may damage the bowel to a variable extent
Ischemic and inflammatory changes
Necrosis of bowel
Surgical intervention is often required
Conservative management is sometimes possible
- antibiotics and parenteral nutrition
what is the outcomes of extreme prematurity?
1/3 dies
1/3 have normal life or mild disability
1/3 have moderate or severe disability for lifetime
1 in 6 is entirely normal at 6 years of age
Subjective quality of life was not different in ex-preterm compared to ex-term controls
