Born Too Small Too Early Flashcards
What weight is classed as too small?
<2500g
Types of “small for dates”
Small for Gestational Age (SGA)
Intra-Uterine Growth Restriction (IUGR)
Hypotrophy (symmetric and asymmetric)
What is classed as severe IUGR
<0.4th centile
Causes for being small for dates
Maternal:
- Smoking
- Maternal Pre-Eclamptic Toxaemia
Foetal:
- Chromosomal (Eg Edwards Syndrome)
- Infection (Eg CMV)
Placental:
-Eg placental abruption
Other:
Twin pregnancy
Common problems that occur when too small for dates
Perinatal hypoxia Hypoglycaemia Hypothermia Polycythaemia Thrombocytopenia Hypoglycaemia Gastrointestinal problems (feeds, Necrotizing enterocolitis)
Long term problems caused by being small for dates
Hypertension
Reduced growth
Obesity
Ischaemic heart disease
Define preterm and extremely preterm?
Preterm <37 weeks
Extremely preterm <28 weeks
Define low birth weight, very low and extremely low
Low b/w <2500g
Very low <1500g
Extremely low <1000g
What happens to a preterm’s respiratory system
Respiratory distress syndrome
Broncho-pulmonary Displasia (BPD)
Prevention of RDS in preterm
Antenatal steroids
Treatment for RDS
Surfactant
N-CPAP
Minimal ventilation (low tidal volume and good inflation)
What is and what causes Broncho-pulmonary dysplasia?
Chronic lung disease of newborns
Caused by :
-Overstretch by volu-baro-trauma
Leads to:
- Atelectasis (collapse)
- Infection via endotracheal tube
- O2 toxicity
- Inflammatory changes
- Tissue repair causing scarring
Treatment of BPD
Patience
Nutrition and growth
Steroids
Preterm minor respiratory problems that can occur?
Apnoea
Irregular breathing
Desaturations
Treatment of preterm minor respiratory problems
Caffeine
N-CPAP
Neuroloigcal problems that can occur in preterm
intra-ventricular haemorrhage
Peri-ventricular leucomalacia (96% adverse outcome)
Post-haemorrhagic hydrocephalus
How to prevent intraventricular haemorrhage
Steroids
Treatment of IVH
Sympthomatic
Drainage
Circulation problems that can occur in preterm
Patent Ductus arteriosus
Patent ductus arteriosus presentation
Additional blood to pulmonary circulation:
-Lung oedema
Steal from systemic circulation:
-Systemic ischaemia
Consequences of PDA
Worsening of respiratory symptoms
Retention of fluids (low renal perfusion)
GI problems (GE ischaemia)
Preterm gastrointestinal presentation
Necrotising Entero-Colitis
What is Necrotising Entero-colitis
Ischaemic, inflammatory changes and necrosis of bowel
Treatment of Necrotising Entero-colitis
Surgical intervention may be required
Antibiotics and parenteral nutrition
Outcome of extreme prematurity
1/3 die
1/3 normal life or mild disability
1/3 have moderate or severe disability for lifetime
Deterioration between year 2 and year 6
