Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OBG: Oncology and neonatalology > Common problems in prematurity > Flashcards

Common problems in prematurity Flashcards

1
Q

How can the gestational age on an infant be determined in not known from ultrasound scanning?

A

based on appearance and neurological findings : Ballard score (6 points for physical, 6 points for neuromuscular signs of maturity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are 12 things accounted for by the Ballard score to determine gestational age?

A
  1. Birthweight
  2. Skin - thickness, colour
  3. Ears: pinna, recoil
  4. Breast tissue
  5. Genitalia
  6. Breathing
  7. Sucking and swallowing
  8. Feeding
  9. Cry
  10. Vision, interaction
  11. Hearing
  12. Posture - extended (premature) vs flexed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

After what age of prematurity is the prognosis now excellent due to modern neonatal care?

A

excellent prognosis after 30 weeks’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are 2 examples of parental involvement in neonatal care for preterm infants?

A
  1. Skin-to-skin contact between infant and parent (Kangaroo care) to promote bonding
  2. Mother giving baby expressed milk (in syringe) via nasogastric tube, allowing close eye and skin contact between mother and baby
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are 16 medical problems of preterm infants?

A
  1. Need for resuscitation and stabilisation at birth
  2. Respiratory: RDS, pneumothorax, apnoea and bradycardia
  3. Hypotension
  4. PDA
  5. Temperature control
  6. Metabolic: hypoglycaemia, hypocalcaemia, osteopenia of prematurity
  7. Nutrition
  8. Infection
  9. Jaundice
  10. IVH/PVL
  11. Necrotising enterocolitis
  12. Retinopathy of prematurity
  13. Anaemia of prematurity
  14. Iatrogenic
  15. Bronchopulmonary dysplasia (BPD)
  16. Inguinal hernias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 4 respiratory problems of preterm infants?

A
  1. Respiratory distress syndrome
  2. Pneumothorax
  3. Apnoea and bradycardia
  4. Bronchopulmonary dysplasia (BPD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 4 metabolic problems of preterm infants?

A
  1. Hypoglycaemia
  2. Hypocalcaemia
  3. Electrolyte imbalance
  4. Osteopenia of prematurity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is another name for respiratory distress syndrome?

A

hyaline membrane disease- proteinaceous exudate seen in airways on histology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is respiratory distress syndrome?

A
  • deficiency of surfactant, which lowers surface tension
  • surfactant deficiency leads to widespread alveolar collapse and inadequate gas exchange
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What normally produces surfactant and what is it?

A

type II pneumocytes of the alveolar epithelium

mixture of phospholipids and proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 2 reasons why surfactant deficiency can occur in term infants?

A
  1. Maternal diabetes
  2. Genetic mutations in surfactant genes (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can be done to help prevent respiratory distress syndrome in preterm delivery is anticipated?

A

glucocorticoids given antenatally to the mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are 3 problems that antenatal steroids given to the mother help to prevent in the newborn?

A
  1. RDS
  2. Bronchopulmonary dysplasia
  3. Intraventricular haemorrhage (IVH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are 4 clinical signs of respiratory distress syndrome in the newborn?

A
  1. Tachypnoea over 60 breaths/minute
  2. Laboured breathing with chest wall recession (particularly sternal and subcostal indrawing) and nasal flaring
  3. Expiratory grunting in order to try and create positive airway pressure during expiration and maintain functional residual capacity
  4. Cyanosis if severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In what time period do the signs of RDS develop in the neonate?

A

within 4 hours of delivery (often at delivery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the characteristic chest x-ray appearance of RDS?

A

diffuse granular or ‘ground glass’ appearance of lungs and air bronchogram, where larger airways are outlined

heart border indistinct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 2 aspects of treatment for RDS?

A
  1. Raised ambient oxygen
  2. Surfactant therapy
    1. surfactant directly into lungs via tracheal tube or catheter
  3. Additional respiratory support may be provided non-invasively with CPAP or high-flow nasal cannular therapy, or invasively with mechanical ventilation via tracheal tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are 2 options for mechanical ventilation?

A
  1. Intermittent positive pressure ventilation
  2. High frequency oscillation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 3 things that invasive mechanical ventilation is adjusted based upon in RDS?

A
  1. Oxygenation
  2. Chest wall movements
  3. Blood gas analyses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the risk of excess oxygen in the neonate? 2 things

A

hyperoxia can be damaging from excess free radicals, and increased risk of reinopathy of prematurity if sats >95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are 2 risks of low oxygen saturations to the neonate?

A
  1. Necrotising enterocolitis
  2. Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does oxygen therapy now involve in neonatal resuscitation?

A

start with 21-30% oxygen in preterm infants, avoiding sats over 95%

use air in term infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can pneumothorax come about in a preterm infant?

A

air from overdistended alveoli may track into the mediastinum, resulting in pulmonary interstitial emphysema

in up to 10% of infants ventilated for RDS, air leaks into the pleural cavity and causes a pnemothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are 3 clinical signs of pneumothorax in the preterm infant?

A
  1. Chest movement reduced on affected side
  2. Reduced breath sounds on affected side
  3. Increased oxygen required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the treatment of tension pneumothorax?

A

decompression by inserting chest drain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How can you try and prevent pneumothorax in the management of the preterm neonate?

A

ventilate with lowest pressures that provide adequate chest movement and satisfactory blood gases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the triad of symptoms common in very low birthweight pre-term infants?

A

apnoea + bradycardia + desaturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do the symptoms of apnoea + bradycardia + desaturation typically occur in the preterm infant?

A

infant stops breathing for 20-30 seconds, causing bradycardia

or breathing continues but against closed glottis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are 8 possible underlying causes of the apnoea + bradycardia + desaturation in preterm neonates that need to be excluded?

A
  1. Hypoxia
  2. Infection
  3. Anaemia
  4. Electrolyte disturbance
  5. Hypoglycaemia
  6. Seizures
  7. Heart failure
  8. Aspiration due to GORD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is often the cause of apnoea + bradycardia + desaturation in preterm infants?

A

due to immaturity of central respiratory control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are 3 possible treatments for apnoea + bradycardia + desaturation in preterm infants caused by immaturity of central respiratory control?

A
  1. Gentle physical stimulation - usually with start breathing again
  2. Caffeine - respiratory stimulant
  3. CPAP or mechanical ventilation if apnoeic episodes are frequent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the risks of hypothermia in the preterm infant?

A

causes increased energy consumption, may result in hypoxia and hypoglycaemia, failure to gain weight and are an independent risk factor for mortality soon after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are 4 reasons why preterm infants are particularly vulnerable to hypothermia?

A
  1. Have large surface area relative to their mass, so greater heat loss than heat generation
  2. Skin is thin and heat-permeable - transepidermal water loss is important in the 1st week of life
  3. Little subcutaneous fat for insulation
  4. Often nursed naked and cannot conserve heat by curling up or generate heat by shivering
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How can the temperatures of preterm babies be maintained? 2 key ways

A

incubators or initially with overhead radiant heaters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What do incubators provide in addition to heat? What is the benfit of this?

A

ambient humidity, which reduces transepidermal heat loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the 4 methods of heat transfer that can be utilised to prevent hypothermia in a preterm infant?

A
  1. Convection
  2. Radiation
  3. Evaporation
  4. Conduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are 3 ways to prevent hypothermia in an infant by convection?

A
  1. Raise temperature of ambient air in incubator
  2. Clothe, including covering head
  3. Avoid draughts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are 2 ways to prevent hypothermia in an infant by radiation?

A
  1. Cover baby
  2. Double walls for incubators
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are 2 ways to prevent hypothermia in an infant by evaporation?

A
  1. Dry and wrap at birth, if extremely preterm, place baby’s body directly into plastic bag at birth without drying
  2. Humidify incubator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is 1 way to prevent hypothermia in an infant by conduction?

A

nurse on heated mattress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the common effect of the patent ductus arteriosus in preterm infants?

A

shunting of blood from left to right is most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What may be the symptoms of PDA in preterm infants? 8 things

A
  1. may be asymptomatic
  2. apnoea
  3. bradycardia
  4. increased oxygen requirement
  5. difficulty in weaning from artificial ventilation
  6. bounding pulses - due to increased pulse pressure
  7. prominent precordial impulse
  8. systolic murmur may be audible (machinery)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What will happen in preterm infants with PDA as circulatory overload increases?

A

signs of heart failure may develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How can more accurate assessment of a preterm infant’s circulation if they have PDA?

A

echocardiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

When do you treat PDA in preterm infants and how?

A

if symptomatic

pharmacological closure with indomethacin or ibuprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How do indomethacin and ibuprofen work to treat PDA?

A

they are prostaglandin synthetase inhibitors

47
Q

If indomethacin/ ibuprofen fail to close a symptomatic PDA what is the next treatment?

A

surgial ligation

48
Q

What are 5 things that determine the fluid requirements of a preterm neonate?

A
  1. Gestational and chronological age
  2. Clinical condition
  3. Plasma electrolytes
  4. Urine output
  5. Weight change
49
Q

What amount of feed is uually required on the first day of life and by the fifth day of life?

A
  1. 60-90ml/kg in first day
  2. By fifth day, 150-180 ml/kg
50
Q

Why do preterm infants have a high nutritional requirement?

A

rapid growth: infants born at 28 weeks gestation double birthweight in 6 weeks and treble in 12 weeks

(term babies double weight only in 4.5 months and treble it in a year)

51
Q

At what gestation of birth are infants mature enough to suck and swallow milk?

A

those born from 35-36 weeks’ gestation

52
Q

What will preterm infants born before 35-36 weeks require to feed?

A

orogastric or nsogastric tube, with enteral feeds introduced as soon as possible (preferably breast milk)

53
Q

In those preter infants receiving breastmilk, what needs to supplement the breast milk? 4 things

A
  • phosphate
  • protein and calories (in breast milk fortifier)
  • calcium
54
Q

What is sometimes done if the mother’s breast milk is not available to feed extremely preterm neonates?

A

donor breast milk fed to neonate in some neonatal units

55
Q

What formula feeds are given to preterm infants if formula feeding is required?

A

special infant formulas designed to meet increased nutritional requirements of preterm infants

56
Q

What is a disadvantage of giving formula milk rather than breast milk to preterm infants?

A

formula milks don’t provide protection against infection or other benefits of breast milk

57
Q

When is parenteral nutrition often required for preterm infants?

A

very immature or sick infant (typically <1kg birthweight)

58
Q

How is parenteral nutrition given to preterm infants if needed? 2 options

A

peripherally inserted central line (PIC or long line), or an umbilical venous catheter, paying strict attention to aseptic technique both during insertion and when lines are accessed

59
Q

What are 2 key risks of central lines meaning parentreal nutrition may be given via a peripheral vein?

A

Sepsis and thrombosis of a major vein

60
Q

What is a risk of parenteral feeding via a peripheral vein, which is sometimes employed?

A

extravasation may cause skin damage wtih scarring

61
Q

What is a risk of cow’s milk based formula milk for preterm infants?

A

increased risk of necrotising enterocolitis

62
Q

What now means that osteopenia of prematurity is rare?

A

provision of adequae phosphate, calcium and vitamin D

63
Q

Why are preterm babies at risk of iron-deficiency anaemia?

A

iron is mostly transferred to the fetus during the last trimester, so if preterm they have low iron stores

also due to los of blood from sampling and inadequate erythropoietin response

64
Q

What is done to prevent iron deficiency in preterm neonates?

A

iron supplements, started at several weeks of age and continued after discharge home

65
Q

Why are preterm infants at an increased risk of infection? 2 reasons

A
  1. IgG is mostly transferred across the placenta in the last trimester and no IgA or IgM is transferred
  2. Infection in or around cervix often a reason for preterm labour and may cause infections shortly after birth
66
Q

What is the most abundant immunoglobulin in human breast milk?

A

IgA (IgG and IgM also present but in lower concentrations)

67
Q

When do most infections in preterm infants occur?

A

after several days of age

68
Q

Where are most infections in preterm infants derived from?

A

most are nosocomial - often from indwelling catheters or mechanical ventilation

69
Q

At what age is necrotising enterocolitis typically seen in preterm infants?

A

first few weeks of life

70
Q

What are 3 key risk factors for necrotising enterocolitis?

A
  1. Ischaemic injury
  2. Bacterial invasion
  3. Being fed with cow’s milk formula rather than only breast milk
71
Q

What is a method for reducing the risk of necrotising enterocolitis?

A

supplementing milk feeds with prebiotics and probiotics

72
Q

What are 6 features of the presentation of necrotising enterocolitis?

A
  1. Feed intolerance
  2. Vomiting - may be bile-stained
  3. Abdominal distension
  4. Fresh blood in stool
  5. Shock
  6. Requirement for mechanical ventilation - due to abdo distension and pain
73
Q

What are 4 characteristic features of necrotising enterocolitis on x-ray?

A
  • distended loops of bowel
  • thickening of bowel wall with intramural gas
  • gas in portal venous tract
  • bowel perforation
74
Q

What imaging may be most useful to diagnostic necrotising enterocolitis?

A

abdominal x-ray

75
Q

What are 2 methods to identify bowel perforation caused by necrotising enterocolitis?

A
  1. Abdominal x-ray
  2. Transillumination of abdomen
76
Q

What is the treatment for necrotising enterocolitis?

A
  • stop oral feeding and give broad-spectrum antibiotics to cover both aerobic and anaerobic organisms
  • parenteral nutrition always needed, mechanical ventilation and circulatory support are often required
  • surgery for bowel perforation
77
Q

What is the mortality associated with necrotising enterocolitis?

A

20%

78
Q

What are 3 long-term risks of necrotising enterocolitis?

A
  1. Development of strictures
  2. Malabsorption - if extensive resection
  3. Poor neurodevelopmental outcome
79
Q

What proportion of very low birthweight infants have brain haemorrhages?

A

20%

80
Q

How can brain haemorrhages be detected in preterm infants?

A

cranial ultrasound scans

81
Q

Where do brain haemorrhages most typically occur in preterm infants?

A

in the germinal matrix above the caudate nucleus - contains fragile network of blood vessels

82
Q

When following birth do most intraventricular haemorrhages occur?

A

within first 72 hours of life

83
Q

What are 3 situations when intraventricular haemorrhages in preterm infants are more common?

A
  1. Following perinatal asphyxia
  2. Severe RDS
  3. Pneumothorax
84
Q

What is the difference between small and large brain haemorrhages in preterm infants in terms of the location?

A

small haemorrhages confined to germinal matrix, but larger haemorrhage extends into the ventricles

85
Q

What is the most severe type of brain haemorrhage in preterm infants and what can it lead to?

A

unilateral haemorrhagic infarction involving the parenchyma of the brain

usually results in hemiplegia

86
Q

What can be a sequela of large intraventricular haemorhage (IVH)?

A
  • may impair drainage and reabsorption of cerebrospinal fluid (CDF) allowing CSF to build-up under pressure
  • this dilatation may resolve spontaneously or progress to hydrocephalus
87
Q

What can occur due to hydrocephalus secondary to intraventricular haemorrhage?

A

can cause cranial sutures to separate, head circumference to increase rapidly and anterior fontanelle to become tense

88
Q

What are 2 aspects of the management of hydrocephalus secondary to IVH?

A
  1. Initially: removal of CSF by lumbar puncture or ventricular tap (symptomatic relief)
  2. Ventriculoperitoneal shunt may be required
89
Q

What disease to about half of infants with progressive post-haemorrhagic ventricular dilatation go on to develop?

A

cerebral palsy

90
Q

What factor increases the risk of cerebral palsy following IVH?

A

parenchymal infarction

91
Q

What can happen to the brain tissue itself following ischaemia or inflammation even int he absence of haemorrhage?

A

periventricular white matter brain injury

92
Q

How might periventricular white matter brain injury be diagnosed?

A
  1. may be an echo-dense area or ‘flare’ initially within the brain parenchyma on ultrasound
  2. this may resolve within a week, or cystic lesions may become visible on ultrasound 2-4 weeks later, indicating definite loss of white matter
93
Q

What is periventricular leukomalacia?

A

bilateral multiple cysts following periventricular white matter brain injury

94
Q

What is the risk of periventricular leukomalacia and what proportion does this affect?

A

spastic diplegia, often with cognitive impairment - 80-90% risk if posteriorly sited

95
Q

Why can IVH and periventricular leukomalacia both go undetected? 2 reasons

A
  1. as they can occur in the absence of abnormal clinical signs
  2. third of premature infants <32 weeks’ gestation who go on to have cerebral palsy have normal cranial ultrasound
96
Q

What is retinopathy of prematurity?

A
  • vascular proliferation at the junction of vascularised and non-vascularised retina
  • may progress to retinal detachment, fibrosis and blindness
97
Q

What are 3 possible adverse outcomes from the vacsular proliferation in the retina in retinopathy of prematurity?

A
  1. Retinal detachment
  2. Fibrosis
  3. Blindness
98
Q

What iatrogenic intervention can increase the risk of retinopathy of prematurity?

A

uncontrolled use of high concentrations of oxygen

99
Q

What are 2 groups of susceptible infants to retinopathy of prematurity?

A
  1. Low birthweight <1500g
  2. <32 weeks’ gestation
100
Q

What intervention is performed for all infants at risk of retinopathy of prematurity?

A

screening by an ophthalmologist

101
Q

What therapy can be given in retinopathy of prematurity and what does it achieve?

A

laser therapy - reduces visual impairment

(intravitreal anti-VEGF being investigated)

102
Q

In what proportion of very low birthweight infants does severe bilateral visual impairment occur?

A

1% (mostly infants <28 weeks’ gestation)

103
Q

What are infants still requiring oxygen requirement at postmenstrual age of 36 weeks described as having?

A

bronchopulmonary dysplasia (previously called chronic lung disease, CLD)

104
Q

What is thought to be the cause of bronchopulmonary dysplasia (previously chronic lung disease)?

A

from delay in lung maturation, but may also be from pressure and volume trauma from artificial ventilation, oxygen toxicity and infection

105
Q

What is typically seen in a CXR of an infant with bronchopulmonary dysplasia (previously CLD)?

A

widespread areas of opacification, sometimes with cystic changes

106
Q

What is the management of bronchopulmonary dysplasia? 2 aspects

A
  1. Some infants need prolonged artificial ventilation, but most are weaned onto CPAP or high-flow nasal cannula therapy followed by additional ambient oxygen, sometimes over several months
  2. Corticosteroid therapy - may facilitate earlier weaning, reduces oxygen requirements
107
Q

What are thought to be the risks of corticosteroid therapy for a baby with bronchopulmonary dysplasia? What is done as a result?

A
  • concern about increased risk of abnormal neurodevelopment including cereral palsy
  • use is limited to short, low-dose courses
108
Q

What is sometimes done for babies who continue to need oxygen and are diagnosed with bronchopulmonary dysplasia?

A

some may go home while still receiving additional oxygen

109
Q

What are 3 things that can cause death/ need for intensive care that are associated with bronchopulmonary dysplasia?

A
  1. May die of intercurrent infection
  2. Pulmonary hypertension
  3. Pertussis and respiratory viral infection (syncytial or rhinovirus) can cause respiratory failure necessitating intensive care
110
Q

What are 9 aspects of management of preterm infants following discharge (i.e. ongoing care)?

A
  1. Home oxygen for bronchopulmonary dysplasia + respiratory reviews to safely wean
  2. RSV prophylaxis in winter (palivizumab)
  3. Cardiac monitoring - check for pulmonary hypertension
  4. Dietician input - phosphate, iron and vitamins
  5. Primary immunisations
  6. Monitoring for inguinal hernias - at greater risk
  7. Ophthalmology review - to monitor any reinopathy of prematurity, determine if treatment required
  8. Low threshold for hospital readmission - usually respiratory problems
  9. In addition to healthy child programme, growth and neurodevelopment will be monitored
111
Q

What proportion of very low birthweight infants develop cerebral palsy?

A

5-10%

112
Q

What is the most common impairment in low birthweight infants?

A

learning difficulties

113
Q

What are 7 aspects of development that are impaired in very low birthweight infants?

A
  1. Fine motor skills e.g. threading beads
  2. Concentration, with short attention span
  3. Behaviour problems, epecially attention deficit disorders
  4. Abstract reasoning e.g. mathematics
  5. Processing several tasks simultaneoulsy
  6. Hearing impairment - small proportion
  7. Refractive errors and squints - many require glasses (small proportion blind in both eyes)

OBG: Oncology and neonatalology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions