Complications of prematurity

Question 1

What is the greatest cause of infant mortality in the United States?

Answer 1

premature birth

Question 2

What can cause premature birth?

Answer 2

1. Preterm Labor
2. Preterm prelabor rupture of membranes
3. Mandated (for mother or fetal health)
4. Multiples

Question 3

What are tocolytics?

Answer 3

category of drugs that slow or stop contraction of uterine smooth muscle

Question 4

What are examples of tocolytics?

Answer 4

1. Magnesium sulfate
2. Terbutaline
3. Indomethacin
4. Magnesium sulfate

Question 5

What are complications associated with premature delivery?

Answer 5

1. Intraventricular hemorrhage
2. Retinopathy of prematurity
3. Patent Ductus arteriosus
4. Necrotizing entercolitis

Question 6

What is the germinal matrix?

Answer 6

high cellular and richly vascularized with capillaries that are poorly supported by muscle or collagen

Question 7

What can cause IVH in neonates?

Answer 7

1. Primitive vasculature
2. Fluctuations in cerebral blood flow
3. Impaired cerebral autoregulation

Question 8

How are neonatal IVH describe?

Answer 8

Graded on a scale from 1-4

Question 9

Describe a grade 1 IVH

Answer 9

hemorrhage only within the germinal matrix

Question 10

Describe a grade 4 IVH

Answer 10

hemorrhage originating from the germinal matrix but extending into the ventricles and parenchyma of the brain

Question 11

What is the second most common cause of death in premature infants?

Answer 11

IVH

Question 12

What are signs and symptoms associated with IVH?

Answer 12

1. Bulging fontanelle
2. apneas
3. variable vital signs
4. changes in level of consciousness
5. irritability
6. Literally nothing

Question 13

How is IVH diagnosed in neonates?

Answer 13

Ultrasound
CT/MRI if further imaging is needed

Question 14

Describe retinopathy of prematurity

Answer 14

Abnormal development of the blood vessels supplying the retina

Question 15

What is an RTs role in retinopathy of prematurity?

Answer 15

Limiting exposure to O2

Question 16

How common is retinopathy of prematurity in infants?

Answer 16

About 66% of infants weighing less than 1250 grams develop some ROP
About 90% of infants weighing less than 750 grams develop ROP

Question 17

What roles does oxygen play in ROP?

Answer 17

Stimulates abnormal blood vessel growth in fetal retinas which can lead to vision loss or blindness

Question 18

What are management options for ROP?

Answer 18

1. Laser ablation
2. injection of antigrowth factors into orbit
3. blocking of vascular endothelial growth factor

Question 19

What can cause a patent ductus arteriosus?

Answer 19

1. Premature birth
2. Maternal infection (Zika, rubella)
3. genetics

Question 20

How is a patent ductus arteriosus diagnosed?

Answer 20

1. Pre/post SpO2
2. Echocardiogram
3. pulse variations
4. Tachypnia
5. Continuous murmur
6. > 15mmg difference on pre/post ABGs

Question 21

What are complications associated with PDA?

Answer 21

1. Pulmonary over-circulation
2. Decreased blood flow to the lower body

Question 22

What are complications associated with pulmonary over circulation caused by a PDA?

Answer 22

1. Increase in PA pressures
2. Pulmonary interstitial edema
3. Reduced lung compliance
4. Impaired oxygenation

Question 23

What are complications associated with decreased blood flow to the lower body caused by PDA?

Answer 23

1. Acute kidney injury
2. Necrotizing enterocolitis

Question 24

How is patent ductus arteriosus managed?

Answer 24

1. Increasing respiratory support while limiting FiO2
2. Strict fluid management

Question 25

What are treatment options for paten ductus arteriosus?

Answer 25

Pharmacologic Surgical

Question 26

What are pharmacologic options for PDA closure?

Answer 26

1. indomethacin 2. Ibuprofen 3. Acetaminophen

Question 27

What are surgical options for treating PDA?

Answer 27

Surgical clip Transcatheter closure

Question 28

When does necrotizing enterocolitis typically occur?

Answer 28

2-3 weeks of life

Question 29

What causes necrotizing enterocolitis?

Answer 29

1. Introduction of enteral feeds to premature gut 2. Neutrophils and inflammatory mediators are released 3. Bacterial invasion

Question 30

What is the progression of necrotizing enterocolitis?

Answer 30

1. Inflammation 2. Bacterial invasion 3. Tissue ischemia 4. Necrosis 5. Perforation

Question 31

What are the signs and symptoms of necrotizing enterocolitis?

Answer 31

1. Fever 2. Increased abdominal girth 3. Intolerable to feeds 4. Tachypnea 5. Abdominal distention 6. Red skin on abdomen 7. Bloody stools

Question 32

How is necrotizing enterocolitis diagnosed?

Answer 32

1. Dilated bowel loops 2. pneumatosis intestinalis 3. Portal venous air 4. Xray

Question 33

How is necrotizing enterocolitis managed?

Answer 33

1. Laparotomy 2. Peritoneal drain

Question 34

When would a peritoneal drain be used to managed necrotizing enterocolitis?

Answer 34

When dealing with extremely low birth weight infants

Question 35

What are respiratory considerations to have when dealing with necrotizing enterocolitis?

Answer 35

Abdominal competition metabolic acidosis high frequency ventilation