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Pediatrics > Complications of prematurity > Flashcards

Complications of prematurity Flashcards

1
Q

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

A

premature birth

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2
Q

What can cause premature birth?

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

What are tocolytics?

A

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

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4
Q

What are examples of tocolytics?

A
  1. Magnesium sulfate
  2. Terbutaline
  3. Indomethacin
  4. Magnesium sulfate
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5
Q

What are complications associated with premature delivery?

A
  1. Intraventricular hemorrhage
  2. Retinopathy of prematurity
  3. Patent Ductus arteriosus
  4. Necrotizing entercolitis
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6
Q

What is the germinal matrix?

A

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

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7
Q

What can cause IVH in neonates?

A
  1. Primitive vasculature
  2. Fluctuations in cerebral blood flow
  3. Impaired cerebral autoregulation
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8
Q

How are neonatal IVH describe?

A

Graded on a scale from 1-4

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9
Q

Describe a grade 1 IVH

A

hemorrhage only within the germinal matrix

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10
Q

Describe a grade 4 IVH

A

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

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11
Q

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

A

IVH

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12
Q

What are signs and symptoms associated with IVH?

A
  1. Bulging fontanelle
  2. apneas
  3. variable vital signs
  4. changes in level of consciousness
  5. irritability
  6. Literally nothing
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13
Q

How is IVH diagnosed in neonates?

A

Ultrasound
CT/MRI if further imaging is needed

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14
Q

Describe retinopathy of prematurity

A

Abnormal development of the blood vessels supplying the retina

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15
Q

What is an RTs role in retinopathy of prematurity?

A

Limiting exposure to O2

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16
Q

How common is retinopathy of prematurity in infants?

A

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

17
Q

What roles does oxygen play in ROP?

A

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

18
Q

What are management options for ROP?

A
  1. Laser ablation
  2. injection of antigrowth factors into orbit
  3. blocking of vascular endothelial growth factor
19
Q

What can cause a patent ductus arteriosus?

A
  1. Premature birth
  2. Maternal infection (Zika, rubella)
  3. genetics
20
Q

How is a patent ductus arteriosus diagnosed?

A
  1. Pre/post SpO2
  2. Echocardiogram
  3. pulse variations
  4. Tachypnia
  5. Continuous murmur
  6. > 15mmg difference on pre/post ABGs
21
Q

What are complications associated with PDA?

A
  1. Pulmonary over-circulation
  2. Decreased blood flow to the lower body
22
Q

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

A
  1. Increase in PA pressures
  2. Pulmonary interstitial edema
  3. Reduced lung compliance
  4. Impaired oxygenation
23
Q

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

A
  1. Acute kidney injury
  2. Necrotizing enterocolitis
24
Q

How is patent ductus arteriosus managed?

A
  1. Increasing respiratory support while limiting FiO2
  2. Strict fluid management
25
Q

What are treatment options for paten ductus arteriosus?

A

Pharmacologic
Surgical

26
Q

What are pharmacologic options for PDA closure?

A
  1. indomethacin
  2. Ibuprofen
  3. Acetaminophen
27
Q

What are surgical options for treating PDA?

A

Surgical clip
Transcatheter closure

28
Q

When does necrotizing enterocolitis typically occur?

A

2-3 weeks of life

29
Q

What causes necrotizing enterocolitis?

A
  1. Introduction of enteral feeds to premature gut
  2. Neutrophils and inflammatory mediators are released
  3. Bacterial invasion
30
Q

What is the progression of necrotizing enterocolitis?

A
  1. Inflammation
  2. Bacterial invasion
  3. Tissue ischemia
  4. Necrosis
  5. Perforation
31
Q

What are the signs and symptoms of necrotizing enterocolitis?

A
  1. Fever
  2. Increased abdominal girth
  3. Intolerable to feeds
  4. Tachypnea
  5. Abdominal distention
  6. Red skin on abdomen
  7. Bloody stools
32
Q

How is necrotizing enterocolitis diagnosed?

A
  1. Dilated bowel loops
  2. pneumatosis intestinalis
  3. Portal venous air
  4. Xray
33
Q

How is necrotizing enterocolitis managed?

A
  1. Laparotomy
  2. Peritoneal drain
34
Q

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

A

When dealing with extremely low birth weight infants

35
Q

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

A

Abdominal competition
metabolic acidosis
high frequency ventilation

Pediatrics (17 decks)

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