Complications of Prematurity - Only * slides Flashcards
Respiratory Distress Syndrome - precipitating factors
Preterm infants Low birth weight Maternal diabetes (if less than 38 wks) Cesarean delivery Delivery before 37 weeks gestation Precipitous delivery Cold stress Perinatal hypoxia ischemia Male gender Second twin
Respiratory Distress Syndrome - precipitating factors - Why maternal diabetes
Infant of diabetic mother - increased insulin in infant can delay surfactant production
Respiratory Distress Syndrome - precipitating factors - cold stress
Suppresses surfactant production
Respiratory Distress Syndrome - precipitating factors - Second twin
My be due to greater risk of asphyxia
First twin is usually smaller, suggesting chronic stress leading to early lung maturation
Three causes of hypoglycemia
1 Inadequate glycogen stores
2 Hyperinsulinemia
3 Increased glucose utilization
Three causes of hypoglycemia - Inadequate glycogen stores seen
Preterm
Three causes of hypoglycemia - Hyperinsulinemia
Suppresses glucose production and increases glucose utilization
Infant of a diabetic mother
Three causes of hypoglycemia - Increased glucose utilization
Sick infant
Now they are sick and have no storage to pull from
Hypothermia - highest risk
Includes preterm and low birth weight infants
Hypothermia - who is also at risk
Infants who are acutely ill
Infants with open defects
Infants who require prolonged resuscitation
Infants who have decreased ability to flex
Hypothermia - who is also at risk - Infants who are acutely ill
Normally infants will flex themselves to stay warm, but when acutely ill they wont
Hypothermia - who is also at risk - Infants with open defects
Gastroschisis
Meningocele
Extra body SA so a lot of heat loss
Hypothermia - who is also at risk - Infants who have dec ability to flex
Preterm
Sedated infant
Paralytics/anesthetic
Intraventricular Hemorrhage - Incidence
30-40% of infants less than 1500 gms or less than 30 weeks gestation
Intraventricular hemorrhage - what weeks are higher risk
Less than 28 weeks have a 3 times higher risk than 28-32 weeks
Intraventricular hemorrhage - Timing of onset
50% by 24 hrs
80% by 48 hrs
90% by 72 hrs
99.5% by 7 days
Intraventricular hemorrhage - progression
20-40% have progression of hemorrhage over 3-5 days
Hypoxic Ischemic Encephalopathy - Pt care - what is a tx to consider
Therapeutic hypothermia
Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia - what is the first qualification
Greater than or equal to 36 weeks
Greater than or equal to 1800 g
Less than or equal to 6 hours of age
Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia - If the first qualification is met, then what
pH of less than 7.0 and//or base deficit of greater than 16 and a blood gas within first hour of life
Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia - If the first qualification is met, then what (if no blood gas available)
Was being ventilated at 10 min of life
Apgar score 5 or less
Hx of an acute perinatal event
Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia - If have had seizure before the 6 hours of life, then what
They are eligible for cooling
Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia - No seizure
Need to do neuro exam and they need to meet 3 of the 5 and have moderate or severe in order to treat
Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia what do they do
Cool them down to 92.3 degrees for 3 days and then very slowly warm them back up while monitoring vitals
