Complications of Prematurity - Only * slides

Question 1

Respiratory Distress Syndrome - precipitating factors

Answer 1

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

Question 2

Respiratory Distress Syndrome - precipitating factors - Why maternal diabetes

Answer 2

Infant of diabetic mother - increased insulin in infant can delay surfactant production

Question 3

Respiratory Distress Syndrome - precipitating factors - cold stress

Answer 3

Suppresses surfactant production

Question 4

Respiratory Distress Syndrome - precipitating factors - Second twin

Answer 4

My be due to greater risk of asphyxia

First twin is usually smaller, suggesting chronic stress leading to early lung maturation

Question 5

Three causes of hypoglycemia

Answer 5

1 Inadequate glycogen stores
2 Hyperinsulinemia
3 Increased glucose utilization

Question 6

Three causes of hypoglycemia - Inadequate glycogen stores seen

Answer 6

Preterm

Question 7

Three causes of hypoglycemia - Hyperinsulinemia

Answer 7

Suppresses glucose production and increases glucose utilization
Infant of a diabetic mother

Question 8

Three causes of hypoglycemia - Increased glucose utilization

Answer 8

Sick infant

Now they are sick and have no storage to pull from

Question 9

Hypothermia - highest risk

Answer 9

Includes preterm and low birth weight infants

Question 10

Hypothermia - who is also at risk

Answer 10

Infants who are acutely ill
Infants with open defects
Infants who require prolonged resuscitation
Infants who have decreased ability to flex

Question 11

Hypothermia - who is also at risk - Infants who are acutely ill

Answer 11

Normally infants will flex themselves to stay warm, but when acutely ill they wont

Question 12

Hypothermia - who is also at risk - Infants with open defects

Answer 12

Gastroschisis
Meningocele
Extra body SA so a lot of heat loss

Question 13

Hypothermia - who is also at risk - Infants who have dec ability to flex

Answer 13

Preterm
Sedated infant
Paralytics/anesthetic

Question 14

Intraventricular Hemorrhage - Incidence

Answer 14

30-40% of infants less than 1500 gms or less than 30 weeks gestation

Question 15

Intraventricular hemorrhage - what weeks are higher risk

Answer 15

Less than 28 weeks have a 3 times higher risk than 28-32 weeks

Question 16

Intraventricular hemorrhage - Timing of onset

Answer 16

50% by 24 hrs
80% by 48 hrs
90% by 72 hrs
99.5% by 7 days

Question 17

Intraventricular hemorrhage - progression

Answer 17

20-40% have progression of hemorrhage over 3-5 days

Question 18

Hypoxic Ischemic Encephalopathy - Pt care - what is a tx to consider

Answer 18

Therapeutic hypothermia

Question 19

Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia - what is the first qualification

Answer 19

Greater than or equal to 36 weeks
Greater than or equal to 1800 g
Less than or equal to 6 hours of age

Question 20

Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia - If the first qualification is met, then what

Answer 20

pH of less than 7.0 and//or base deficit of greater than 16 and a blood gas within first hour of life

Question 21

Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia - If the first qualification is met, then what (if no blood gas available)

Answer 21

Was being ventilated at 10 min of life
Apgar score 5 or less
Hx of an acute perinatal event

Question 22

Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia - If have had seizure before the 6 hours of life, then what

Answer 22

They are eligible for cooling

Question 23

Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia - No seizure

Answer 23

Need to do neuro exam and they need to meet 3 of the 5 and have moderate or severe in order to treat

Question 24

Hypoxic Ischemic Encephalopathy - Pt care - Therapeutic Hypothermia what do they do

Answer 24

Cool them down to 92.3 degrees for 3 days and then very slowly warm them back up while monitoring vitals

Question 25

Acute perinatal event includes what

Answer 25

abruptio placenta
cord prolapse
variable or late deceleration