conditions of prematurity

Question 1

respiratory distress syndrome

Answer 1

affects premature neonates, born before lungs start producing adequate surfactant
- commonly before 32wks

Question 2

pathophys of resp distress syndrome

Answer 2

inadequate surfactant leads to high surface tension within alveoli
-> leads to lung collapse as more difficult for alveoli + lungs to expand

-> inadequate gas exchange

Question 3

management of resp distress syndrome

Answer 3

antenatal steroids given if suspected preterm labour
- increases production of surfactant

prem babies may need
- intubation/ventilation
- endotracheal surfactant
- CPAP

support with breathing gradually stops as baby develops

Question 4

resp distress syndrome complications

Answer 4

short term
- infection
- pneumothorax
- pulmonary haemorrhage
- IVH
- necrotising enterocolitis

long term
- chronic lung disease of prematurity
- retinopathy of prem - occurs more often/severely in those with RDS
- neuro, hearing + visual impairment

Question 5

transient tacypnoea of newborn (TTN)

Answer 5

commonest cause of resp distress in newborn period
- cause by delayed resorption of fluid in the lungs

Question 6

which births is transient tacypnoea of newborn (TTN) more common

Answer 6

csections
- due to lung fluid not being”squeezed out”

Question 7

transient tacypnoea of newborn (TTN) investigation

Answer 7

CXR = hyperinflation of lung + fluid in horizontal fissures

Question 8

transient tacypnoea of newborn (TTN) management

Answer 8

supportive care
supplementary oxygen if required

usually settles within 1-2days

Question 9

intraventricular haemorrahages in premature babies

Answer 9

haemorrhage into ventricular system of brain
- can occur spontaneously

may clot + occlude CSF flow -> hydrocephalus

Question 10

when do intraventricular haemorrahages in premature babies typically occur? management?

Answer 10

within first72hrs

largely supportive, shunt if hydroceph

Question 11

Hypoxic-Ischaemic Encephalopathy

Answer 11

occurs in neonates as a result of hypoxia during birth
- can lead to permanenet damage + cerebral palsy or death

Question 12

Hypoxic-Ischaemic Encephalopathy grading

Answer 12

sarnat staging

Question 13

retinopathy of prematurity

Answer 13

babies born <32wks
abnormal neovascularisation causing scarring, retinal detachment

premature babies are screened for it

Question 14

management of retinopathy of prematurity

Answer 14

1st line = transpupillary laser photocoag (to hault/reverse neovascularisation)

others = cryotherapy, intravitreal antiVEGF