HIGH-RISK INFANTS

Question 1

4 main groups of High risk infant

Answer 1

• Preterm
• Infants with special health care needs
• Infants at risk because of family issues
• Infants with anticipated early death

Question 2

present with either monozygotic or dizygotic twin

Answer 2

Single placenta

Question 3

• Result from simultaneous maturation of multiple ovarian follicles
• Occur in many women treated for infertility

Answer 3

Polyovular pregnancies

Question 4

Twinning results from the splitting of a single conceptus, with the timing resulting in differing amnionicity and chorlonicity

Answer 4

Fission theory

Question 5

Inner cell mass of trophectoderm fuse after the initial 2-cell splitting stage

Answer 5

Fussion theory

Question 6

obligate monozygotes

Answer 6

Conjoined twin

Question 7

• Result from later fission of a single zygote (0-14 days) or from fusion of 2 zygotes
• Majority are female
• Site of connection:
  > Thoracoomphalopagus (28%)
  > Thoracopagus (18%)
  > Omphalopagus (10%)
  > Craniopagus (6%)
  > Incomplete duplication (10%)

Answer 7

Atypical twinning

Question 8

• smaller and less completely developed member of a pair of conjoined twins
• Has embryonic demise but remains vascularized by the surviving independent twin (autocyte)

Answer 8

Parasitic twin

Question 9

for asymmetrically attached conjoined twins in whom one twin is dependent on the cardiovascular system of the intact autocye

Answer 9

Exoparasitic twin

Question 10

one fetus exists as a benign mass in the autocyte

Answer 10

Endoparasitic twins

Question 11

• fertilization of an ovum by an insemination that takes place after 1 ovum has already been fertilized
• fertilization and subsequent development of an embryo when a fetus is already present in the uterus

Answer 11

• Superfecundation
• Superfetation

Question 12

high fatality; intertwining of cords with multiple gestation

Answer 12

Monoamniotic twins

Question 13

Placental vascular anastomoses occur in monochorionic placentas

Answer 13

Twin Syndromes (TRAP, TTTS)

Question 14

• twin reversed arterial perfusion
• Acardiac fetus - combination of a-a and v-v anastomoses

Answer 14

TRAP syndrome

Question 15

• artery from one twin acutely or chronically delivers blood that is drained into the vein of the other
• Common in monozygotic twin and affects 30% of monochorionic twins

Answer 15

TTTS

Question 16

Diagnosis of Twin Syndromes

Answer 16

• Uterine size greater than that expected for gestational age
• Auscultation of 2 fetal hearts
• Elevated maternal serum AFP or HCG levels
• Confirmed by UTZ

Question 17

Tx of Twin Syndromes

Answer 17

• Elective delivery of twins at 37 wks or earlier for
  monochorionic, monoamniotic twins
• Close observation and attendance by a pediatric team

Question 18

Duration for Extremely and very preterm infants

• Preterm:
• Extremely PT or extremely low gestational age
  newborns:
• Very preterm:
• Moderate and late preterm:

Answer 18

• Preterm: <37 wks from the 1st day of LMP
• Extremely PT or extremely low gestational age
  newborns: <28 wks
• Very preterm: 28wks and 31 6/7 wks
• Moderate and late preterm: 32 wks and 36 6/7 wk
  gestation

Question 19

BIRTHWEIGHT CATEGORIES

• Extremely LBW:
• Very low birthweight infant -
• Low birthweight - born

Answer 19

• Extremely LBW: <1000 grams
• Very low birthweight infant - <1500gms
• Low birthweight - born <2500gms

Question 20

classified as reduced birthweight and appear to have a disproportionately larger head relative to body size

Answer 20

IUGR

Question 21

Assessment of Gestational age

• Symmetric
• Asymmetric

Answer 21

• Symmetric :
  > earlier onset
  > asstd with diseases that affect fetal cell number
• Asymmetric :
  > late onset
  > associated with poor maternal nutrition

Question 22

Nursery Care

• Thermal control
• Oxygen therapy

Answer 22

• Thermal control
  > Incubators and radiant warmers
  > Maintain infants core temp at 36.5-37C (97.7-98.6F)
  > Kangaroo Mother Care
  > Maintain relative humidity of 40-60%
• Oxygen therapy
  > Reduce the risk of injury from hypoxia and circulatory insufficiency
  > ROP and BPD
  > O02 saturation range: 90-95%

Question 23

Fluid Requirements and Nutrition

• Early Parenteral Nutrition
• Human milk
• Enteral Nutrition

Answer 23

• Early Parenteral Nutrition
  > Minimum of 2g/kg of amino acid given in the 1% 24h after birth to at least 3.5g/kg within 24-48hr after birth
• Human milk: lower incidence of NEC
• Enteral Nutrition
  > Starts between 6 and 48hr with some period of trophic/ minimal enteral feeding volume
  > Slowly advance 15-30 mi/kg/day with target of 110-135 kcal/kg/day and 3.5-4.5g protein/kg/day

Question 24

• 32 and 33 6/7wks. Risk of postnatal morbities: poor feeding, wt loss, RDS, NEC, hypothermia
• 34 and 36 6/7 wks. Increase incidence of congenital anomalies, requires resuscitation, hypoglycemia, respiratory distress, apnea, feeding difficulties and jaundice

Answer 24

• Moderate PT
• Late preterm:

Question 25

- Early term: - Full term: - Late term:

Answer 25

- Early term: 37 - 38 6/7wks - Full term: 39 - 40 6/7wks - Late term: 41 - 41 6/7 wks

Question 26

Large for Gestational Age - Birthweight - Decreases mortality - Predisposing factors

Answer 26

- Birthweight > the 90" percentile for gestational age - Neonatal mortality decreases with increasing BW until 4000 gms; increase after - Predisposing factors: maternal diabetes and obesity

Question 27

- Born after 42 completed weeks of gestaiton from the LMP - Common complication > Perinatal depression, meconium aspiration, PPHN, hypoglycemia, hypocalcemia and polycythemia - Mgt: > monitor (NST, BPP, Doppler velocimetry) > Induction of labor

Answer 27

Postterm Infants

Question 28

Infant of Diabetic Mothers - 1st trimester - 2nd trimester 3rd trimerster

Answer 28

- 1st trimester > Major congenital anomalies and fetal growth restriction - 2nd trimester > Chronic hyperinsulinism -3rd trimerster Multiple d/o or dses presenting after delivery