Lecture 76 - Basics of Prematurity Flashcards
what is a term pregnancy
what is prematurity
Term = Born at or after 37 weeks gestation
Preterm = < 37 weeks gestation
some physical differences seen in pre term births
Skin not keritinized
Difficulty breathing
eye lids not open
underdeveloped
Range of a non viable birth
moderate prematurity?
late prematurity?
non viable: 1-23, 25 weeks
moderate – 32 -34 weeks
Late preterm - 34-36 weeks
Epi: what is the rate of prematurity in the US
what % of infants deaths are due to preterm
12%
8% are late preterm
1/3 of infant deaths
Risk factors for preterm labor
Previous preterm deliver/preterm labor
Maternal age35
AA
Cocaine, Cigarettes
Uterine malformations
DM and other chronic maternal disease
Infection;
Pre-eclampsia
Placental previa or abruption
Multigestations (2/3s of the time, deliver premature)
Oligo and Polyhydramnios
Immature Thermoregulation in preterm babies:
pathophsy
reasons and mechanisms of heat loss
Skin:Below 32 weeks gesation, kerainzied layer of the skin is immature
Skin is friable and there is a loss of free water
Other mechanims of Heat Loss: Evaporative Conductive Convective Radiant
Premature babies have less brown fat
Treatment of Immature Thermoregulation in preterm babies:
Double wall isolettes
Reduce radiant loss
Polyurethane wraps
Reduce evaporative loss
Humidification
Reduce evaporative loss
Gel mattress
Reduce conductive loss
what is the factor most attributable to mortality in premature patient?
Respiratory Distress Syndrome
Respiratory Distress Syndrome
symptoms:
Tachypnea, Cyanosis, Grunting, Nasal Flaring, Retraction (inter and sub costal)
Grunting = maintains positive expiratory pressure to maintain FRC
Respiratory Distress Syndrome
pathophys
softer Cartilage/Ribs
Diecrased intercostal and Diaphragm
Decreased surfactant production (which reduces surface tension; allows the baby to use less negative pressure to open up alveoli)
Inadequate alverolar lung development
Diagnosis of respiratory distress syndomre
labored breathing
ineffective ventilation by blood gas
Treatment of RDS
Surfacatant
Ventilation support
Feeding immaturity in premature babies:
- how long of a gestation is necessary to achieve full oral feeding?
full oral feeding: 35+ weeks
Premature brains mature before functional swallow
Treatment for babies who have immature feeding?
how can you further examine for any other abnormalities of baby feeding?
TPN
Gavage tube feeding
Pacifier use (oral-motor stimulation)
Occupational/speech therapy
Barium swallow study – exam for aspiration
Intestinal Immaturity
what is different about a premature babies intestines?
Increased permeability
Decreased peristalsis
Altered mucous production
Decreased secretory IgA
Main complication of this intestinal immaturity
what are the features of this disease process?
Necrotizing Enterocolitis
Bloody stool, emesis, poor gut motility, enlarged abdomen,
Shock, acidosis, respiratory failure
Treatment for necrotizing colitis
abx
bowel rest
Monitory for bowel stricture
what cerebral disease processes are prematures babies at higher risk for?
Intraventicular hemorrhage
Neurodevelopment impairment
what is neurodevelopment impairment
what are these babies at higher risk of developing?
Disorder of brain function
Emotion Cognition Memory Movement Sensation
higher risk of: Cerebral palsy hearing impairment Visual impairment Adverse behaviors, Mood disorders
what is cerebral palsy
Permanent brain injury such that motor control, balance and posture are affected
True or false – most children with NDI are premature
false - most children with NDI are not premature.
but <28 weeks gestation = 50% of survivors with NDI
