Lecture 76 - Basics of Prematurity Flashcards

1
Q

what is a term pregnancy

what is prematurity

A

Term = Born at or after 37 weeks gestation

Preterm = < 37 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

some physical differences seen in pre term births

A

Skin not keritinized
Difficulty breathing
eye lids not open

underdeveloped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Range of a non viable birth

moderate prematurity?

late prematurity?

A

non viable: 1-23, 25 weeks

moderate – 32 -34 weeks

Late preterm - 34-36 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Epi: what is the rate of prematurity in the US

what % of infants deaths are due to preterm

A

12%
8% are late preterm

1/3 of infant deaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risk factors for preterm labor

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Immature Thermoregulation in preterm babies:

pathophsy
reasons and mechanisms of heat loss

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment of Immature Thermoregulation in preterm babies:

A

Double wall isolettes
Reduce radiant loss

Polyurethane wraps
Reduce evaporative loss

Humidification
Reduce evaporative loss

Gel mattress
Reduce conductive loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the factor most attributable to mortality in premature patient?

A

Respiratory Distress Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Respiratory Distress Syndrome

symptoms:

A

Tachypnea, Cyanosis, Grunting, Nasal Flaring, Retraction (inter and sub costal)

Grunting = maintains positive expiratory pressure to maintain FRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Respiratory Distress Syndrome

pathophys

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diagnosis of respiratory distress syndomre

A

labored breathing

ineffective ventilation by blood gas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment of RDS

A

Surfacatant

Ventilation support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Feeding immaturity in premature babies:

  • how long of a gestation is necessary to achieve full oral feeding?
A

full oral feeding: 35+ weeks

Premature brains mature before functional swallow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment for babies who have immature feeding?

how can you further examine for any other abnormalities of baby feeding?

A

TPN
Gavage tube feeding
Pacifier use (oral-motor stimulation)

Occupational/speech therapy

Barium swallow study – exam for aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Intestinal Immaturity

what is different about a premature babies intestines?

A

Increased permeability
Decreased peristalsis
Altered mucous production
Decreased secretory IgA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Main complication of this intestinal immaturity

what are the features of this disease process?

A

Necrotizing Enterocolitis

Bloody stool, emesis, poor gut motility, enlarged abdomen,
Shock, acidosis, respiratory failure

17
Q

Treatment for necrotizing colitis

A

abx
bowel rest
Monitory for bowel stricture

18
Q

what cerebral disease processes are prematures babies at higher risk for?

A

Intraventicular hemorrhage

Neurodevelopment impairment

19
Q

what is neurodevelopment impairment

what are these babies at higher risk of developing?

A

Disorder of brain function

Emotion 
Cognition
Memory
Movement
Sensation
higher risk  of: 
Cerebral palsy 
hearing impairment 
Visual impairment 
Adverse behaviors, Mood disorders
20
Q

what is cerebral palsy

A

Permanent brain injury such that motor control, balance and posture are affected

21
Q

True or false – most children with NDI are premature

A

false - most children with NDI are not premature.

but <28 weeks gestation = 50% of survivors with NDI