Low Birth Weight And Prematurity

Question 1

Low birth weight

Answer 1

Less than 2500g

Question 2

Very low birth weight

Answer 2

Less than 1500g

Question 3

Extremely low birth weight

Answer 3

Less than 1000g

Question 4

Normal weight at term

Answer 4

2500-4200g

Question 5

Inter uterine growth restriction

Answer 5

Fetus with birth weight <10th percentile of those born at same gestational age and displays signs of chronic hypoxia and failure to thrive

Question 6

How many standard deviations below population mean is considered growth restricted

Answer 6

2

Question 7

What does fetal growth depend on

Answer 7

Genetic potential
Substrate supply from placenta

Question 8

How much weight does the fetus gain a day at 14wks, 20wks, and 33wks

Answer 8

5g
10g
30-35g

Question 9

At what week does fetal growth rate start to decrease

Answer 9

35

Question 10

How is symphysiofindal height measured

Answer 10

Pubic symphysis to top of uterus

Question 11

What affects symphysiofindal height

Answer 11

Fetal size
Amniotic fluid volume

Question 12

Where is abdominal girth measured

Answer 12

Level of umbilicus

Question 13

How much does symphysiofindal height increase per day between weeks 14 and 32

Answer 13

1cm

Question 14

How much does abdominal girth increase per day after 30wks

Answer 14

2.5cm

Question 15

Which type of IUGR is symmetrical

Answer 15

1

Question 16

What causes type 1 IUGR

Answer 16

Growth inhibition in early pregnancy - 4-20wks

Question 17

What causes type 2 IUGR

Answer 17

Restriction of nutrient supply in utero

Question 18

What is the criteria for type 1 IUGR

Answer 18

All parameter below 10th percentile for gestational age with normal ratio

Question 19

What can cause growth inhibition in early pregnancy

Answer 19

Genetics
Infection of fetus/amniotic sac
Multiple gestation
Environmental toxins - smoking

Question 20

What weeks is growth restricted in type 1, type 2, and type 3IUGR

Answer 20

1 - 4-20wks
2 - 28+wks
3 - 20-28wks

Question 21

What causes brain sparing effect/asymmetry in type 2 IUGR

Answer 21

Redistribution of CO to brain and heart

Question 22

Effects of Type 3 IUGR

Answer 22

Skeletal shortening
Decr soft tissue mass

Question 23

What conditions can lead to type 2 IUGR

Answer 23

Maternal HT and pre eclampsia
Renal disease
Vasculopathy

Question 24

What conditions can lead to type 3 IUGR

Answer 24

Chronic HT
Lupus nephritis
Maternal vascular disease

Question 25

Which types of IUGR affect hyperplasia and hypertrophy

Answer 25

1 - hyperplasia 2 - hypertrophy 3 - both

Question 26

What Antepartum, Intrapartum, and neonatal Complications are more common with IUGR

Answer 26

perinatal morbidity, morality, and still birth Oligohydramnios Meconium aspiration Fetal distress Hypoxic ischaemic encephalopathy Fetal circulation insufficiency Temperature regulation difficulty Hypoglycaemia Chronic intrauterine hypoxia Birth/perinatal asphyxia Retinopathy of prematurity Hypocalcemia Polycythemia/hyperviscocity Low serum ferritin Pulmonary haemorrhage Immunodeficiency Renal dysfunction Feed intolerance/necrotising enterocolitis Persistent pulmonary hypertension

Question 27

Why do babies with IUGR have difficulty regulating temperature

Answer 27

Little brown fat Small body mass to surface area

Question 28

Why is Oligohydramnios more common with IUGR

Answer 28

Fetal kidneys not developed

Question 29

Childhood IUGR complications

Answer 29

Increased mortality from infections and congenital abnormalities Cerebral palsy Impaired cognitive performance

Question 30

Adult IUGR complications

Answer 30

Coronary heart disease Hypertension T2 diabetes Dislipidaemia Stroke

Question 31

IUGR diagnosis

Answer 31

Identify at risk mothers Serial fundal height measurement Serial abdominal girth measurement Head circumference Amniotic fluid volume Doppler ultrasound - umbilical artery, middle cerebral artery, cerebral/placental ratio

Question 32

What lag in fundal height suggests IUGR

Answer 32

4wks 6wks = severe IUGR

Question 33

What ratio between MCA and umbilical artery is normal

Answer 33

Below 1 1.1= brain sparing

Question 34

IUGR management

Answer 34

Treatment of underlying cause Bed rest in left lateral position Maternal oxygen therapy Delivery Antenatal steroids

Question 35

Why are mothers with IUGR on bed rest in left lateral position

Answer 35

Increases uteroplacental blood flow

Question 36

Main cause of infant deaths

Answer 36

Congenital defects and chromosomal disorders

Question 37

preterm birth

Answer 37

Born Before 37 weeks

Question 38

Deficiency of what nutrient increases pre term births

Answer 38

Vitamin D

Question 39

Peripheral inserted central catheter

Answer 39

IV used for medications and replacing fluids

Question 40

How is a pre term baby’s airways kept open in an incubator

Answer 40

SIPAP or CPAP

Question 41

Orogastric tube function in preterm baby

Answer 41

Aid feeding Remove air from stomach

Question 42

What causes respiratory distress syndrome

Answer 42

Structural and functional immaturity of lungs - underdeveloped parenchyma and surfactant insufficiency

Question 43

Why do antenatal steroids decrease respiratory distress syndrome

Answer 43

Stimulate maturation of type 2 pneumocytes to produce surfactant

Question 44

Intra ventricular haemorrhage

Answer 44

bleeds into ventricles and brain tissue

Question 45

Periventricular leukomalacia

Answer 45

White matter softens and dies around lateral ventricles leaving fluid filled cysts due to interventricular haemorrhage

Question 46

What causes retinopathy of prematurity

Answer 46

Abnormal fragile blood vessels grow across retina and leak scarring and detaching retina causing reduced vision or blindness

Question 47

When in gestation does the eye start developing

Answer 47

Week 16

Question 48

Why do pre term baby’s have temperature control problems

Answer 48

Large SA:volume Less subcutaneous and brown fat Inadequate thermal response Skin may be thinner and may not be fully keratinised Poor capillary response

Question 49

Why might premature babies need Parenteral infusion of fluids, nutrients and vitamins

Answer 49

GI system usually immature and unable to process enteral feeds

Question 50

Why do pre mature babies have lower energy requirements than term babies

Answer 50

Less activity and movement

Question 51

Why do premature babies need more protein, calcium, and phosphorus

Answer 51

Muscle and bone growth

Question 52

Necrotising enterocolitis symptoms

Answer 52

Milk aspirated from stomach Bile stained vomit Distended abdomen Bloody stools Shock Distended bowel loops, thickened bowel wall, and intramural gas on x ray Bowel perforation

Question 53

What causes necrotising enterocolitis

Answer 53

Bacterial invasion of ischemic bowel wall

Question 54

What condition is more likely in babies fed cows milk

Answer 54

Necrotising enterocolitis

Question 55

Necrotising enterocolitis treatment

Answer 55

Stop oral feeding Broad spectrum antibiotics Surgery to remove perforated bowel

Question 56

Why is fluid and electrolyte balance monitored

Answer 56

Prevent dehydration, fluid overload, electrolyte balance, fluid loss

Question 57

What can fluid overload lead to

Answer 57

Congestive heart failure Necrotising enterocolitis Mortality

Question 58

How is fluid loss through the skin minimised in preterm babies

Answer 58

Humidified incubators Skin emollients

Question 59

Why is sodium restricted in pre term babies

Answer 59

Immature Nephrons not equipped to handle large amounts of sodium

Question 60

Why are premature babies often given iron supplements for 6 months corrected age

Answer 60

Anaemia of prematurity