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HD 2 > Low Birth Weight and Prematurity > Flashcards

Low Birth Weight and Prematurity Flashcards

1
Q

What is the median UK birth weight at term (40 weeks)?

A

3.480 kg

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2
Q

What classifies as a low birth weight?

A

<2500g

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3
Q

What classifies as a very low birth weight?

A

<1500g

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4
Q

What classifies as an extremely low birth weight?

A

<1000g

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5
Q

Define prematurity.

A

Birth before 37 completed weeks of gestation

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6
Q

Define small for gestational age.

A

Birth weight below the 10th/3rd centile for gestation

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7
Q

Define foetal growth restriction.

A

Failure to achieve normal rate of foetal growth (e.g from utero-placental insufficiency or foetal infection)

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8
Q

How many % of babies worldwide have low birth weight? What about the UK?

A

15.5%

8%

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9
Q

38 out of 1000 live births born with low birth weight suffered neonatal death. What is the figure for those with extremely low birth weight?

A

390/1000

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10
Q

How many % of babies born at 25 weeks survival to 28 days?

A

72%

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11
Q

How many % of babies born at 24 weeks survive to 28 days?

A

51%

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12
Q

How many % of babies born at 23 weeks survive to 28 days?

A

18%

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13
Q

What are the acquired causes of small for gestational age babies? (5)

A

Utero-placental insufficiency Congenital infection e.g. CMV
Smoking
Maternal chronic illness e.g. renal, sickle cell disease
Multiple pregnancy

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14
Q

What are the genetic causes of small for gestational age babies? (3)

A

Normal small baby
Chromosomal disorders
Inherited disorders

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15
Q

What effect does congenital CMV have on the brain?

A

Hydrocephalus and calcification

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16
Q

What is Edwards syndrome?

A

Trisomy 18

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17
Q

Utero-placental insufficiency - how many it be detected?

A

Antenatally because of poor growth

Using Doppler ultrasound of uterine arteries and foetal circulation

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18
Q

What causes utero-placental insufficiency?

A

Failure of syncytiotrophoblast invasion of the high resistance spiral arteries
Poor placental development with raised resistance in the placental vascular bed

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19
Q

In the hypoxic foetus, where is blood flow prioritised?

A

Brain and cardiac muscle, and the adrenals

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20
Q

How can hypoxia in the foetus be detected?

A

Doppler ultrasound of foetal vessels

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21
Q

What neonatal problems do SGA babies have?

A

Temperature control
Polycythemia
Poor nutritional status (hypoglycaemia)
Increased risk of necrotising enterocolitis

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22
Q

Why do SGA babies have temperature control problems?

A

Increased surface area to volume ratio
Reduced adipose tissue insulation
Reduced capacity for thermogenesis

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23
Q

How is hypoglycaemia treated?

A

Low blood sugar treated with feeds or (if very low) with intravenous dextrose

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24
Q

What are the symptoms of hypoglycaemia? What is the risk?

A

Lethargy
Fits
Risk of adverse neuro-developmental outcome

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25
How is hypoglycaemia in a neonate defined?
<2.6mmol/l
26
What is the name of this hypothesis? Name a few of the adult diseases.
Barker hypothesis ``` Diabetes Hypertension Coronary Heart Disease Stroke Chronic Bronchitis ```
27
Why is low birth weight associated with adult disease?
Foetal environment affects cellular growth, gene expression and hormonal axes.
28
What are the causes of spontaneous preterm labour? (4)
Infection Ruptured membranes Cervical incompetence Polyhydramnios
29
Why might an obstetrician deliver a baby preterm?
To save mother (hypertension, haemorrhage) | To save foetus (placental insufficiency)
30
Why is a preterm baby at high risk of heat loss? (5)
``` Large surface area : body mass ratio Thin skin and less adipose tissue Wet at birth Can’t shiver Poor metabolic reserve ```
31
Why is hypothermia important?
Hypothermia is an independent predictor of death & morbidity among survivors
32
How is hypothermia prevented in preterm babies?
Modern incubators provide humidified warmth (to help the baby maintain temperature at minimal metabolic cost). Also by delivering the baby into a polythene bag to prevent evaporative heat loss.
33
Why are the reasons for respiratory problems in premature babies? (3)
Structural immaturity Functional immaturity Susceptibility to infection
34
Structural immaturity in preterm babies - what does this consist of?
Primitive alveolar development | Susceptibility to oxygen toxicity and barotrauma
35
Functional immaturity in preterm babies - why is this?
Surfactant deficiency | Lack of respiratory drive
36
Susceptibility to infection in preterm babies - why is this?
Immature immune system
37
What are the important short term respiratory problems in premature babies? (3)
Respiratory Distress Syndrome Pneumonia Apnoea
38
What are the important long term respiratory problems in premature babies? (1)
Chronic Lung Disease of Infancy (Bronchopulmonary Dysplasia)
39
What is the role of surfactant?
Reduces surface tension at the air-fluid interface
40
What does surfactant mainly consist of?
Dipalmitylphosphatidylcholine (DPPC) & Phosphatidylglycerol (PG)
41
What is surfactant?
Monolayer of phospholipid molecules at air-liquid interface in the alveoli
42
What stabilises surfactant?
Surfactant protein B
43
What causes RDS?
Lack of surfactant in the premature baby
44
What are the signs of respiratory distress? (3)
Tachypnoea, expiratory grunting, recession
45
How is RDS prevented? (5)
``` Antenatal steroids Avoidance of intrauterine hypoxia Prophylactic surfactant treatment Keep warm Avoid acidosis ```
46
How is RDS treated?
Surfactant | Respiratory support
47
What is chronic lung disease of infancy? What is seen?
Oxygen dependency in a preterm baby at 36 weeks post menstrual age. Inflammation, fibrosis, emphysema
48
How many % of babies born <26 weeks gestational age develop CLDI?
50%
49
What cardiovascular diseases are associated with prematurity? (3)
Persistent pulmonary hypertension of the newborn Failure to maintain blood pressure Patent Ductus Arteriosus
50
How many calories per kg per day does a preterm baby need to grow?
110-135 kcals/kg/d
51
How calorific is mature human milk?
68 calories per 100 ml
52
How many ml per kg per day is required for growth?
160-200 ml/kg/day
53
What nutritional challenges are there with preterm babies? (3)
Immature sucking (so use tube feeding) Poor gut motility May not tolerate enteral feeds - causes gut mucosa atrophy
54
What may enteral feeding precipitate?
NEC - nectrotising enterocolitis
55
What is NEC?
Acute bacterial invasion/inflammation/necrosis of bowel with gas formation in bowel wall (pneumotosis).
56
How does NEC present? (5)
``` Abdominal distension Tenderness Discolouration Blood in stools Generalised collapse ```
57
How is NEC treated?
Stop feeds Antibiotics May require surgery
58
What are the complications of NEC?
Death Short gut secondary to resection Strictures and late obstruction
59
What are the risk factors for NEC? (4)
Prematurity, hypoxia, infection, enteral feeding
60
What bacteria most commonly cause early infections (<48 hours)? (2)
Group B beta haemolytic Streptococcus | E. coli
61
What bacteria most commonly cause hospital acquired infections (>48 hours)? (2)
Coagulase Negative Staphylococci | Gram negative organisms that colonise the intestine
62
What protects term babies from infection? (4)
Transplacental IgG in third trimester IgA and immunologically active cells in colostrum Skin barrier Acquisition of normal flora from mother and family
63
What two short-term CNS conditions are preterm babies susceptible to?
``` Periventricular haemorrhage Periventricular leucomalacia (ischaemia of white matter) ```
64
What are some risk factors of PVH?
``` Prematurity RDS Pneumothorax Hypercapnia Acidosis Hypotension Instability and handling Severe bruising at birth ```
65
What are the complications of intracerebral bleeding? (3)
Collapse and death Loss of brain parenchymal tissue with cyst development Blockage of CSF circulation/hydrocephalus
66
How might prematurity affect the eyes? How is this treated?
Retinopathy of prematurity | Laser
67
How many % of very LBW babies develop cerebral palsy?
10%

HD 2 (25 decks)

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