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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
Q

How is hypoglycaemia in a neonate defined?

A

<2.6mmol/l

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26
Q

What is the name of this hypothesis? Name a few of the adult diseases.

A

Barker hypothesis

Diabetes
Hypertension
Coronary Heart Disease
Stroke
Chronic Bronchitis
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27
Q

Why is low birth weight associated with adult disease?

A

Foetal environment affects cellular growth, gene expression and hormonal axes.

28
Q

What are the causes of spontaneous preterm labour? (4)

A

Infection
Ruptured membranes
Cervical incompetence
Polyhydramnios

29
Q

Why might an obstetrician deliver a baby preterm?

A

To save mother (hypertension, haemorrhage)

To save foetus (placental insufficiency)

30
Q

Why is a preterm baby at high risk of heat loss? (5)

A 
Large surface area : body mass ratio
Thin skin and less adipose tissue
Wet at birth
Can’t shiver
Poor metabolic reserve
31
Q

Why is hypothermia important?

A

Hypothermia is an independent predictor of death & morbidity among survivors

32
Q

How is hypothermia prevented in preterm babies?

A

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
Q

Why are the reasons for respiratory problems in premature babies? (3)

A

Structural immaturity
Functional immaturity
Susceptibility to infection

34
Q

Structural immaturity in preterm babies - what does this consist of?

A

Primitive alveolar development

Susceptibility to oxygen toxicity and barotrauma

35
Q

Functional immaturity in preterm babies - why is this?

A

Surfactant deficiency

Lack of respiratory drive

36
Q

Susceptibility to infection in preterm babies - why is this?

A

Immature immune system

37
Q

What are the important short term respiratory problems in premature babies? (3)

A

Respiratory Distress Syndrome
Pneumonia
Apnoea

38
Q

What are the important long term respiratory problems in premature babies? (1)

A

Chronic Lung Disease of Infancy (Bronchopulmonary Dysplasia)

39
Q

What is the role of surfactant?

A

Reduces surface tension at the air-fluid interface

40
Q

What does surfactant mainly consist of?

A

Dipalmitylphosphatidylcholine (DPPC) & Phosphatidylglycerol (PG)

41
Q

What is surfactant?

A

Monolayer of phospholipid molecules at air-liquid interface in the alveoli

42
Q

What stabilises surfactant?

A

Surfactant protein B

43
Q

What causes RDS?

A

Lack of surfactant in the premature baby

44
Q

What are the signs of respiratory distress? (3)

A

Tachypnoea, expiratory grunting, recession

45
Q

How is RDS prevented? (5)

A 
Antenatal steroids
Avoidance of intrauterine hypoxia
Prophylactic surfactant treatment
Keep warm
Avoid acidosis
46
Q

How is RDS treated?

A

Surfactant

Respiratory support

47
Q

What is chronic lung disease of infancy? What is seen?

A

Oxygen dependency in a preterm baby at 36 weeks post menstrual age.
Inflammation, fibrosis, emphysema

48
Q

How many % of babies born <26 weeks gestational age develop CLDI?

A

50%

49
Q

What cardiovascular diseases are associated with prematurity? (3)

A

Persistent pulmonary hypertension of the newborn
Failure to maintain blood pressure
Patent Ductus Arteriosus

50
Q

How many calories per kg per day does a preterm baby need to grow?

A

110-135 kcals/kg/d

51
Q

How calorific is mature human milk?

A

68 calories per 100 ml

52
Q

How many ml per kg per day is required for growth?

A

160-200 ml/kg/day

53
Q

What nutritional challenges are there with preterm babies? (3)

A

Immature sucking (so use tube feeding)
Poor gut motility
May not tolerate enteral feeds - causes gut mucosa atrophy

54
Q

What may enteral feeding precipitate?

A

NEC - nectrotising enterocolitis

55
Q

What is NEC?

A

Acute bacterial invasion/inflammation/necrosis of bowel with gas formation in bowel wall (pneumotosis).

56
Q

How does NEC present? (5)

A 
Abdominal distension
Tenderness
Discolouration
Blood in stools
Generalised collapse
57
Q

How is NEC treated?

A

Stop feeds
Antibiotics
May require surgery

58
Q

What are the complications of NEC?

A

Death
Short gut secondary to resection
Strictures and late obstruction

59
Q

What are the risk factors for NEC? (4)

A

Prematurity, hypoxia, infection, enteral feeding

60
Q

What bacteria most commonly cause early infections (<48 hours)? (2)

A

Group B beta haemolytic Streptococcus

E. coli

61
Q

What bacteria most commonly cause hospital acquired infections (>48 hours)? (2)

A

Coagulase Negative Staphylococci

Gram negative organisms that colonise the intestine

62
Q

What protects term babies from infection? (4)

A

Transplacental IgG in third trimester
IgA and immunologically active cells in colostrum
Skin barrier
Acquisition of normal flora from mother and family

63
Q

What two short-term CNS conditions are preterm babies susceptible to?

A 
Periventricular haemorrhage
Periventricular leucomalacia (ischaemia of white matter)
64
Q

What are some risk factors of PVH?

A 
Prematurity
RDS
Pneumothorax
Hypercapnia
Acidosis
Hypotension
Instability and handling
Severe bruising at birth
65
Q

What are the complications of intracerebral bleeding? (3)

A

Collapse and death
Loss of brain parenchymal tissue with cyst development
Blockage of CSF circulation/hydrocephalus

66
Q

How might prematurity affect the eyes? How is this treated?

A

Retinopathy of prematurity

Laser

67
Q

How many % of very LBW babies develop cerebral palsy?

A

10%

HD 2 (25 decks)

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