Neonatal medicine - preterm Flashcards

1
Q

What is the most common cause of respiratory distress in preterm infants?

A

Respiratory Distress Syndrome (RDS)

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2
Q

Describe the pathophysiology of RDS

A

Surfactant deficiency, leading to widespread alveolar collapse + inadequate gas exchange (surfactant is secreted by type II pneumocytes)

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3
Q

Describe the investigation of suspected RDS

A

CXR - characteristic ‘ground-glass’ appearance

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4
Q

If preterm delivery is anticipated, which treatment is given to reduce the risk of RDS?

If the infant develops RDS after birth, which treatments are given?

A

Prophylactic treatment:
- Steroids (e.g. dexamethasone) are given to the mother to stimulate foetal surfactant production

Management of RDS after birth:

  • Exogenous surfactant instilled via ETT
  • Oxygen and ventilatory support
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5
Q

Why is it necessary to be cautious with oxygen and artificial ventilation in the preterm infant?

A
  • Oxygen can cause retinopathy of prematurity

- Artificial ventilation may precipitate pneumothorax (this can also happen in the term infant)

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6
Q

What is bronchopulmonary dysplasia (BPD)?

A
  • Babies born prematurely often require treatments to help with breathing, e.g. oxygen, artificial ventilation
  • If infants still require these treatments at 36 weeks corrected age, they are said to have BPD
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7
Q

Describe the presentation of apnoea of prematurity

A

A preterm baby presents with periods where breathing spontaneously stops for < 20 seconds, accompanied with bradycardia

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8
Q

Describe the pathophysiology of apnoea of prematurity

A

Underdevelopment/immaturity of autonomic nervous system and brainstem, leading to dysfunctional regulation of breathing

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9
Q

Describe the management of apnoea of prematurity

A
  • IV caffeine

- Tactile stimulation during apnoeic episodes

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10
Q

Describe the pathophysiology of necrotising enterocolitis (NEC)

Why is NEC important to recognise?

A

Bacterial invasion and ischaemia of the large bowel

NEC is the leading cause of death in preterm infants

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11
Q

What are the clinical features of necrotising enterocolitis?

A
  • Abdominal distension
  • Bilious vomiting
  • Bloody stools
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12
Q

Describe the investigation of necrotising enterocolitis

A

Abdominal XR:

  • Dilated loops of bowel
  • Thickening of bowel wall
  • Intramural gas
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13
Q

Describe the management of necrotising enterocolitis

A
  • NBM, parenteral nutrition
  • IV broad spectrum antibiotics
  • Laparotomy

Babies may also need ventilatory and/or circulatory support

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14
Q

Which factors can increase the risk of SIDS?

A
  • Prematurity
  • Parental smoking
  • Co-sleeping
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