Neonatal medicine - preterm Flashcards
What is the most common cause of respiratory distress in preterm infants?
Respiratory Distress Syndrome (RDS)
Describe the pathophysiology of RDS
Surfactant deficiency, leading to widespread alveolar collapse + inadequate gas exchange (surfactant is secreted by type II pneumocytes)
Describe the investigation of suspected RDS
CXR - characteristic ‘ground-glass’ appearance
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?
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
Why is it necessary to be cautious with oxygen and artificial ventilation in the preterm infant?
- Oxygen can cause retinopathy of prematurity
- Artificial ventilation may precipitate pneumothorax (this can also happen in the term infant)
What is bronchopulmonary dysplasia (BPD)?
- 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
Describe the presentation of apnoea of prematurity
A preterm baby presents with periods where breathing spontaneously stops for < 20 seconds, accompanied with bradycardia
Describe the pathophysiology of apnoea of prematurity
Underdevelopment/immaturity of autonomic nervous system and brainstem, leading to dysfunctional regulation of breathing
Describe the management of apnoea of prematurity
- IV caffeine
- Tactile stimulation during apnoeic episodes
Describe the pathophysiology of necrotising enterocolitis (NEC)
Why is NEC important to recognise?
Bacterial invasion and ischaemia of the large bowel
NEC is the leading cause of death in preterm infants
What are the clinical features of necrotising enterocolitis?
- Abdominal distension
- Bilious vomiting
- Bloody stools
Describe the investigation of necrotising enterocolitis
Abdominal XR:
- Dilated loops of bowel
- Thickening of bowel wall
- Intramural gas
Describe the management of necrotising enterocolitis
- NBM, parenteral nutrition
- IV broad spectrum antibiotics
- Laparotomy
Babies may also need ventilatory and/or circulatory support
Which factors can increase the risk of SIDS?
- Prematurity
- Parental smoking
- Co-sleeping