Neonate Flashcards
Define preterm
A birth that occurs before 37 completed weeks of gestation
Define term
A birth between 37 weeks and 42 weeks of gestation
Define post term
A birth that occurs after 42 completed weeks of gestation
Over half of deaths in childhood occur when and are strongly influenced by which factors?
- in the first year
- strongly influenced by pre-term delivery and low birth weight
- other risk factors include; mothers maternal age, smoking and disadvantaged circumstances
Which babies are most at risk for death in the first year?
- black or black british, asian or asian british >50% higher risk
- teenage mother and mothers over 40 39% higher risk
- mothers living in poverty 57% higher risk
Name causes of preterm birth from most to least common
- spontaneous preterm labour - multiple pregnancy
- preterm prelabour rupture of membranes
- pregnancy associated hypertension
- cervical incompetence / uterine malformation
- antepartum haemorrhage
- intrauterine growth restriction
Name risk factors for pre term birth
- > 2 preterm deliveries previously (70% risk)
- abnormally shape uterus increases by 19%
- 9 times more likely if multiple pregnancy
- interval of <6 months between pregnancies
- conceiving through in vitro fertilisation
- smoking, drinking alcohol and using illicit drugs
- poor nutrition, some chronic conditions
- multiple miscarriages or abortions
Name common problems of prematurity
- temperature control
- feeding / nutrition
- sepsis
- system immaturity / dysfunction; RDS, patent ductus arteriosus, intraventricular haemorrhage, necrotising enterocolitis
- others; metabolic, ROP
Why is thermal regulation ineffective in the neonate?
- low BMR
- minimal muscular activity
- subcutaneous fat insulation is negligible
- high ratio of surface area to body mass
Name reasons why there is an increased risk of nutritional compromise in the neonate
- limited nutrient reserves
- gut immaturity
- immature metabolic pathways
- increased nutrient demands
When can neonatal sepsis be acquired?
- early onset; mainly due to bacteria acquired before and during delivery
- late onset; acquired after delivery (nosocomial or community sources)
Name organisms causing neonatal sepsis
Early onset;
- group B streptococcus
- gram negatives
Late onset;
- coagulase negative staphylococci
- gram negatives
- staph aureus
Name respiratory complications of prematurity
- respiratory distress syndrome (RDS)
- apnoea of prematurity
- bronchopulmonary dysplasia
Describe respiratory distress syndrome - hyaline membrane disease
- primary pathology; surfactant deficiency, structural immaturity
- secondary pathology
- alveolar damage; formation of exudate from leaky capillaries, inflammation, repair
- common; 75% of infants born before 29 weeks, 10% in infants born after 32 weeks
Describe the clinical features of RDS
- respiratory distress
- tachypnoea; grunting, intercostal recessions, nasal flaring, cyanosis
- worsen over minutes to hours
Describe the management of RDS
- maternal steroid
- surfactant
- ventilation; invasive / non-invasive
Name the grades and outcomes of intraventricular haemorrhage
- Grade 1 and 2; neurodevelopmental delay up to 20%, mortality 10%
- grade 3 and 4; neurodevelopmental delay up to 80%, mortality 50%