Neonatology 2 Flashcards
Define intrauterine growth retardation. Epidemiology?
Reduction and restriction in expected fetak growth pattern
4-8 times higher mortality rates. 50% have morbidity. Affects 3-10% of pregnancies.
Failure of growth in utero that may or may not result in SGA.
Weight and abdominal circumference will lie on a lower centile than that of the head due to brain development taking priority.
What is small for gestational age (SGA)?
Birth weight <10th centile for gestational age.
Often normal but small. Includes IUGR
Incidence of congenital abnormalities and neonatal problems is higher when birth weight is <2nd centile.
Common placental causes of IUGR
Small placenta
Pre-eclampsia
Foetal causes of IUGR
Multiple pregnancies Chromosomal abnormalities (eg. Down/Edward/Turner/Patuau) Congenital defects Intrauterine infection (CMV, toxoplasmosis, Rubella, Syphilis)
Maternal causes of IUGR
Increased age HTN Heart disease Diabetes Alcohol abuse Drugs (including warfarin, steroids, phenytoin) Maternal smoking Renal disease Thrombophilia
Short term consequences of IUGR
if placental cause, there is usually catch-up growth in first 1-2 yrs of life
In 15-20% there will be short stature
Significant developmental delay if there was slow head growth before 26 weeks
Extremely low birth weight means high risk of perinatal mortality
Long term consequences of IUGR
HTN Coronary artery disease Early onset obesity PCOS T2DM
(long-term effects on insulin sensitivity and endocrine function)
Signs of respiratory distress
Tachypnoea >60breaths/min
Laboured breathing with chest wall recession and nasal flaring
Expiratory grunting
Cyanosis if severe
Risk factors for transient tachypnoea
Commonest cause of respiratory distress in term infants
More common after birth by C-section
Management of transient tachypnoea
CXR show fluid in the horizontal fissure
Additional ambient oxygen may be required
Usually settless within first day of life, but can take several days for complete resolution
Risk factors for Respiratory distress syndrome
Pre-term Immature lungs (<28 weeks) -deficiency in surfactant and immature respiratory centre in brain
Can be genetic if term infants.
Diabetic mother.
Meconium aspiration
Symptoms usually develop within 4hrs postpartum (grunting, which is breathing out against a closed epiglottis to maintain positive pressure in airways)
Treatment of respiratory distress syndrome
Antenatal steroids in 2 doses within 48hrs before delivery when labour is <34 weeks gestation
2nd therapy is artificial surfactant
Risk factors for congenital pneumonia
Prolonged rupture of membranes
Chorioamnionitis
Low birth weight
Management of congenital pneumonia
Broad-spectrum antibiotics until the results of the infection screen are available
Congenital anomalies that can cause respiratory distess syndrome
Heart disease eg. HPLH syndrome
Diaphragmatic hernia
