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Paediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What is the definition of preterm? Define the different levels of severity.

A

Preterm: babies born alive <37 weeks of gestation

  • Moderate-late preterm: 32-37 weeks
  • Very preterm: 28-32 weeks
  • Extremely preterm: <28 weeks

(According to the lecture, extreme prematurity = <30 weeks)

It is for this reason that induction of labour or C/S should not be planned <39 weeks unless medically indicated to prevent iatrogenic prematurity.

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2
Q

What is the definition of low birth weight? Define the levels of severity.

A
  • Low birth weight (6%): <2500g
  • Very low birth weight (1%): <1500g
  • Extremely low birth weight (<1%): <1000g
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3
Q

What is the definition of term?

A

37-42 weeks of maturity

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4
Q

What are the factors of PPROM?

A
  • *Maternal**
  • Ascending infection
  • Cervical incompetence
  • Smoking
  • *Fetal**
  • Polyhydramnios
  • Breech
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5
Q

What are the risk factors for preterm labour?

A
  • *Maternal factors**
  • Maternal age <15 yeras of >40 years
  • Low body weight
  • History of preterm delivery
  • Primigravida
  • Pre-eclampsia
  • Extra-uterine infections
  • Social causes: alcohol, smoking, drugs, domestic violence, stress etc.

Pregnancy-related factors
- Uterus
>> Overdistension from fibroids, multiple gestation or polyhydramnios
>> Uterine abnormalities
>> Uterine trauma
- Membranes
>> Chorioamnionitis
>> PPROM
- Placenta
>> Abruptio
>> Previa
- Fetus
>> Multiple gestation
>> Chromosomal abnormalities
>> Congenital abnormalities
- Cervix
>> Cervical incompetence
>> Cervical trauma/surgery

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6
Q

What are the risk factors for chorioamnionitis?

A
  • PPROM
  • Prolonged rupture of membranes (>24 hours)
  • Preterm labour with or without ROM
  • GBS carriage of the mother
  • Bacterial vaginosis of the mother
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7
Q

What are the complications of prematurity to the baby?

A

Acute complications
- Respiratory
>> Respiratory distress syndrome
>> Apnea of prematurity
>> Pneumothorax
- Patent ductus arteriosus
- Necrotizing enterocolitis
- Intraventricular hemorrhage
- Hypoglycemia, hypocalcemia and electrolyte disturbances
- Hypothermia
- Dehydration

  • *Chronic complications**
  • Bronchopulmonary dysplasia
  • Retinopathy of prematurity (ROP)
  • Post-NEC complications: short bowel syndrome
  • Periventricular leukomalacia >> quadriplegic cerebral palsy
  • Post-hemorrhagic hydrocephalus
  • Developmental delay
  • Osteopenia of prematurity
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8
Q

What is the presentation of respiratory distress syndrome?

A

Features of respiratory distress (tachypnea >60, tachycardia, nasal flaring, expiratory grunting, use of accessory muscles, intercostal and subcostal insucking) within 4 hours of delivery with difficulty waning off oxygen

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9
Q

What are the typical CXR findings of RDS?

A
  • Ground-glass appearance of fine reticular, homogenous shadows
  • Hazzing out of the cardiac shadow
  • Air bronchogram
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10
Q

How does one manage a case of RDS?

A
  1. Stabilize the patient: ABC, fluid resuscitation if necessary
  2. Look out for anemia and malnutrition
  3. Nasal CPAP
  4. IPPV/HFOV (intermittent positive pressure ventilation, high frequency oscillation ventilation)
    >> Prolonged and frequent apnea
    >> Severe hypoxemia
    >> CO2 retention
    >> Respiratory fatigue
  5. Surfactant replacement with exosurf VS. survanta

>> Maternal steroids given 24-48 hours prior to delivery helps prevent RDS

Most patients with ?RDS also receive antibiotics since congenital pneumonia and RDS are clinically and radiologically indistinguishable.

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11
Q

What is necrotizing enterocolitis?

A

Intestinal inflammation associated with focal or diffuse ulceration and necrosis, primarily affecting the terminal ileum and colon

Mucosal damage and enteral feeding –> bacterial growth –> bowel necrosis, gangrene and perforation

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12
Q

What are the risk factors for NEC?

A
  • Prematurity
  • Enteral feeding with formula (breast milk can be protective)
  • Asphyxia, shock, sepsis
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13
Q

How does NEC present?

A
  • Poor feeding
  • Bile-stained vomiting
  • Frank/occult blood in stool
  • Abdominal distension
  • Diminished bowel sounds
  • Signs of bowl perforation
    >> Peritonitis
    >> Shock
    >> DIC
    >> Sepsis
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14
Q

What are the typical AXR findings for NEC?

A
  • Intramural gas: pneumatosis intestinalis
  • Distended bowel loops
  • Fixed bowel loops
  • Thickened bowel wall
  • Portal tract gas
  • Free gas (“Football sign”)
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15
Q

How does one manage a case of NEC?

A
  • *Prevention in pre-emies**
  • Cautious feeding regime
  • Breastfeeding
  • Early treatment for PDA and polycythemia

Treatment
- NPO with parenteral nutrition
- Vigorous IV fluid resuscitation
- Decompression with NG tube
- Antibiotics
>> Ampicillin, gentamicin +/- metronidazole x 7-10 days)
- Supportive ventilation and circulation

  • *- Serial AXRs to detect early perforation**
  • Surgical resection of necrotic bowel, perforation and strictures
  • *Possible complications**
  • Intestinal obstruction
  • Short gut syndrome
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16
Q

What is intraventricular hemorrhage?

A

Hemorrhage in the periventricular subependymal germinal matrix, usually occurring within 72 hours of delivery

17
Q

How common is RDS?

A

14% of all LBW infants

18
Q

How common is IVH?

A

~25% of lal LBW infants

19
Q

What are the risk factors for IVH?

A
  • Prematurity <32 weeks
  • BW <1500mg (very low birth weight)
  • Need for vigorous resuscitation at birth
  • Pneumothorax
  • Respiratory distress syndrome
  • Hemodynamic instability
20
Q

How may IVH present?

A

Most are asymptomatic

  • Apnea
  • Bradycardia
  • Altered level of consciousness
  • Hypotension
  • Seizures
  • Acidosis
  • Bulging fontanelle with separation of sutures
  • Shock
21
Q

What are the complications of IVH?

A
  • *Acute**
  • Post-hemorrhagic hydrocephalus
  • Post-hemorrhagic infarction
  • Cyst formation
  • Extension of bleed
  • Death
  • *Chronic**
  • Epilepsy
  • Cerebral palsy
  • Visual and hearing impairment
  • Developmental delay
  • Intellectual disability
22
Q

Routine head USG screening for all preterm infants <32 weeks or <1500g throughout NICU stay to screen for IVH – In Canada.

A
23
Q

What is retinopathy of prematurity (ROP)?

A

Vasoproliferative retinopathy

  • Nasal retina vascularization completion: 36 weeks
  • Temporal retina vascularization completion: 40 weeks
  • Due to high oxygen exposure after birth, disrupting the vascularization process

>> The most common cause of blindness in preterm infants
>> Treatment: laser, cryotherapy

24
Q

Hwo does ROP present?

A
  • Retinal hemorrhage
  • Retinal fibrosis and detachment
  • Blindness
25
Q

Weekly screening by ophthalmologist in infants born at <32 weeks of gestation or <1500g birth weight for RETINOPATHY OF PREMATURITY.

A
26
Q

~10% of infants with respiratory distress syndrome treated with ventilation with develop pneumothorax as a complication.

A
27
Q

What is apnea of prematurity

A

Episodic central apnoea of >20 second in premature infants due to an immature central respiratory control; often associated with bradycardia and desaturation

28
Q

How does one manage a case of apnoea of prematurity?

A
  1. Gentle physical stimulation
  2. Respiratory stimulant: caffeine (methylxanthine)
  3. CPAP +/- intermittent positive pressure ventilation (IPPV)

>> Apnea of prematurity is NOT PATHOLOGICAL.

29
Q

What is bronchopulmonary dysplasia?

A

A chronic lung disorder of prematurely that is clinically defined as oxygen dependence at 36 weeks’ postmenstrual age

  • Barotrauma from prolonged mechanical ventilation
  • Oxygen toxicity
30
Q

What are the CXR findings for bronchopulmonary dysplasia?

A

Widespread area of opacification, cystic changes and lung collapse

31
Q

What are the complications of bronchopulmonary dysplasia?

A
  • Feeding problems from prolonged intubation
  • Recurrent wheezing episodes
  • Recurrent respiratory infections
  • Pulmonary hypertension
  • Right-sided heart failure
  • Growth and developmental delay
32
Q

How does one manage a case of bronchopulmonary dysplasia?

A
  • *- Optimize nutrition**
  • Supplemental O2 PRN
  • CPAP with gradual weaning from ventilator
  • *- Bronchodilators**
  • Corticosteroid therapy (short-term): decrease inflammation and encourage weaning
33
Q

Premature infants have proportionally more fluid in the ECF than in ICF —- therefore they are EASIER TO DEHYDRATE

A
34
Q

What are the fluid requirements for a premature baby?

A

First day of life: 60-90mL/kg

Subsequently increase by 20-30mL/kg/day until you reach 150-180mL/kg

35
Q

What is the normal rate of growth in term infants?

A
  • Double of birth weight: 4.5 months
  • Triple of birth weight: 1 year
36
Q

What is the normal rate of growth/target rate of growth for premature infants?

A
  • Double of birth weight: 6 weeks
  • Triple of birth weight: 12 weeks
37
Q

Both IRON and IgG ANTIBODIES are transferred to the fetus during the 3rd trimester.

A
38
Q

BREAST MILK is the best choice for enteral feeding in premature infants due to the INCREASED RISK FOR NEC and DECREASED PROTECTION AGAINST INFECTION associated with formula milk.

A
39
Q

What are the long-term follow-up items for prematur einfants?

A
  1. Growth and nutrition
  2. Neurodevelopmental delay and learning difficulties
  3. Bronchopulmonary dysplasia
  4. Retinopathy of prematurity
  5. Gastroesophageal reflux (associated with BP)

>> Pavalizumab for RSV prophylaxis

Paediatrics (16 decks)

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