Neonatology-Prematurity Flashcards
when is the baby: preterm & extremely preterm
- preterm = < 37 weeks
- extremely preterm = <28 weeks
aetiology of prematurity
- complication to pregnancy - PET, Abruption
- maternal disease- diabetes
- infection
- foetus issues- chromosomal abnormality, twin pregnancy
problems facing premature babies? and some ways to overcome these
- hypoxia
- ventilator support
- hypo/hyperglycaemia
- hypothermia
- due to low brown fat content; incubator controls temp
- anaemia
- bradycardia
- may have to give inotropes in first 72h
- jaundice
complications of prematurity?
- RDS
- Apnoea
- PDA
- Retinopathy of prematurity
- Intraventricular haemorrhage
- Necrotising enterocolitis
- Infection–> Sepsis
- Osteopenia of prematurity
why are premature babies more prone to infection? and what can you do to prevent infection
- because they lack IgG–> more vulnerable
- give prophylactic Penicillin & Gentamicin
long-term consequences of prematurity?
- HT
- IHD
- reduced growth
- obesity
what kind of support will premature babies require?
feeding support- naso/orogastric tube feeds +/- TPN
Mx of anaemia in premature babies?
iron supplements
pathology of RDS
insufficient surfactant secreted; lungs unable to stay expanded
signs /symptoms of RDS
- tachypnoea
- tachycardia
- cyanosis
- hypoxia
- grunting
- nasal flaring
- intercostal recession
what is seen on CXR in RDS?
ground glass appearance of lung fields
prevention of RDS
antenatal steroids
Rx of RDS
- Surfactant
- Respiratory support
- CPAP/ invasive ventilation/ oxygen
pathology of Apnoea?
cessation of breathing up to 20 seconds, due to immaturity of respiratory centres & neurotransmitters
prevention of apnoea?
give steroids antenatally
Rx of apnoea?
- Caffeine < 28 weeks
- CPAP
pathology of Necrotising Enterocolitis
ischaemia & necrosis of bowel mucosa and secondary infection of bowel
presentation of necrotising enterocolitis
- feed intolerance
- distended abdo
- bile stained vomiting
- bloody stool
rapid progression to shock
Risk factor for necrotising enterocolitis
CHD
Ix of Necrotising enterocolitis
XRay- distended loops of bowel
Rx of necrotising enterocolitis
Resus
- NBM
- IV Abx
- Urgent surgical review
what reduced risk of necrotising enterocolitis?
breast milk
pathology of Retinopathy of Prematurity (RoP)
proliferation of blood vessels at junction between vascularised & non-vascularised retina –> may lead to retinal detachment and vision loss
risk factors for RoP
- low birth weight
- prematurity
- excessive oxygen therapy
how is screening for RoP performed?
by indirect ophthalmoscopy
rx of RoP
laser therapy
pathology of intraventricular haemorrhage
haemorrhage of fragile blood vessels in germinal matrix secondary to hypoxia
Ix of intraventricular haemorrhage
Cranial US –> bleed graded
prevention of intraventricular haemorrhage
antenatal steroids
Rx of intraventricular haemorrhage
treatment of venricular dilatation - CSF taps / shunt insertion
Rx of Osteopenia of prematurity
if ALP keeps rising –> give bisphosphonates & vit D
