Neonatology-Prematurity

Question 1

when is the baby: preterm & extremely preterm

Answer 1

• preterm = < 37 weeks
• extremely preterm = <28 weeks

Question 2

aetiology of prematurity

Answer 2

• complication to pregnancy - PET, Abruption
• maternal disease- diabetes
• infection
• foetus issues- chromosomal abnormality, twin pregnancy

Question 3

problems facing premature babies? and some ways to overcome these

Answer 3

• 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

Question 4

complications of prematurity?

Answer 4

• RDS
• Apnoea
• PDA
• Retinopathy of prematurity
• Intraventricular haemorrhage
• Necrotising enterocolitis
• Infection–> Sepsis
• Osteopenia of prematurity

Question 5

why are premature babies more prone to infection? and what can you do to prevent infection

Answer 5

• because they lack IgG–> more vulnerable
• give prophylactic Penicillin & Gentamicin

Question 6

long-term consequences of prematurity?

Answer 6

• HT
• IHD
• reduced growth
• obesity

Question 7

what kind of support will premature babies require?

Answer 7

feeding support- naso/orogastric tube feeds +/- TPN

Question 8

Mx of anaemia in premature babies?

Answer 8

iron supplements

Question 9

pathology of RDS

Answer 9

insufficient surfactant secreted; lungs unable to stay expanded

Question 10

signs /symptoms of RDS

Answer 10

• tachypnoea
• tachycardia
• cyanosis
• hypoxia
• grunting
• nasal flaring
• intercostal recession

Question 11

what is seen on CXR in RDS?

Answer 11

ground glass appearance of lung fields

Question 12

prevention of RDS

Answer 12

antenatal steroids

Question 13

Rx of RDS

Answer 13

• Surfactant
• Respiratory support
  
  • CPAP/ invasive ventilation/ oxygen

Question 14

pathology of Apnoea?

Answer 14

cessation of breathing up to 20 seconds, due to immaturity of respiratory centres & neurotransmitters

Question 15

prevention of apnoea?

Answer 15

give steroids antenatally

Question 16

Rx of apnoea?

Answer 16

• Caffeine < 28 weeks
• CPAP

Question 17

pathology of Necrotising Enterocolitis

Answer 17

ischaemia & necrosis of bowel mucosa and secondary infection of bowel

Question 18

presentation of necrotising enterocolitis

Answer 18

• feed intolerance
• distended abdo
• bile stained vomiting
• bloody stool

rapid progression to shock

Question 19

Risk factor for necrotising enterocolitis

Answer 19

CHD

Question 20

Ix of Necrotising enterocolitis

Answer 20

XRay- distended loops of bowel

Question 21

Rx of necrotising enterocolitis

Answer 21

Resus

• NBM
• IV Abx
• Urgent surgical review

Question 22

what reduced risk of necrotising enterocolitis?

Answer 22

breast milk

Question 23

pathology of Retinopathy of Prematurity (RoP)

Answer 23

proliferation of blood vessels at junction between vascularised & non-vascularised retina –> may lead to retinal detachment and vision loss

Question 24

risk factors for RoP

Answer 24

• low birth weight
• prematurity
• excessive oxygen therapy

Question 25

how is screening for RoP performed?

Answer 25

by indirect ophthalmoscopy

Question 26

rx of RoP

Answer 26

laser therapy

Question 27

pathology of intraventricular haemorrhage

Answer 27

haemorrhage of fragile blood vessels in germinal matrix secondary to hypoxia

Question 28

Ix of intraventricular haemorrhage

Answer 28

Cranial US –> bleed graded

Question 29

prevention of intraventricular haemorrhage

Answer 29

antenatal steroids

Question 30

Rx of intraventricular haemorrhage

Answer 30

treatment of venricular dilatation - CSF taps / shunt insertion

Question 31

Rx of Osteopenia of prematurity

Answer 31

if ALP keeps rising –> give bisphosphonates & vit D