Pre-term infant Flashcards
Risk factors for pre-term delivery (6)
Previous pre-term delivery Multiple pregnancy Uterine abnormality IVF conception Smoking/drugs/drinking Chronic medical conditions
What happens after failure to breath for around 2-3 mins?
Primary apnoea induces reflexive gasping breaths using accessory muscles
How long should cord clamping be delayed for?
At least a minute
What causes bronchopulmonary dysplasia?
Over-inflation of fragile pre-term lungs, causing inflammation and subsequent permanent damage
Solutions for hypothermia in the pre-term infant (3)
Wraps/plastic bags
Pre-warmed incubator
Skin to skin care
How are growth charts corrected for pre-term labour?
Subtract the number of weeks pre-term from the age of neonate; for babies born 32-36 weeks, continue this for a year, before 32 weeks- continue this for two years
Two different types of neonatal sepsis?
Early onset- acquired before/during delivery
Late onset- community/nosocomial
Pathophysiology of respiratory distress syndrome (RDS)
Insufficient surfactant production; lungs unable to stay expanded meaning re-inflation is required with each breath, leading to exhaustion and respiratory failure
Clinical features of RDS (5)
Tachypnoea Grunting intercostal recessions nasal flaring Cyanosis
Prevention of RDS
Betamethasone 12mg IM, two injections 12hours apart. Tocolytics e.g. nifedipine can be given to allow time for corticosteroids to be given
Treatment of RDS
Intubate at birth if
Complications of RDS (4)
Bronchopulmonary dysplasia
Persistent pulmonary hypertension
Patent ductus arteriosus
Intracranial haemorrhage
The role of the ductus arteriosus
In the foetus it is a right-left shunt allowing blood to escape the pulmonary artery into the descending aorta
Why is PDA an acyanotic heart disease?
It’s a left to right shunt, causing overload of the pulmonary circulation
Examination/investigations findings in PDA (3)
“Machinery” murmur in the pulmonary area
Systolic thrill in the pulmonary area
LVH on ECG
Treatment of PDA (2)
Dexamethasone helps close PDAs; NSAIDs (ibuprofen, indomethacin) reduce prostaglandin synthesis and thereby help close the duct
A form of intracranial haemorrhage which begins with bleeding into the germinal matrix
Intraventricular haemorrhage
Two main risk factors for IVH
Prematurity, RDS
Symptoms and signs of IVH (3)
Diminished moro reflex Poor muscle tone Sleepiness and floppiness Bulging fontanelles Apnoea
Prevention of IVH (3)
Antenatal steroids
Indomethacin
Vit K
What is the most common surgical emergency in neonates?
Necrotizing enterocolitis
What causes necrotizing enterocolitis?
Bowel ischamia, overgrowth of gas-forming bacteria causing inflammation, necrosis and perforation
Signs of NE? (3)
Bloody stool
Bile stained vomiting
Abd. distension
Management of NE (3)
NBM
Naso/orogastric tube to decompress bowel with suction
IV fluids, total parenteral nutrition, IV antibiotics for 10-14 days
Mortality rate for NE
Between 20-40%
