Pre-term Infant

Question 1

pre vs post term?

Answer 1

pre = <37 weeks
post = >42 weeks

Question 2

classifications of pre-term?

Answer 2

preterm = <37 weeks
very pre-term = <32 weeks
extremely preterm = <28 weeks

Question 3

how does pregnancy interval affect risk of preterm delivery?

Answer 3

interval <6 months increases risk

Question 4

what things must be considered in preterm infant?

Answer 4

need more help to stay warm
have more fragile lungs (more fluid in lungs and lungs immature)
dont breathe effectively
have fewer reserves (so need more nutrition)
delay cord clamping if possible

Question 5

common problems in prematurity?

Answer 5

temp control
feeding/nutrition
sepsis
system immaturity/dysfunction
- resp distress, PDA, intraventricular haemorrhage, necrotising enterocolitis
metabolic problems etc

Question 6

risk of hypothermia?

Answer 6

low admission temp is an independant risk factor for neonatal death and increases severity for all preterm morbidities

Question 7

why is thermal regulation ineffective in preterm infants?

Answer 7

low basal metabolic rate (BMR)
minimal muscular activity
subcutaneous fat insulation is negligible
high surface area to body mass ratio

Question 8

what can hypothermia lead to?

Answer 8

hypoglycaemia

hypothermia

Question 9

what can be used to keep baby warm?

Answer 9

wrap/bags (cosy bags)
skin to skin
transwarmer matress
prewarmed incubator

Question 10

why is there an increases risk of nutritional compromise in preterm?

Answer 10

limited nutrient reserves
gut immaturity (cant cope with load of food)
immature metabolic pathways (struggles to deal with feed)
increased nutrient demands

Question 11

advice for breastfeeding in prematurity?

Answer 11

advise mother to start expressing breast milk just before or around time of birth and store it until the baby is mature enough to feed

Question 12

cause of early onset neonatal sepsis?

Answer 12

mainly due to bacteria acquired before and during delivery

• group B strep
• gram -ves

Question 13

cause of late onset neonatal sepsis?

Answer 13

acquired after delivery (nosocomial or community sources)

• coagulase -ve staph
• gram -ve
• staph aureus

Question 14

why is there increases infection risk in prematurity?

Answer 14

immature immune system
intensive care environment
indwelling tubes and lines used during treatment

Question 15

important aspects of care to reduce infection risk?

Answer 15

be careful with umbilical cord
be vigilant and infection screening
judicious use of antibiotics

Question 16

3 respiratory complications of premeturity?

Answer 16

resp distress syndrome
apnoea of prematurity
bronchopulmonary dysplasia

Question 17

what is the primary pathology in resp distress syndrome?

Answer 17

surfactant deficiency

structural immaturity

Question 18

secondary pathology in resp distress syndrome?

Answer 18

alveolar damage

• formation of exudate from leaky capillaries
• inflammation
• repair

Question 19

hyaline membrane disease??

Answer 19

old name for respiratory distress syndrome

Question 20

clinical features of RDS?

Answer 20

resp distress
tachypnoea
grunting
intercostal recessions
nasal flaring
cyanosis
worsens over mins to hrs
natural history

Question 21

how is RDS managed?

Answer 21

maternal steroid
surfactant
ventilation (invasive/non-invasive ventilation)

Question 22

grading of intraventricular haemorrhage?

Answer 22

grade 1-4
grade 1/2 = neurodevelopmental delay up to 20%, 10% mortality
grade 3/4 = neurodevelopmental delay up to 80%, 50% mortality

Question 23

what is necrotizing entercolitis?

Answer 23

condition where a part of the bowel dies in a premature infant
gut is immature so cant handle milk
can result in infection and bacteria from gut translates across broken barriers and enters the blood stream

Question 24

other complications of prematurity?

Answer 24

retinopathy of prematurty (6-8 weeks after delivery)
metabolic problems
- early = hypoglycaemia and hyponatraemia
- late = osteopenia of prematurity