Pre-term infant Flashcards
Define:
- Pre-term
- Term
- Post-term
- Pre-term = a birth that occurs before 37 completed weeks of gestation & after 22 weeks
- Term = a birth between 37 weeks and 42weeks of gestation
- Post-term = a birth that occurs after 42 completed weeks of gestation
List the causes of pre-term births
- Spontaneous pre-term labour
- Multiple pregnancy
- Preterm PROM
- Pregnancy associated HTN (PET included in this)
- IUGR
- Antepartum haemorrhage
- Cervical incompetence/ uterine malformation
What are the main differences in care that needs to be provided for a pre-term baby compared to a term baby ?
- Need more help to stay warm
- Have more fragile lungs and don’t breathe effectively
- Have fewer nutrient reserves (less fat)
- Delay cord clamping if possible
How are pre-term babies given extra help to keep warm when born ?
They are put in a plastic bag under a radiant heater
What are the other extra measures taken to care for a preterm baby when born ?
- Ensure airway/ breating, if not require ventilation
- Take to NICU
- Plan supplemental breastmilk or LBW formula if < 2kg
- Measure BG before each 3hrly feed & tube if oral not tolerated
- If tube feed/oral contraindicated e.g. is in resp distress give IV feeding
What are the 4 common problems a premature babies face?
- Temp control i.e. hypothermia
- Feeding/ nutrition problems
- Sepsis
- System immaturity/ dysfunction - commonly resp distress sydrome (RDS), Patent ductus arteriosus (PDA), Intraventricular haemorrhage (IVH) & necrotising enterocolitis (NEC)
Why is there a risk of hypothermia in pre-term infants (note some of these apply to term infants too as you still have to keep them warm also)
- Low basal metabolic rate (BMR)
- Minimal muscular activity
- S/C fat insulation and brown fat is negligable
- High ratio of surface area to body mass
Why is there an increased risk of nutritional compromise in pre-term infants ?
- They have limited nutritional reserves (low fat reserves)
- Gut immaturity - malabsorption
- Immature metabolic pathways
- Increased nutrient demands
How are pre-term infants (between 32 to 36+6 weeks) plotted on a growth chart ?
- There is a pre-term section on the standard growth charts which is to the left of the main plotting graph
- It is used for preterm infants aged 32+0 and above until 42 weeks
How are pre-term infants (< 32 weeks) plotted on a growth chart ?
- A special low birth weight growth chart should be used
- Note EDD = estimated delivery date which is simply alculated by adding 40 weeks onto last menstrual period
What are the risk factors for the development of neonatal sepsis ?
- Mother colonised with Group B strep (GBS) - streptococcus agalctinae main one
- Prolonged rupture of membranes (PROM) > 18hrs
- Significant GBS bacteruria during current pregnancy > 104 cfu/ml
- Maternal temp > 38 during labour
- Chorioamnioitis = inflam of fetal membranes due to bacterial infection
- Sustained intrapartum fetal tachycardia
- Prior delivery of an infant with GBS disease
Why are premature babies more at risk of developing sepsis?
- Immature immune system
- Intensive care environment
- Indwelling tubes and lines
Describe the presentation of neonatal sepsis
- Resp distress symptoms (same as RDS)
- Pallor
- Delayed cap refill
- Lethargy, poor feeding and indifferent to pain when taking bloods from them
- Vital signs - tachypnoea, tachycardia, hypotension, variable temp (high, low or norm)
What investigations should be done for suspected neonatal sepsis ?
- Blood culture, lumbar puncture & urine culture
- BG levels
- FBC; WBC & neutrophils
- CRP
What is the treatment of pyrexia of unkown source (same as sepsis)
IV Amoxicillin + metronidazole + gentamicin (GAM)
Note - if possible meningococcal septicaemia then treat as per menigitis guidelines
What is the paediatric treatment of meningitis ?
- < 3 months tx = cefotaxime + amoxicillin
- > 3 months tx = 1st dose cefotaxaxime + amoxicillin, subsequent doses are ceftriaxone + amoxicillin
- dexamethasone
What is the paeidatric treatment of a suspected line infection (common in NICU as they often have lines in) ?
IV vancomycin (+ gentamicin if gram -ve sepsis suspected)
Define what aponea of prematurity is
This is fairly common in premature babies where they stop breathing for 15-20 seconds during sleep
Define what bronchopulmonary dysplasia is and how it is treated
- This is immature/ underdeveloped lungs & airways, resulting in breathing problems
- Tx = ventilation + pulmonary surfactant + O2
Describe the pathogenesis of respiratory distress syndrome
- This condition is due to a deficiency of alveolar surfactant, which is mainly confined to premature babies
- The insufficient surfactant leads to alveolar collapse, re-inflamtion with each breath exhausts the baby & respiratory failure follows which leads to decreased CO, hypotension, acidosis & renal failure
- It is treatable and usually gradually worsens until 2-4 days & then gradually gets better
What are the presenting features of RDS?
- Tachypnoea
- Grunting
- Nasal flaring
- Intercostal recessions
- Cyanosis
What is the management of RDS ?
Give pulmonary surfactant
- Ventilation 1st line = non-invasive ventilation with CPAP
- Ventilation 2nd line = invasive ventilation
What are the signs/symptoms of a patent ductus arteriosus ?
Typically asmptomatic but can present with:
- Tachypnoea
- Excessive sweating
- Inability or difficult feeding & weight loss/ no gain
Murmur heard is systolic in first few weeks of life developing into a continuous machine like murmur
Why are premature babies at greater risk of intraventricular haemorrhage (IVH)?
Due to having unsupported blood vessels
What are the signs/symptoms suggestive of IVH ?
- Seizures
- Bulging fontanelles
- Decreased conciousness
- Decreased moro reflex
- May be asymptomatic
How is IVH diagnosed ?
U/S (transfontanelle)
What is the treatment of IVH ?
- Head elevation
- Circulatory support
- Seizure control
What is retinopathy of prematurity ?
- This is where abnormal vessels grow in the back of the eye which then tend to leak/bleed leading to scarring of the retina.
- This scarring can lead to retinal dettachement & blindness
What is osteoporosis of prematurity ?
Premature infants may not recieve the proper amount of calcium & phosphorus, putting them at risk of fractures & possibly rickets
Nectrotising enterocolitis, hypoglycaemia & hyponatraemia all mentioned in sick-term infant lecture
