Pre-term infant Flashcards

1
Q

Define:

  1. Pre-term
  2. Term
  3. Post-term
A
  1. Pre-term = a birth that occurs before 37 completed weeks of gestation & after 22 weeks
  2. Term = a birth between 37 weeks and 42weeks of gestation
  3. Post-term = a birth that occurs after 42 completed weeks of gestation
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2
Q

List the causes of pre-term births

A
  • Spontaneous pre-term labour
  • Multiple pregnancy
  • Preterm PROM
  • Pregnancy associated HTN (PET included in this)
  • IUGR
  • Antepartum haemorrhage
  • Cervical incompetence/ uterine malformation
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3
Q

What are the main differences in care that needs to be provided for a pre-term baby compared to a term baby ?

A
  • 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
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4
Q

How are pre-term babies given extra help to keep warm when born ?

A

They are put in a plastic bag under a radiant heater

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5
Q

What are the other extra measures taken to care for a preterm baby when born ?

A
  • 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
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6
Q

What are the 4 common problems a premature babies face?

A
  1. Temp control i.e. hypothermia
  2. Feeding/ nutrition problems
  3. Sepsis
  4. System immaturity/ dysfunction - commonly resp distress sydrome (RDS), Patent ductus arteriosus (PDA), Intraventricular haemorrhage (IVH) & necrotising enterocolitis (NEC)
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7
Q

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)

A
  • 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
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8
Q

Why is there an increased risk of nutritional compromise in pre-term infants ?

A
  • They have limited nutritional reserves (low fat reserves)
  • Gut immaturity - malabsorption
  • Immature metabolic pathways
  • Increased nutrient demands
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9
Q

How are pre-term infants (between 32 to 36+6 weeks) plotted on a growth chart ?

A
  • 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
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10
Q

How are pre-term infants (< 32 weeks) plotted on a growth chart ?

A
  • 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
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11
Q

What are the risk factors for the development of neonatal sepsis ?

A
  • 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
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12
Q

Why are premature babies more at risk of developing sepsis?

A
  • Immature immune system
  • Intensive care environment
  • Indwelling tubes and lines
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13
Q

Describe the presentation of neonatal sepsis

A
  • 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)
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14
Q

What investigations should be done for suspected neonatal sepsis ?

A
  • Blood culture, lumbar puncture & urine culture
  • BG levels
  • FBC; WBC & neutrophils
  • CRP
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15
Q

What is the treatment of pyrexia of unkown source (same as sepsis)

A

IV Amoxicillin + metronidazole + gentamicin (GAM)

Note - if possible meningococcal septicaemia then treat as per menigitis guidelines

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16
Q

What is the paediatric treatment of meningitis ?

A
  • < 3 months tx = cefotaxime + amoxicillin
  • > 3 months tx = 1st dose cefotaxaxime + amoxicillin, subsequent doses are ceftriaxone + amoxicillin
    • dexamethasone
17
Q

What is the paeidatric treatment of a suspected line infection (common in NICU as they often have lines in) ?

A

IV vancomycin (+ gentamicin if gram -ve sepsis suspected)

18
Q

Define what aponea of prematurity is

A

This is fairly common in premature babies where they stop breathing for 15-20 seconds during sleep

19
Q

Define what bronchopulmonary dysplasia is and how it is treated

A
  • This is immature/ underdeveloped lungs & airways, resulting in breathing problems
  • Tx = ventilation + pulmonary surfactant + O2
20
Q

Describe the pathogenesis of respiratory distress syndrome

A
  1. This condition is due to a deficiency of alveolar surfactant, which is mainly confined to premature babies
  2. 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
  3. It is treatable and usually gradually worsens until 2-4 days & then gradually gets better
21
Q

What are the presenting features of RDS?

A
  • Tachypnoea
  • Grunting
  • Nasal flaring
  • Intercostal recessions
  • Cyanosis
22
Q

What is the management of RDS ?

A

Give pulmonary surfactant

  • Ventilation 1st line = non-invasive ventilation with CPAP
  • Ventilation 2nd line = invasive ventilation
23
Q

What are the signs/symptoms of a patent ductus arteriosus ?

A

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

24
Q

Why are premature babies at greater risk of intraventricular haemorrhage (IVH)?

A

Due to having unsupported blood vessels

25
Q

What are the signs/symptoms suggestive of IVH ?

A
  • Seizures
  • Bulging fontanelles
  • Decreased conciousness
  • Decreased moro reflex
  • May be asymptomatic
26
Q

How is IVH diagnosed ?

A

U/S (transfontanelle)

27
Q

What is the treatment of IVH ?

A
  • Head elevation
  • Circulatory support
  • Seizure control
28
Q

What is retinopathy of prematurity ?

A
  • 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
29
Q

What is osteoporosis of prematurity ?

A

Premature infants may not recieve the proper amount of calcium & phosphorus, putting them at risk of fractures & possibly rickets

30
Q

Nectrotising enterocolitis, hypoglycaemia & hyponatraemia all mentioned in sick-term infant lecture

A