Pre-term Infant

Question 1

Over __% of deaths in childhood occur in the 1st year of life, and are strongly influenced by ________ delivery and low birth _____. With risk factors including _________ ___, _______ and ________ circumstances,

Answer 1

Over 50% of deaths in childhood occur in the 1st year of life, and are strongly influenced by pre-term delivery and low birth weight. With risk factors including maternal age, smoking and disadvantaged circumstances,

Question 2

Which babies are more at risk of death?

Answer 2

Black or black british

Asian or asian british

Teenage mothers

Mothers over 40

Mothers living in poverty

Question 3

__ _______ babies are born preterm every year

Answer 3

15 million

Question 4

Why is the number of preterm babies increasing?

Answer 4

• Increased maternal age
• Increasing rate of pregnancy-related complications
• greater use of infertility treatments
• more cesearean deliveries before term

Question 5

What are the causes of preterm birth?

Answer 5

• spontaenous preterm labour
• preterm rupture of membranes
• multiple pregnancy
• pregnancy associated hypertension
• cervical incompetence/uterine malformation
• antepartum haemorrhage
• IUGR

Question 6

What are the risk factors for preterm birth

Answer 6

• > 2 preterm deliveries increases the risk of another premature baby by 70%
• abnormally shaped uterus increases the risk of giving birth by 19%
• women are 9 times more likely to give birth early if they have a multiple pregnancy
• interval of <6 months between pregnancies
• concieving through IVF
• smoking, drinking alcohol and using ilicit drugs
• poor nutrition, chronic conditions (hypertension, diabetes), multiple miscarriages or abortions

Question 7

What is the difference in managing a preterm baby?

Answer 7

• need more help to stay warm
• have more fragile lungs
• don’t breathe effectively
• have fewer reserves
• delay cord clamping if possible

Question 8

How are preterm babies best kept warm?

Answer 8

Place them while still wet in a suitable plastic bag and later under a radiant heater

Question 9

What are the common problems of prematurity?

Answer 9

• temperature control
• feeding/nutrition
• sepsis
• system immaturity/dysfunction
  
  • RDS
  • PDA
  • IVH
  • NEC
• others; metabolic, ROP (retinopathy of prematurity)

Question 10

Why is thermal regulation ineffective in premature babies?

Answer 10

• Low BMR
• minimal muscular activity
• subcutaenous fat insulation is negligible
• high ratio of surface area to body mass

Question 11

What are the methods of keeping babies warm?

Answer 11

• wrap or bags
• skin to skin care
• prewarmed incubator
• transwarmer mattress

Question 12

Why is there an increased risk of nutritional compromise in premature babies?

Answer 12

• limited nutrient reserves
• gut immaturity
• immature metabolic pathways
• increased nutrient demands

Question 13

What causes early onset neonatal sepsis?

Answer 13

Mainly due to bacteria acquired before and during delivery

Question 14

What causes late onset neonatal sepsis?

Answer 14

Acquired after delivery (nosocomial or community sources)

Question 15

What organisms cause early onset neonatal sepsis?

Answer 15

Group B streptococcus

Gram negatives

Question 16

Which organisms cause late onset neonatal sepsis?

Answer 16

Coagulase negative Staphylococci

Gram Negatives

Staph Aureus

Question 17

What are the risks of sepsis associated with prematurity?

Answer 17

Immature immune system

Intensive care environment

Indwelling tubes and lines

Question 18

How can risk of neonatal sepsis be managed?

Answer 18

Prevention

Hand-washing

Super vigilant and infection screening

Judicious use of antibiotics

Supportive measures

Question 19

What are the respiratory complications of prematurity?

Answer 19

Respiratory distress syndrome

Apnoea of prematurity

Bronchopulmonary dysplasia

Question 20

What is the primary pathology in hyaline membrane disease?

Answer 20

Surfactant deficiency

Structural immaturity

Question 21

What is the secondary pathology of hyaline membrane disease?

Answer 21

Alveolar damage; formation of exudate from leaky capillaries

Inflammation

Repair

Question 22

What are the clinical features of hyaline membrane disease?

Answer 22

Respiratory distress

Tachypnoea

• grunting
• • intercostal recessions*
• • nasal flaring*
• • cyanosis*

Worsen over minutes to hours

Natural history

• gradual worsening to nadir at 2-4 days

Question 23

What is the management of hyaline membrane disease (RDS)?

Answer 23

Maternal steroid

Surfactant

Ventilation

-invasive/non-invasive

Question 24

What is the classification and outcomes for intraventricular haemorrhage?

Answer 24

Grade 1 and 2

• neurodevelopmental delay up to 20%
• mortality 10%

Grade 3 & 4

• neurodevelopmental delay up to 80%
• Mortality 50%

Question 25

When does retinopathy of prematurity present?

Answer 25

6-8 weeks after delivery

Question 26

What are the early metabolic complications of prematurity?

Answer 26

Hypoglycaemia

Hyponatraemia

Question 27

What are the late metabolic complications of prematurity?

Answer 27

Osteopenia of prematurity