Pre-term Infant

Question 1

What is a preterm birth?

Answer 1

Before 37 weeks

Question 2

What is extreme preterm?

Answer 2

Before 28 weeks

Question 3

What is very preterm?

Answer 3

28-32 weeks

Question 4

What is moderate to late preterm?

Answer 4

32-37 weeks

Question 5

What are risk factors for preterm delivery?

Answer 5

Previous preterm delivery
Multiple pregnancy
Smoking/drug use in pregnancy
Under/over weight in pregnancy

Question 6

What is RDS?

Answer 6

Respiratory distress syndrome

Insufficient surfactant produced by type 2 pneumocytes in the lungs

Question 7

What is function of surfactant?

Answer 7

Increases the surface tension so prevents the alveoli collapsing

Question 8

What gestation does surfactant begin to be produced?

Answer 8

28 weeks

Question 9

What are signs of RDS?

Answer 9

Tachypnoea >60
Laboured breathing
Expiratory grunting

Question 10

How is RDS managed?

Answer 10

Antenatally = steroids

Postnatally = exogenous surfactant + ventilatory support

Question 11

What is CLD?

Answer 11

Chronic lung disease

Requiring oxygen post corrected 36 weeks

Question 12

What is CLD also known as?

Answer 12

BPD - bronchopulmonary dysplasia

Question 13

What is premature apnoea?

Answer 13

Short periods where the infant stops breathing

Question 14

What causes premature apnoea?

Answer 14

Immature central respiratory control

Question 15

How is premature apnoea managed?

Answer 15

Caffeine

Ventilatory support

Question 16

What is PDA?

Answer 16

Patent ductus arteriosus

Failure of the ductus arteriosus to close

Question 17

What is the function of the ductus arteriosus in utero?

Answer 17

Shunt between the pulmonary artery and aorta to bypass the lungs

Question 18

What problem can a PDA cause?

Answer 18

Shunt can reverse from right->left to left->right as aortic pressure increases

This results in increase blood flow to the lungs -> pulmonary oedema

Question 19

How is PDA managed?

Answer 19

Ibuprofen

Surgical ligation

Question 20

What is IVH?

Answer 20

Intraventricular haemorrhage

Question 21

Why do IVHs occur?

Answer 21

Underdeveloped ventricular system
Highly vascular choroid

Very delicate and susceptible to damage

Question 22

What problem can an IVH cause?

Answer 22

Large bleed/clot can block the ventricles and impair CSF drainage

Leads to hydrocephalus

Question 23

How are IVHs screened for?

Answer 23

Preterm infants get cranial ultrasounds

Question 24

What is PVL?

Answer 24

Periventricular lecuomalacia

Ischaemic damage to periventricular white matter

Question 25

Why do preterm infants have feeding problems?

Answer 25

Immature gut | Do not develop ability to suckle and swallow until ~34 weeks

Question 26

How are preterm feeding problems managed?

Answer 26

NG feeding | Parental nutrition

Question 27

What is NEC?

Answer 27

Necrotizing enterocolitis

Question 28

What causes NEC?

Answer 28

Impaired blood flow to gut = ischaemic injury + microbial growth

Question 29

What are the features of NEC?

Answer 29

Bilious vomiting Bloody diarrhoea Abdominal distension

Question 30

What are the x-ray features in NEC?

Answer 30

Distended bowel loops Intramural gas Portal venous tract gas

Question 31

How is NEC managed?

Answer 31

NBM Antibiotics Surgery - resect bowel

Question 32

What is ROP?

Answer 32

Retinopathy of prematurity Proliferation of new blood vessels in an area of relative ischaemia in a developing retina

Question 33

What is the cause of ROP?

Answer 33

Higher oxygen levels outside of uterus

Question 34

How is ROP screened for?

Answer 34

Preterm infants screened by ophthalmologist

Question 35

How is ROP managed?

Answer 35

Keeps sats 92-96 Anti-VEGF Laser ablation