Pre-term Infant Flashcards
What is a preterm birth?
Before 37 weeks
What is extreme preterm?
Before 28 weeks
What is very preterm?
28-32 weeks
What is moderate to late preterm?
32-37 weeks
What are risk factors for preterm delivery?
Previous preterm delivery
Multiple pregnancy
Smoking/drug use in pregnancy
Under/over weight in pregnancy
What is RDS?
Respiratory distress syndrome
Insufficient surfactant produced by type 2 pneumocytes in the lungs
What is function of surfactant?
Increases the surface tension so prevents the alveoli collapsing
What gestation does surfactant begin to be produced?
28 weeks
What are signs of RDS?
Tachypnoea >60
Laboured breathing
Expiratory grunting
How is RDS managed?
Antenatally = steroids
Postnatally = exogenous surfactant + ventilatory support
What is CLD?
Chronic lung disease
Requiring oxygen post corrected 36 weeks
What is CLD also known as?
BPD - bronchopulmonary dysplasia
What is premature apnoea?
Short periods where the infant stops breathing
What causes premature apnoea?
Immature central respiratory control
How is premature apnoea managed?
Caffeine
Ventilatory support
What is PDA?
Patent ductus arteriosus
Failure of the ductus arteriosus to close
What is the function of the ductus arteriosus in utero?
Shunt between the pulmonary artery and aorta to bypass the lungs
What problem can a PDA cause?
Shunt can reverse from right->left to left->right as aortic pressure increases
This results in increase blood flow to the lungs -> pulmonary oedema
How is PDA managed?
Ibuprofen
Surgical ligation
What is IVH?
Intraventricular haemorrhage
Why do IVHs occur?
Underdeveloped ventricular system
Highly vascular choroid
Very delicate and susceptible to damage
What problem can an IVH cause?
Large bleed/clot can block the ventricles and impair CSF drainage
Leads to hydrocephalus
How are IVHs screened for?
Preterm infants get cranial ultrasounds
What is PVL?
Periventricular lecuomalacia
Ischaemic damage to periventricular white matter
Why do preterm infants have feeding problems?
Immature gut
Do not develop ability to suckle and swallow until ~34 weeks
How are preterm feeding problems managed?
NG feeding
Parental nutrition
What is NEC?
Necrotizing enterocolitis
What causes NEC?
Impaired blood flow to gut = ischaemic injury
+
microbial growth
What are the features of NEC?
Bilious vomiting
Bloody diarrhoea
Abdominal distension
What are the x-ray features in NEC?
Distended bowel loops
Intramural gas
Portal venous tract gas
How is NEC managed?
NBM
Antibiotics
Surgery - resect bowel
What is ROP?
Retinopathy of prematurity
Proliferation of new blood vessels in an area of relative ischaemia in a developing retina
What is the cause of ROP?
Higher oxygen levels outside of uterus
How is ROP screened for?
Preterm infants screened by ophthalmologist
How is ROP managed?
Keeps sats 92-96
Anti-VEGF
Laser ablation
