Premature Babies Flashcards
What are the classifications of prematurity?
Moderately preterm (32-37) Very preterm (28-32) Extremely preterm (<28)
Which 2 drugs should be given to mothers of preterm babies?
- Corticosteroids (if <34/40) for lung maturation
2. Magnesium Sulphate (if <3040) to protect the brain
What are 2 commonly used corticosteroids for prematurity?
Betamethasone or Dexamethasone
What are some of the clinical features of a premature baby?
- Surfactant deficiency
- Poor suck/swallow reflex
- Poor tone
- Nipples flat
- Smooth sole of foot
- Red, shiny skin
What are some causes of preterm birth?
- Smoking/alcohol/drugs
- Stress
- Low/high maternal age
- Infection
- Prev. premature birth
- Multiple birth
- High BP
How does prematurity affect sodium levels?
- Sodium leaks from immature kidneys
- Premature EBM has high concentrations of sodium
What are the advantages of delayed cord clamping?
- Increased blood supply from placenta
- Decreases need for transfusions
- Decreases risk of NEC and intraventricular haemorrhage
What is NEC?
Necrotising Enterocolitis (portion of the bowel dies)
What causes RDS?
Lack of endogenous surfactant so lungs struggle to inflate
What is a normal body temperature?
36.5-37.4
When should a hat not be put on a preterm baby?
If on a hot cot/mattress
What are the 4 ways in which heat is lost from the body?
- Radiation (lose heat from skin to cooler outside temp)
- Convection (draught)
- Evaporation (wet at birth, urine, sweat, dribble)
- Conduction (lose heat through contact with cool objects)
What are the 10 steps of the WHO warm chain?
- Warm delivery room
- Immediate drying
- Skin to skin
- Breastfeeding
- Bathing and weighing postponed
- Appropriate clothing
- Mother and baby together
- Warm transportation
- Warm resuscitation
- Training and awareness
What temperature should the delivery room be?
Approx. 25-28
When should a baby be wrapped in plastic rather than dried?
<30/40
Why do premature babies get cold?
- Large SA:V ratio
- Less fat
- Increased water content
- Immature skin (evaporation)
- Poor response to cold stress
What is cold stress?
Cold = inc. oxygen consumption = inc. RR = vasoconstriction = dec. oxygen to tissues = anaerobic metabolism = metabolic acidosis
What is Domperidone sometimes administered for?
Raises prolactin levels to encourage breast milk production in mothers of babies in NICU
What is non-nutritive sucking?
- Done from 30/40
- Encourage sucking without giving food to aid quicker transition to suck feeding
- Must gain parental consent
What are the management options for threatened premature labour?
- Cervical cerclage
- Progesterone
- Corticosteroids >26/40
- Nifedipine
- MgSO4
What is foetal fibronectin?
Protein in amniotic membrane which is in cervical fluid up to 22/40 and then released as an indicator of possible delivery (positive preterm = risk of preterm labour)
Why are corticosteroids given?
Stresses the baby which causes production of surfactant that helps lungs stay inflated
Why is Nifedipine given?
Inhibits contractions (tocolytic)
When is a foetal fibronectin test inaccurate?
- Cervix >3cm
- PPROM
- Pv bleeding
What should never be used on a preterm baby?
Ventouse
What is the dose of MgSO4 given?
4g bolus, then 1g/hr maintenance dose until delivery/ up to 24 hours
Why would lipids be given to a premature baby?
Aids weight gain
Why would dextrose be given to a premature baby?
- Hypoglycaemia
- Decreased urine output
What effects may prolonged light exposure have on a premature baby?
- Eye damage
- Minimises weight gain
- Increased stress
- Interrupts the Circadian rhythm
Why do premature babies not like noise?
Causes stress and sensory overload as the NS is immature
What are the 3 main positions that premature babies are put in?
- Supine
- Side-lying
- Prone
What are the benefits of the supine position?
- Head in midline aids development
- Easy to access for procedures
- Clear visual monitoring
What are the benefits of the side-lying position?
- Helps develop hand to mouth coordination
- Aids ventilation in lungs
What are the benefits of the prone position?
- Supports sternum and rib cage
- Optimal for oxygenation
- Increases quiet sleep
- Lowers energy expenditure
