premature birth - own notes Flashcards
risk factors for premature birth?
Previous preterm delivery
Multiple pregnancy
Smoking and illicit drug use in pregnancy
Being under or overweight in pregnancy
Early Pregnancy (within 6 months of previous pregnancy)
Problems involving cervix, uterus or placenta, including infection
Certain chronic conditions such as diabetes and hypertension
Physical injury/trauma
what baseline investigations would you do on a premature baby?
blood gas FBC Urea, creatinine and electrolytes blood culture CRP Blood group
CXR
AbdoXR
cranial USS
why are antenatal steroids given if premature birth is expected?
reduces risk of death, intraventricular haemorrhage, RDS.
why should magnesium sulphate be offered to woman with suspected soon preterm birth?
as it is a neuro-protective to the baby
what respiratory complications are there in preterm babies and how are they managed?
Respiratory distress syndrome, Surfactant deficient lung disease, Chronic lung disease/ Bronchopulmonary dysplasia, recurrent apnoea
Exogenous surfactant administration, endotracheal intubation and mechanical ventilation, Bilevel positive airway pressure, continuous positive airway pressure, high flow oxygen, nasal cannula low flow oxygen, ambient incubator oxygen, caffeine administration
what are the cardiovascular complications in preterm babies and how are they managed?
Hypotension, perfusion abnormalities, PDA
Inotrope infusions (including dopamine, dobutamine, adrenaline, and noradrenaline), fluid management, ibuprofen or indomethacin administration, ligation of PDA (rare)
what are the neurological complications in preterm babies and how are they managed?
Intraventricular haemorrhage, seizures, post haemorrhagic ventricular dilatation, neurodevelopmental delay, cerebral palsy.
Regular surveillance with CrUSS, regular head circumference measurement, administration of antiepileptic drugs (phenobarbital and phenytoin), referral to neurosurgical team if needed, long term neurodevelopmental follow up and support as necessary, awareness of level of stimulation (handling, noise, light, etc)
what are the gastrointestinal complications in preterm babies and how are they managed?
mmature gut causing feed intolerance, necrotising enterocolitis (NEC)
Total parenteral nutrition (TPN), nasogastric and orogastric feeds, maternal and donor expressed breast milk, feeding protocols, antibiotic therapy and surgical review if NEC is suspected
what are the renal/electrolyte complications in preterm babies and how are they managed?
Immature renal function
Close monitoring of fluid and electrolyte balance, electrolyte supplements when indicated, catheterisation if indicated
what are the metabolic complications in preterm babies and how are they managed?
Jaundice, hyperglycaemia, hypoglycaemia, Inborn errors of metabolism
Phototherapy, exchange transfusion, insulin infusion, increase concentration or volume of glucose given via central IV access, baseline metabolic investigations (including Guthrie Card)
what are the infection/immune complications in preterm babies and how are they managed?
Sepsis, increased risk of infection due to central lines and multiple procedures
Septic screen, intravenous antibiotic therapy according to local guidelines
what are the skin complications in preterm babies and how are they managed?
Immature skin barrier leading to increased insensible losses and increased risk of infection
Nursing in a warm, humid incubator, aseptic non-touch technique during procedures
what are the thermoregulation complications in preterm babies and how are they managed?
Immature regulation
Nursing in a warm humid incubator, cot warmer, awareness of exposure whilst performing procedures and examinations
what are the eyes complications in preterm babies and how are they managed?
Retinopathy of prematurity
Avoid excessive oxygen exposure, screening for retinopathy of prematurity by ophthalmology team, laser treatment if indicated
