Premature infant. Pediatric care for the premature children + Most frequent diseases of premature infants Flashcards
what are the terminology of prematurity ?
extremely preterm = below 28 weeks
very preterm = 28 weeks and less than 32 weeks
moderate preterm = less than 34wks - 32 weeks
late preterm = 34 weeks to less than 37 weeks
—— less than 37 weeks = preterm——-
early term = 37 weeks to less than 39 weeks
term =39-less than 41 weeks
preterm babies are usually not SGA correct ?
yes
there are morphological characteristics which can helps determine the age of the baby such as?
ballard score
nippes become visible in the 31 gestational week - if visible we know the baby has passed its 31st gestational week
position go the testis in the inguinal canal and scrotum
neurological development
what are the aetiology of preterm labour ?
50 percent remain unknown
maternal factors = pr eclampsia mother's age lower than 16 or higher than 40 smoking vibration alcohol drugs stress
anemia , diabetes , hyperthyroidism
uterine anomlais- tumors , cervical insuffieicny , vaginal infections and infection of the cervix
prom- usually infections , placenta previa , twin pregnancy ,
fetus - IUGR ,
multiple fetus
polyhydroaminos - uterine stretch pathway
how can we diagnose PROM ?
good test for this is cervical and vaginal fibronectin - substance of basement membrane protein produced but the membrane - when fetal membranes are disrupted - fibronectin is secreted into the vaginal and cervix
A positive fetal fibronectin test at 22 to 24 weeks predicts more than half of the spontaneous preterm births that occur before 28 weeks.
what re the characteristic features of preterm babies ?
small
head bigger to body
translucent skin with visiblee blood vessels
fine lanugo hair
soft pliable ear cartilage
soft bones
closed eyes
listless and inactive
extended extremities
partially developed REFLEX ACTIVITIES- lack of suction reflex
INABILITY TO MAINTAIN BODYTEMP = less body fat
inability to excrete urine
female - prominent clitorious
ABNORMAL BREATHING PATTERNS - shallow and irregular pauses
lower muscle tone
problems feeding - difficulty sucking or coordinated swallowing
what are preterm babies dangerously susceptible to ?
no surfactant produced so respiratory distress = hyaline membrane disease or respiratory distress syndrome
immature respiratory centre so cannot breath periodically = apnea
metabolic acidosis
more susceptible to hypoglycaemia
hyperbilirubinemia
heart failure = patent ductus arteriosus
INFECTIONS -sepsis and necrotic enterocolitis
intraventricular haemorrhages
fluid and electrolyte imbalance
RETINOPATHY of prematurity
anemia
what are the long term problems for preterm babies ?
bronchopulmonary dysplasia delayed growth and development mental or physical disability or delay increased risk for intellectual disability cerebral palsy vision and hearing loss = retinopathy
what are the standard care given to preterm babies
baby should be dried and effectively covered and warm
electie intubation for extremely low birth weight babies = less tan 1000g
exogenous surfactant given
corticosteroids for lung development through endotracheal tube
ventilator - continuous positive airway pressure
less than 30 weeks old - IV fluid and nasogastric
30-34 = nasogastric / breast feeding
more than 34 = breast feeding or katori
10 percent of daily calories should be derived for protein
40 percent - carbs
5 percent fats
2.5-3.5 mew/kg/per day
vit a recommended for preterm promoting epithelial repair and minimise fibrosis
vit D - prevents rickets
vitamin K 0.5mg should be given intramuscularly
factors 2 , 7 , 9 ,1 administers
prevent haemolytic disease of the new born
immunisation and put in sterile conditions
antibiotics given if there are signs of infection
for a preterm baby it is put in a system of neonatal intensive care unit which measure what ?
there is overhead warmer they eyes are sealed closed closed there is a ventilator a feeding tube = feeding method oxygen saturation monitor Iv pump IV pump with umbilical artery catheter = feeding method PICC line - central line = feeding method ECG and blood pressure monitor / HR temperature monitor bilirubin lights incubator
what is kangaroo care
placing a premature baby in an upright position on the mothers bare chest allowing tummy to tummy contact and planning the premature baby in between the mother’s breast
and baby head is tubers so the ear is above the parents heart
kangaroo care has been shown to help prmature newborn with ?
body temp
allow easy access to breast feeding
increase weight gain - allows the baby total into deep sleep = allows the baby to conserve energy
increased intimacy and attachment
what are the symptoms for necrotising enetrocoitis
poor feeding
blood in stool
vomiting bile
failure to thrive
later on
abdominal discolouration , peritonitis
intestinal perforation
systemic hypotension
what is necrotising enterocolitis ?
where a portion of the bowel dies it is thought to involve the combination of poor blood flow and infection of the intestines
how can we prevent necrotising enetroclitis
use breast milk
probiotics
when is the typical onset of enterocolitis ?
after 4 weeks of life
generally inversely proportional to the gestational age of the baby birth
how is the diagnosis of necrotising enterocolitis ?
radiography
transillumination of the abdomen
Bells stages of disease
stage 1 = mild symptoms such as apnea , lethal , bradycardia , temp instability
abdominal distension , increased gastric residual bloody stools
no radiological signs
stage 2
mild to moderate symptoms
additional intestinal signs : absent bowel sound and abdominal tenderness
radiologic - pneumatosis intestinal or portal venous gas
lab =metabolic acidosi , thrmbocytopenia
stage 3
hypotension
peritonitis and striking abdominal distension
radiology = pneumoperitoneum
lab test = metabolic and resp acidosis
DIC
US = bowel gas , sentinel loop
what is the treatment for necrotising colitis ?
bowel rest by stopping oral feeding, gastric decompression with nasogastric tube suction , fluid repletion to correct electrolyte abnormalities parenteral nutrition always antibiotic therapy mechanical ventilation
supine and left lateral decubitus abdominal X-rays should be performed every six hours
As an infant recovers from NEC, feeds are gradually introduced. “Trophic feeds” or low-volume feeds (<20 ml/kg/day) are usually initiated firs
Where the disease is not halted through medical treatment alone, or when the bowel perforates what is the course of action in NE
emergency surgery to resect the dead bowel is generally required, although abdominal drains may be placed in very unstable infants as a temporizing measure
In the case of an infant whose bowel is left in discontinuity, the surgical creation of a mucous fistula or connection to the distal bowel may be helpful as this allows for re-feeding of ostomy output to the distal bowel. This re-feeding process is believed to improve bowel adaptation and aid in advancement of feeds.
some children may suffer what whenextensive portions of the bowel had to be removed in NE ?
short bowel syndrome = malabsorption disorder
a patent ductus arteriousus creates what type of shunt ?
and what are the signs and symptoms ?
diagnosis ?
left to right shunt
signs and symptoms depends on the size of the shunt
pulse can be bounding , systolic murmur audible ,
apnea , bradycardia , increased oxygen requirement
echocardiography - doppler through ultrasound
what are the main problems in the left to right shunt in PDA?
HYPERperfusion in lung circulation = pulmonary haemorrhages
HYPOperfusion of system circulation to gut and brain = NEC
heart failure - increase volume load on left side of heart = bounding pulses , hyperactive pericardium , murmur , cardiomegaly
patent ductus arteriosuus closes physiologically in premature babies?
yes however they are more delayed especially if there is respiratory distress syndrome
normally the physiological closure is within 24 hours and the anatomical closure several weeks later
= arterial hypoxemia and reduced response to oxygen prevents the fast closure of ductus arteriosusu in children
what can treat this closure of ductus arteriosus?
echocardiography done when there is congestive heart failure with all the symptoms that persists heart failure to ratio between left atrium and aortic root diameter ratio normal is 0.86 if it is more than 1 or 1.1 early treatment started with indomethacin
inhibitors of prostaglandin such as ASA (cogulative effects and bilirubin displacement ) or indomethacin (renal function :( ) closure of persistant ductus arteriosus
surgical ligation
what re the signs for respiratory distress syndrome ?
increased resp rate - tachypnea - more than 60 breaths per min
chest wall recession - sternal and subcostal undraping
tachycardia
expiratory grunting = to create positive pressure
nasal flaring
cyanosis
prolonged periods of apnea
is respiratory disease is treated or not the acute symptoms lasts how many days ?
2-3 days
first day child worsens
second day - baby remarkably stable
resolution on the third day
what can be differential diagnosis to respiratory distress syndrome ?
acute respiratory distress syndrome - widespread inflammation of the lungs
how can we diagnose respiratory distress syndrome ?
bell shaped chest
chest x ray - decreased lung volume , absence of thymus - after 6 hrs
in pregnancy over 30 weeks fetal lung maturity checked by amniocentesis
L/S ratio and PG - phosphatidylglycerol
less than 2:1 and absence of PG means there is no lung maturity
surfactant an albumin ratio
less than 35 indicates immature lungs
greater than 55 inidicates mature surfactant production
what is the treatment for respiratory distress syndrome ?
CPAP- continuous positive airway pressure
intravenous fluid to stabilise the blood sugar and blood blood pressure
if the baby shows signs of worstenng - endotracheal tubing
or put in mechanical ventilation
CPAP
exogenous pulmonary surfactant given through the breathing tube
extracorporeal membrane oxygenation = cannot be placed until over 2KG
because small blood vessels for cannulation giving higher vascular resistance
in severe RDS what is the problem ?
bronchopulmonary dysplasia
there are four grades of intraventricular haemorrhages what are they ?
grade 1 - germinal matrix bleeding where there are tender vessels
grade 2 - bleeding occurs inside the ventricles
grade 1 and two are small amounts bleeding
grade 3 and 4
grade 3 - the blood presses the brain tissue the ventricles are enlarged with he blood
grade 4 the bleeding is directly involved with the brain tissue - intraparenchymal haemorrhage
most severe being uniltarel hemorrhagic infraction = resulting in hemiplegia = paralysis of one side of the body
here blood clots can form and reduce the drainage of cerebrospinal fluid giving hydrocephalus
what are the symptoms in intraventricular haemorrhages
apnea
change in blood pressure and heart rates
decreased muscle tone
decreased reflexes
excessive sleep
seizures and abnormal movements
how is the diagnosis done of intraventricula hemorrhegae ?
all babies born before 30 weeks should have ultrasoundd of the head
what is the treatment for intravenetricular haemorrhages ?
no way to stop the bleeding
give diuretics
streptokinase therapy
most recently combo of drainage , irrigation and fibrinolytic therapy = DRIFT therapy
blood transfusion given to maintain blood pressure
if fluid builds ip to point that there is cancer - a spinal tap done to relive the pressure
surgery needed to place a tube shunt to drain the fluid from the brain
