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Paediatrics > Premature / LBW / NICU > Flashcards

Premature / LBW / NICU Flashcards

1
Q

What type of small babies can you get

A

SGA
- Could be genetic or due to IUGR
LBW
IUGR

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2
Q

What is IUGR

A

If still in womb
<10th centile
Suggest something happening in womb to compromise blood flow / sick baby

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3
Q

What causes LBW

A 
Idiopathic
Placental insufficiency
Chromosomal
Infection - TORCH / CMV / syphillis
MCMA twins
Malformation
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4
Q

What causes placental sufficiency

A 
Maternal IHD
High BP 
PET 
Abruption 
DM
Systemic
Sickle cell  
Smoking / alcohol
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5
Q

What are common problems in LBW

A

Perinatal hypoxia - increased haematocrit, bilirubin and plasma viscosity
= Polycytheaemia as hypoxia = produce more
Hypoglycaemia
Hypothermia
Thrombocytopenia - BM concentrating on making RBC

NEC
GI - as blood flow to more important organs in stress
Nutrition
Meconium aspiration syndrome as stressed
IRDS as less surfactant
Infection

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6
Q

What are long term problems of LBW

A 
DM
Hypertension
Reduced Growth 
IHD
Obesity 
Renal failure
Stroke
Retinopathy 
Lung - asthma
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7
Q

What is mild LBW and extreme

A

LBW <2.5kg
VLBW <1.5kg
Extreme <1kg

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8
Q

What is symmetric LBW

A

OFC and weight in the same percentile

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9
Q

What causes symmetric

A 
1st trimester insult
Affects all DNA
Chromosomal 
Infection - TORCH 
Teratogenic drug 
Severe smoke / alcohol
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10
Q

Will symmetric LBW improve

A

Unlikely as will never have enough cells

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11
Q

What is asymmetric

A

OFC spares

Weight <10 centile

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12
Q

What causes asymmetric LBW

A

3rd trimester insult
Placental insufficiency - PIH
Will have catch up growth

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13
Q

Why is LBW associated with hypothermia

A

Lack of fat stores

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14
Q

Why is LBW associated with hypoglycaemia

A

No glycogen reserve as IUGR throughout pregnancy so constantly used up

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15
Q

What does the hypoxic state in utero of LBW babies cause

A

Increased haematocrit 20-22 (normal 18-20)
Increased plasma viscosity (VTE / slow circulation)
Polycythaemic to increase RBC as hypoxic
Increased bilirubin as have to break down
Thrombocytopenia as BM making RBC

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16
Q

How do you treat the hypoxic state of LBW babies

A

Partial exchange transfusion

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17
Q

Why does premature make you more prone to infection

A

IgG transfer in 3rd trimester
Immune system is underdeveloped
Interventions in premature
Can be caused by chorioamnitis

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18
Q

How do you treat infection

A

Prophylactic penicillin and gentamicin to cover strep and staph / gram -ve E.coli
Diff Ax if think meningitis

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19
Q

Do you worry more about pre-term but appropriate for gestational age or the pre-term SGA

A

Pre-term appropriate gestational age

SGA baby will have been under stress in the womb so produce natural steroids to mature lungs

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20
Q

Neonatal abstinence syndrome

A

OK

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21
Q

What has decreased infant mortality

A 
Obstetric care
Housing
Nutrition 
Immunisation
Ax
NHS
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22
Q

What is most important in LBW babies

A

Nutrition

More prone to food intolerance and gut unable to absorb

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23
Q

What causes pre-term babies

A 
Idiopathic 
Smoking / alcohol / drugs 
Over or underweight
FH 
Malnutrition
Infection - chorioamnitis
PET
DM
APH
Polyhydramnios
Twins
Malformation
PPROM
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24
Q

What is term

A

37-42

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25
Q

Mild prematurity

A

32-37

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26
Q

Moderate

A

28-32

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27
Q

Extreme

A

<28 weeks

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28
Q

What Is important if premature

A 
Nutrition
Fluid - dextrose
TPN if long term
Syringe feed
NG
Vitamins ABIDEK
Iron at 28 days 
Establish feet
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29
Q

Complications of pre-term

A 
IRDS
Bronchopulmonary dysplasia
Minor resp issues
IVH
Periventricular leucomalacia
Post haemorrhagic hydrocephalus
Hypoxic ischaemic encephalopathy 
Neonatal jaundice 
NEC
PDA
Infection 
Low BP 
Hypothermia
Hypoglycaemia 
Nutrition as poor feeding
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30
Q

What are long term complications of pre-term

A 
Chronic lung - asthma / bronchiolitis
Anaemia of prematurity
Metabolic bone disease
Retinopathy
Cerebral palsy 
Low IQ / learning difficulties 
Hearing and visual
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31
Q

How do you screen for long term issues

A

Cranial USS

Retinopathy

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32
Q

What causes IRDS

A 
Deficiency of alveolar surfactant
Lungs can't expand
Collapse
Large pressure needed to inflate
Leads to inadequate gas exchange, hypoxia and hypercapnia
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33
Q

What does this cause

A 
Respiratory distress
- Tachypnoea
- Grunting
- Nasal flaring 
- Cyanosis
- Recession 
Exhaustion
Resp failure - hypoxia/. hypercapnia
34
Q

What are RF for IRDS and what is protective

A 
Pre-term
- Surfact produced >24 weeks 
Maternal DM
- Hyperinsulin in baby inhibits cortisol 
C-section
Male 
Perinatal asphyxia 
2nd born twin

Protective - stresses baby = cortisol production

  • PPROM
  • IUGR
  • Maternal HTN
  • Antenatal steroid
35
Q

How do you Dx

A 
Blood gas
CXR 
- Widespread bilateral change
- Indistinct heart border
- Air bronchogram
- Ground glass opacity 
- May see tube if intubated
36
Q

How do you prevent

A

Antenatal steroid
12 hours apart if any threat
Stresses lung to prevent
Delayed cord clamping

37
Q

How do you Rx

A 
O2 - nasal or mask or just flow to maintain pressure
CPAP - open and inflate lung 
Support ventilation if blood gas worsens
May need intubation 
Endotracheal surfactant once intubated
38
Q

Complications of RDS / increased risk

A 
Pneumothorax
Infection 
Apnoea
IVH
Pulmonary haemorrhage
NEC 
Renal failure

Long term
Chronic lung
Retinopathy due to hypoxia
Neuro, hearing and visual

39
Q

When do you use CPAP

A

If only problem is keeping airway open

40
Q

What is Ddx of IRDS

A 
Sepsis = important 
TTN
Meconium aspiration
Congenital lung
Persistent pulmonary hypertension 
Cardiac
41
Q

What causes bronchopulmonary dysplasia

A

Lung overstretch e.g. ventilation

Causes oxygen toxicity

42
Q

What does bronchopulmonary dysplasia cause

A 
Persistent hypoxia
Difficulty weaning of ventilation 
Infection due to tube
Severe bronchiolitis
Atelactisis - collapse
Poor feeding
43
Q

How do you treat

A

Steroids
Surfactant
High calories feed

44
Q

What are complications

A 
GORD
Feeding issue 
Decreased IQ
Cerebral palsy 
Asthma
45
Q

What causes minor respiratory issues and what can underlying issue be

A

Baby forget to breath
Babies are mouth breather’s
Can be a pre-drome of illness

46
Q

What minor issues is there

A

Apnoea >15s
Desaturation
Bradycardia
Irregular breathing

47
Q

How do you treat

A

Attach apnoea monitors to premature baby
IV Caffeine - neuroprotective and stimulates resp
CPAP

48
Q

What is most common limiting factor for poor prognosis in pre-term

A

Intra-ventricular haemorrhage

49
Q

When does IVH occur

A

First 72 hours

50
Q

How does it present

A

Seizure
Bulging fontanelle
Cerebral irritability

51
Q

How do you Dx

A

Cranial USS as fontanelle hasn’t closed
MRI
Bloods

52
Q

How do you Rx

A

Ante-natal steroid

Treat haemorrhagic shock

53
Q

What do you do if hydrocephalus / raised ICP

A

Drainage

Shunt

54
Q

What are complications

A

Post haemorrhagic hydrocephalus if clot occlude
Decreased IQ
Cerebral palsy

55
Q

What is periventricular leucomalacia

A

White matter surrounding ventricles deprived O2 and blood

56
Q

What types of intracranial haemorrhage I there

A

IVH = most common in pre-term
SAH
Subdural after forceps

57
Q

What causes hypoxic ischaemic encephalopathy

A 
SUSPECT IF ANY OF THESE EVENTS 
Brain injury 2 prolonged hypoxia / asphyxia / resp distress
IVH
PML
Placental insufficeincy
Cord prolapse
Long delivery
Abruption
Maternal hypoxia / shock 
Infection
Anaemia
58
Q

What does mild HIE present with and how does it resolve

A 
Hyperalert
Hypertonia
Poor feeding 
Irritable 
Acidosis on blood gas / poor
Low APGAR 
Resolve within 24 hours and normal prognosis
59
Q

How does more severe present and how does it resolve

A

Hypotonia
Seizure
Apnoea
Hyporeflexia / absent sucking rreflex etc
Resp depression
Coma
Takes weeks to resolve and usually lasting damage

60
Q

How do you Dx

A

EEG

Flat single line

61
Q

How do you Rx

A 
Neonatal resus and ventilation 
Support circulation 
Support seizure
Support nutrition 
Support acid base balance 
Therapeutic hypothermia for brain protection
62
Q

What are the complications

A 
Cerebral palsy
Epilepsy 
Blind
Deaf
Learning difficulty
63
Q

How does hypoglycaemia present

A 
Hypothermia
Hypotonia 
Lethargy
Infection
Apnoea
Resp difficulty
Poor feeding
Vomiting
High pitched cry
Seizure
Neuro complications
64
Q

What are RF

A 
Physiological in first few hours just encourage feed 
Pre-term
IUGR 
SGA
LGA / macrosomia 
Maternal DM
Maternal BB use 
Sepsis
Hypothermia
Inborn error
Beckwith Weidman
65
Q

What should all irritable babies get

A

U+E
BG
Sepsis screen

66
Q

How do you treat

A 
Dextrogel 
Enteral feed - NG tube 
IV 10% glucose
Regular electrolyte if on fluid
Glucagon 
Hydrocrotisone 
Recheck glucose
67
Q

When is hypo normal

A

Transient in 1st few days

Observe and encourage feed

68
Q

What are RF for hypothermia

A

Premature
LBW
Prolonged resus

69
Q

How do you investigate

A

Sepsis screen
TFT
Monitor blood glucose

70
Q

How do you Rx

A 
Dry
Warm towel
Radiant heater
Heated oxygen
Incubator
71
Q

What are the complications

A

Increased energy demand + O2
Metabolic acidosis as poor perfusion
Pulmonary hypotension

72
Q

What causes hypotonia

A 
Sepsis
Hypothyroid
Jaundice
Prader-Willi
Down
Benzo's
HIE
Cerebral palsy
Neuromuscular
Maternal myasthenia gravis 
Meconium aspiration 
Hypoglycaemia
73
Q

What are neuromuscular causes

A 
Spina bifida
Myasthenia gravis
Muscular dystrophy
Guillian Barre
Spinal muscular atrophy
Cerebral palsy 
DMD - but doesn't present till later
74
Q

What do you do if hypotonic

A

Sepsis screen

Underlying cause - BG / TFT / LFT

75
Q

What do you follow up on

A

Development

76
Q

What causes haemorrhage disease of newborn

A

Vit K defiicency

77
Q

How does it present

A

Bruising
Jaundice
IVH / kidney

78
Q

What causes retinopathy of premature / LBW

A

Abnormal development of retinal blood vessels

Can lead to scarring, retinal detachment and blindness

79
Q

How is it screened of

A

30-31 weeks gestation if born <27 weeks
Or 4-5 weeks if >27 weeks
Screen every 2 weeks until can be seen that developing normal

80
Q

How do you Rx

A

Laser photocoagulation to prevent neovascularisation
Intravitreal VEGF
Surgery if retinal detachment occurs

Paediatrics (35 decks)

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