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Premature / LBW / NICU Flashcards

1
Q

What type of small babies can you get [3]

A

SGA
LBW
IUGR

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2
Q

What causes LBW [5]

A 
Idiopathic
Placental insufficiency
Chromosomal, Malformation
Infection - TORCH / CMV / syphillis
Monochorionic monoamniotic  twins
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3
Q

What causes placental insufficiency [5]

A 
Maternal factors: 
IHD, DM
High BP, PET 
Placental Abruption 
Sickle cell  
Smoking / alcohol
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4
Q

What are common problems in LBW [8]

A
  1. Perinatal hypoxia - increased haematocrit, bilirubin and plasma viscosity
    = Polycytheaemia as hypoxia = produce more
  2. Hypoglycaemia
  3. Hypothermia
  4. Thrombocytopenia - BM concentrating on making RBC
  5. NEC
  6. Meconium aspiration syndrome as stressed
  7. IRDS as less surfactant
  8. Infection
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5
Q

What are long term problems of LBW [5]

A 
DM, Obesity
Hypertension, IHD, Stroke
Reduced Growth 
Renal failure
Lung - asthma
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6
Q

What is mild LBW and what is considered extreme

A

LBW <2.5kg

Extreme <1kg

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7
Q

What is symmetric LBW [2]

A

OFC and weight in the same percentile

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8
Q

Pathogenesis of symmetric IUGR

What causes symmetric [4]

A

1st trimester insult
Affects all DNA

Chromosomal
Infection / TORCH
Teratogens
Severe smoke / alcohol

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9
Q

Will symmetric LBW improve

A

Unlikely as will never have enough cells

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10
Q

What is asymmetric [2]

A

OFC spared

Weight <10 centile

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11
Q

What causes asymmetric LBW [3]

A

3rd trimester insult
Placental insufficiency
PET
Small amount of smoking/drug use

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12
Q

Why is LBW associated with hypothermia

A

Lack of fat stores

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13
Q

Why is LBW associated with hypoglycaemia

A

No glycogen reserve as IUGR throughout pregnancy so constantly used up

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14
Q

Hematological sequelae of hypoxic state in utero of LBW babies cause [5]

A
  • Increased haematocrit 20-22 (normal 18-20)
  • Increased bilirubin as have to break down
  • Increased plasma viscosity (VTE / slow circulation)
  • Polycythaemic to increase RBC as hypoxic
  • Thrombocytopenia as BM making RBC
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15
Q

How do you treat the hypoxic state of LBW babies

A

Partial exchange transfusion

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16
Q

Why does premature make you more prone to infection [3]

A

IgG transfer in 3rd trimester
Immune system is underdeveloped
Interventions in premature
Chorioamnionitis

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17
Q

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

A

Pre-term appropriate gestational age higher risk of complications
SGA baby will have been under stress in the womb so produce natural steroids to mature lungs

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18
Q

What is most important in LBW babies

A

Nutrition

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19
Q

What causes pre-term babies [4]

A

Idiopathic
External: Smoking, Malnutrition
Maternal infection (chorioamnionitis), PET, DM
Factors that stretch womb: Polyhydramnios, Twins
APH, PPROM

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20
Q

What is term

A

37-42

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21
Q

Mild prematurity

A

32-37

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22
Q

Moderate

A

28-32

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23
Q

Extreme

A

<28 weeks

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24
Q

What is important if premature [5]

A 
Fluid - dextrose
TPN if long term, Syringe feed, NG
Vitamins Abidec
Iron at 28 days 
Establish feet
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25
Complications of respiratory distress syndrome if untreated? [3]
Respiratory distress Exhaustion Respiratory failure - hypoxia/. hypercapnia
26
What are RF for IRDS [3]
Pre-term DM C-section
27
How do you Dx [2]
Blood gas | CXR - indistinct heart border
28
How do you prevent [2]
Antenatal steroid, 12 hours apart | Delay birth with tocolytics
29
How do you Rx [2]
O2 - nasal or mask or just flow to maintain pressure | CPAP - open and inflate alveoli after intubation
30
Complications [4]
Retinopathy Renal failure due to hypoxia PTX Bronchopulmonary dysplasia
31
When do you use CPAP
If only problem is keeping airway open
32
What is Ddx of IRDS [5]
``` Sepsis TTN Meconium aspiration Congenital lung Cardiac anomaly ```
33
What causes bronchopulmonary dysplasia [4] | Pathophysiology [2]
- volume barotrauma - atelectasis - oxygen toxicity - infection via ETT inflammation and scarring of lungs (necrotising bronchiolitis with alveolar fibrosis)
34
What does bronchopulmonary dysplasia cause [4]
Persistent hypoxia Difficulty weaning off ventilation Severe bronchiolitis Poor feeding
35
How do you treat bronchopulmonary dysplasia [4]
Steroids Surfactant High calories feeding diuretics (SPIRNOLACTONE and FUROSEMIDE)
36
What are complications of bronchopulmonary dysplasia [5]
``` GORD Feeding issue Decreased IQ Cerebral palsy Asthma ```
37
What minor issues is there in terms of respiration [3]
Apnoea >15s Desaturation Irregular breathing
38
How do you treat minor respiratory problems in premature infants [2]
Caffeine - neuroprotective and stimulates resp | NCPAP
39
When does IVH occur Ax Px [2]
First 72 hours Ax: rupture of germinal matrix blood vessels Px: - blood vessels in germinal matrix, lateral to ventricles lack structural support and rupture - particularly with abnormal cerebral autoregulation
40
Signs of IVH [8]
``` Seizure Bulging fontanelle Cerebral irritability, drowsiness Diminished or absent moro reflex Poor muscle tone Apnoea Pallor, cyanosis Failure to suck, shrill cry ```
41
How do you Dx [3]
Cranial USS as fontanelle hasn't closed MRI Bloods
42
How do you Rx [3]
Fluid replacement Anticonvulsants Acetazolamide to prevent post-hemorrhagic hydrocephalus
43
What do you do if hydrocephalus / raised ICP [2]
Drainage | Shunt
44
What are complications of IVH [3]
Post haemorrhagic hydrocephalus if clot occlude Decreased IQ Cerebral palsy
45
What types of intracranial haemorrhage are there
IVH = most common in pre-term SAH Subdural after forceps
46
What causes hypoxic ischaemic encephalopathy? [7] What is HIE?
``` IVH Placental insufficiency, abruption Cord prolapse Long delivery Maternal hypoxia Infection Anaemia ``` HIE is brain injury secondary to hypoxic ischemic insult and reperfusion injury
47
What does mild HIE present with [2]
Hyperalert | Hypertonia
48
HIE associated symptoms [3] | Ix [2]
Resp depression Coma Encephalopathy within first 24h ie seizures Ix: capillary gas (at birth pH <7 and base excess -12), flat line in EEG
49
Describe EEG in HIE
EEG | Flat single line
50
How do you Mx HIE[4]
Support seizure Avoid hyperthermia Therapeutic hypothermia Cranial USS, MRI and neurodevelopmental f/u
51
What are the complications HIE [5]
``` Cerebral palsy Epilepsy Blind Deaf Learning difficulty ```
52
Describe general resuscitative management in HIE [4] | Describe therapeutic hypothermia [2]
General principles: - Intermittent positive pressure ventilation (IPPV) - Avoid hyperthermia - Cerebral function analysis monitoring - Phenobarbital Therapeutic hypothermia: - baby cooled to 33o for 72h and then rewarmed slowly over 12h with sedation
53
Ax of neonatal sepsis. Differentiate between early and late onset by the typical causative organisms [3] Risk factors of early onset sepsis [5] Risk factors of late onset sepsis [5]
Early onset: transplacental or ascending infection by GBS, E.coli, listeria Late onset: environmental infection by coagulase negative staphylococci, staph aureus, GBS, candida Risk factors: - Early onset: prolonged rupture of membranes, maternal infection, preterm labour, fetal distress, mucosal/skin breaks in neonate - Late onset: central lines and catheters, congenital malformations e.g. spina bifida, severe illness, malnutrition, immunodeficiency
54
How does sepsis present? [7]
``` Fever/hypothermia Resp distress Poor feeding, lethargy Jaundice Hypoglycaemia, Seizure Shock, Collapse DIC ```
55
What are the complications of group B strep [5]
``` Meningitis DIC Pneumonia, Respiratory failure Hypotension Shock ```
56
How long does GBS last
Early = 1 week | Can recur up to 3 months
57
How do you investigate sepsis? [7]
``` Admit NICU SEPSIS 6 protocol FBC, CRP (repeat as could be delayed) Blood cultures VBG, Glucose CXR LP ```
58
What do you do if 1 RF
Observe
59
What do you do if 2RF or red flag
Full sepsis screen IV Ax to baby Even if no signs
60
What antibiotics to give EMPIRICALLY: Early onset [2] Late onset [2]
Early onset: - IV pencilling or vancomycin - + gentamicin Late onset: - IV flucloxicillin - +gentamicin
61
When can you stop gent
2x CRP <4
62
What do you do when cultures back? [4]
Vanc if MRSA Metronidazole If surgical or abdominal concerns Cefotaxime for meningitis Amoxicillin for listeria
63
Etiology of neonatal hypoglycemia - describe 3 mechanisms
* Limited glucose supply: prematurity, perinatal stress * Hyperinsulinism: diabetic mothers, labetalol use in pregnancy * Increased glucose utilisation: SGA, LGA, hypothermia, sepsis
64
What should all irritable babies get [3]
U+E BG Sepsis screen
65
How do you treat [3]
IV 10% glucose Regular electrolyte if on fluid Hydrocrotisone
66
What causes haemorrhage disease of newborn
Vit K defiicency
67
How does HDON present [3]
Bruising Jaundice IVH / kidney

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