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MOD > Prematurity (10) > Flashcards

Prematurity (10) Flashcards

1
Q

What defines prematurity?

A

Gestational age LESS than 37 weeks

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2
Q

Gestational age less than 37 weeks is defined as?

A

Prematurity

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3
Q

4 risks for prematurity?

A
  1. PPROM
  2. Intrauterine infections
  3. Uterine, cervical, placental abnormalities
  4. Multiple gestations
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4
Q

PPROM

A

Preterm Premature Rupture of Membranes before 37 weeks

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5
Q

Rupture of Membrane means?

A

Amniotic membrane spontaneously ruptures

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6
Q

What increases risk for PPROM?

A

History of PPROM, bleeding during pregnancy and maternal smoking

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7
Q

Chorioamnionitis

A

Inflammation of the placental membranes

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8
Q

Inflammation of the placental membranes

A

Chorioamnionitis

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9
Q

Funisitis

A

Inflammation of fetal umbilical cord

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10
Q

Inflammation of fetal umbilical cord

A

Funisitis

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11
Q

What histologic correlates are seen with intrauterine infections?

A

Chorioamnionitis

Funisitis

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12
Q

With prematurity, what are some things that could result?

A

Neonatal Respiratory Distress Syndrome
Necrotizing Enterocolitis
Sepsis
Intraventricular hemorrhage

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13
Q

Although preterm infants have low birth weight, is it usually proportional to their gestational age?

A

Yes

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14
Q

Infants who weigh less than 2500g at term are considered?

A

Undergrown (SGA)

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15
Q

Infants who weigh less than 2500g at term are given the designation?

A

SGA

Small for Gestational Age

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16
Q

What do SGA infants suffer from?

A

FGR

Fetal Growth Restriction

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17
Q

What 3 factors can cause FGR and thus SGA?

A

Maternal
Fetal
Placental

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18
Q

Most common maternal abnormality associated with FGR?

A

Decreased placental blood flow

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19
Q

What are examples of maternal conditions that can cause decreased placental blood flow and thus FGR?

A

Pre-eclampsia and Chronic Hypertension

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20
Q

Most common fetal abnormalities associated with FGR?

A

Congenital anomalies

Infections

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21
Q

If FGR is due to a fetal factor, how will the growth restriction present?

A

Symmetric

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22
Q

If FGR is due to a placental factor, how will the growth restriction present?

A

Asymmetrical that spares the brain

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23
Q

Another name for Neonatal Respiratory Distress Syndrome

A

Hyaline Membrane Disease

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24
Q

Cause of RDS?

A

Pulmonary immaturity and surfactant deficiency

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25
Q

What stimuli promote surfactant DEFICIENCY?

A

Insulin and C section

26
Q

What stimuli promote surfactant synthesis?

A

Cortisol and Labor

27
Q

What cells produce surfactant and when is production amplified?

A

Type 2 alveolar cells after 35 weeks gestation

28
Q

Decreased surfactant directly causes?

A

Increased surface tension in the alveoli

29
Q

Increased surface tension in the alveoli causes?

A

Atelectasis - collapse of lung tissue due to loss of alveolar spaces

30
Q

Decreased surfactant causes increased tension and atelectasis. What does that cause?

A

Hypoventilation and uneven perfusion

31
Q

Main result of decreased surfactant, increased tension and atelectasis?

A

HYPOXEMIA AND CO2 RETENTION

32
Q

Describe the order of events that ensue to get Hypoxemia and CO2 retention with RDS

A
  • Decreased surfactant production
  • Increased surface tension in the alveoli
  • Atelectasis (collapse of alveoli)
  • Hypoventilation and uneven perfusion
    = HYPOXEMIA and CO2 RETENTION
33
Q

Once Hypoxemia and CO2 retention have occurred with RDS, then what ensues?

A

Acidosis and pulmonary vasoconstriction that damages endothelial and epithelial cells

34
Q

Acidosis and pulmonary vasoconstriction that damages the pulmonary cells then causes what?

A

Plasma leaks into the alveoli

35
Q

If plasma leaks into the alveoli, what is formed?

A

Fibrin + necrotic cells

36
Q

Fibrin + necrotic cells =

A

Hyaline membrane disease

37
Q

Once Hypoxemia and CO2 Retention occur, describe how hyaline membrane disease is established

A
  • Hypoxemia and CO2 retention
  • Acidosis and pulmonary vasoconstriction damages the endothelial and epithelial cells
  • Plasma is able to leak into the alveoli
    = Fibrin + necrotic cells in the lungs
38
Q

Once RDS is already taking place, what in the cycle only causes further surfactant deficiency?

A

Hypoxemia and CO2 Retention

39
Q

What do the lungs look like with RDS?

A

Solid, airless, reddish - purple color and they sink in water

40
Q

Hyaline membrane disease has what characteristic features?

A

Necrotic tissue inside eosinophilic hyaline membranes made of fibrin

41
Q

Symptoms of RDS?

A

Trouble breathing and cyanosis right after birth

42
Q

How can you tell how much surfactant is present in a child’s lungs?

A

Measure the phospholipids in the amniotic fluid

43
Q

An L/S ratio of > ___ indicates mature lungs

A

2

44
Q

What are the 2 options to prevent RDS and preterm birth?

A
  1. Delay preterm labor

2. Give antenatal steroids to increase maturation of lungs

45
Q

2 complications that can arise after RDS?

A
  1. Retrolental Fibroplasia

2. Bronchopulmonary Dysplasia

46
Q

Retrolental Fibroplasia

A

Occurs after RDS

- Increased VEGF –> induces angiogenesis and blood vessel formation that causes lesions on the retina

47
Q

What is increased with Retrolental Fibroplasia?

A

VEGF

48
Q

What cytokines cause Bronchopulmonary Dysplasia?

A

TNF
IL-6
IL-8
IL-1beta

49
Q

With Bronchopulmonary Dysplasia, what do the cytokine cause to happen?

A

Arrest alveolar development = large simplified alveoli

50
Q

What 3 things are infants who survive RDS at risk for?

A
  1. Patent ductus arteriosus
  2. Intraventricular hemorrhage
  3. NEC
51
Q

NEC

A

Necrotizing Enterocolitis

52
Q

What are most causes of Necrotizing Enterocolitis associated with?

A

Introduction of bacteria possible through enteral feeding

53
Q

What molecule is always increased with NEC?

A

PAF

platelet activating factor

54
Q

Describe the process of NEC

A
  • Bacteria entry
  • Increased PAF increases permeability and enterocyte apoptosis
  • Inflammation with bacteria now inside colon
  • Necrosis
  • Further bacterial entry
55
Q

What does increased PAF do?

A

Increases permeability and enterocyte apoptosis

56
Q

What portions of the intestines are commonly impacted by NEC?

A

Terminal ileum, cecum, right colon

57
Q

What does a segment of intestine look like with NEC?

A

Distended, gangrenous and with perforations

58
Q

If perforations are present in the intestine with NEC what can that cause?

A

Peritonitis

59
Q

What is always seen on x-ray with NEC?

A

GAS in the intestines!!!

pneumatosis Intestinalis

60
Q

Symptoms of NEC?

A

Bloody stool
Abdominal distention
Circulatory collapse
PNEUMATOSIS INTESTINALIS (GAS) on x-ray!!!!

MOD (68 decks)

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