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Paediatrics finals > Prematurity > Flashcards

Prematurity Flashcards

1
Q

What is prematurity?

A

Delivery before 37 completed weeks gestation

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2
Q

Name the 3 types of prematurity as defined by WHO

A

Extreme preterm - <28 weeks
Very preterm - 28-32 weeks
Moderate to late preterm - 32-37 weeks

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3
Q

How many babies each year are born <37 weeks?

A

15 million

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4
Q

What is the most common cause of neonatal death globally?

A

Prematurity

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5
Q

What is the number one cause of death in <5yos?

A

Prematurity

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6
Q

What do morbidity and mortality rates depend on?

A

Gestation
Birth weight
High/low income country of birth

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7
Q

List some risk factors for prematurity

A

Previous preterm delivery
Multiple pregnancy

Smoking and illicit drug use

Being over/underweight

Early pregnancy - being <6months of previous pregnancy

Problems involving cervix, placenta and uterus (infection)

Chronic conditions - diabetes and hypertension

Physical injury or trauma

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8
Q

Describe the clinical features from the history of prematurity

A

Estimated due date
In cases where antenatal care has not been accessed the assessment of gestational age needs to be made by the clinician

LMP can be used to estimate gestational age but this may not be known

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9
Q

Describe examination of a preterm baby to check for gestational age

A

Dubowitz/ballard examination for gestational age - estimates neonatal maturity - uses a combination of external physical and neuromuscular features to determine this score
Estimate of a 2 week window of gestation

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10
Q

What physical features are assessed in the preterm?

A 
Skin
Lanugo (soft, thin hairs)
Eye
Ear 
Genital formation 
Neuromuscular assessment - posture and arm recoil
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11
Q

What investigations should be done in the preterm infant?

A 
Blood gas
FBC
U&Es
Blood culture
CRP
Blood group and direct coombs test/direct antiglobulin test (DCT/DAT)
CXR
AXR
Cranial ultrasound scan CrUSS
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12
Q

Describe the management of preterm infant

A

Start antenatally - tertiary level neonatal unit

Obstetric team should administer a course of antenatal steroids

Magnesium sulphate

Parents counselled

Resuscitation

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13
Q

Describe the effect of antenatal steroids on the baby

A

Reduce the risk of death, intraventricular haemorrhage and respiratory distress

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14
Q

Describe the effect of magnesium sulphate on the baby

A

Neuroprotective

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15
Q

Describe the guidelines on resuscitation of the preterm baby

A

<23 weeks - no resuscitation
23-23+6 weeks - may be a decision not to resuscitate in the best interests of the baby
24-24+6 weeks - resuscitation should be commenced unless the baby is thought to be severely compromised
>25 weeks - appropriate to resuscitate and start intensive care

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16
Q

Describe the organs of a preterm

A

Immature and require assistance

17
Q

What respiratory complications can occur?

A 
Respiratory distress syndrome
Surfactant deficient lung disease
Chronic lung disease
Bronchopulmonary dysplasia
Recurrent apnoea
18
Q

Describe the management of respiratory complications

A

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

19
Q

Describe the cardiovascular complications

A

Hypotension
Perfusion abnormalities
PDA

20
Q

Describe the management of cardiovascular complications

A

Inotrope infusions - dopamine, dobutamine, adrenaline and noradrenaline

Fluid management

Ibuprofen or indomethacin administration

Ligation of PDA

21
Q

Describe the neurological complications

A 
Intraventricular haemorrhage
Seizures
Post haemorrhagic ventricular dilation 
Neurodevelopmental delay 
Cerebral palsy
22
Q

Describe the management of neurological complications

A 
Regular CrUSS surveillance
Regular head circumference measurement
Administration of antiepileptic drugs - phenobarbital and phenytoin 
Refer to neurosurgical team
Long term neurodevelopmental follow up 
Awareness of level of stimulation
23
Q

Describe the GI complications

A

Immature gut causing feed intolerance and necrotising enterocolitis

24
Q

Describe the management of GI complications

A 
TPN
Nasogastric and orogastric feeds
Maternal and donor expressed milk 
Feeding protocol 
Antibiotic therapy and surgical review if NEC suspected
25
Q

Describe the renal complications

A

Immature renal function

26
Q

Describe the management of immature renal function

A

Close monitoring of fluid and electrolyte balance

Electrolyte supplements

When indicated catheterisation

27
Q

Describe the metabolic complications of prematurity

A

Jaundice
Hyperglycaemia
Hypoglycaemia
Inborn errors of metabolism

28
Q

Describe the management of metabolic complications

A

Phototherapy
Exchange transfusion
Increase concentration or volume of glucose given via IV access
Baseline metabolic investigations - Guthrie card

29
Q

Describe the skin complications of prematurity

A

Immature skin barrier leading to increased insensible losses and increased risk of infection

30
Q

Describe the management of skin complications

A

Nurse in a warm, humid incubator, aseptic non touch technique during procedures

31
Q

Describe the eye complications of prematurity

A

Retinopathy of prematurity

32
Q

How is retinopathy of prematurity prevented/managed?

A

Avoid excessive O2 exposure
Screening by ophthalmology team
Laser treatment if indicated

33
Q

What is the percentage survival for 26 weeks gestation?

A

75%

34
Q

What is the percentage survival for 27 weeks gestation?

A

90%

35
Q

What increases the chance of neurodevelopmental impairment

A

The earlier the baby is born

36
Q

Describe the neurodevelopmental impairment

A

Gross motor
Fine motor
Speech and language
Learning and behavioural difficulties

Paediatrics finals (37 decks)

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