Prematurity Flashcards
What is prematurity?
Delivery before 37 completed weeks gestation
Name the 3 types of prematurity as defined by WHO
Extreme preterm - <28 weeks
Very preterm - 28-32 weeks
Moderate to late preterm - 32-37 weeks
How many babies each year are born <37 weeks?
15 million
What is the most common cause of neonatal death globally?
Prematurity
What is the number one cause of death in <5yos?
Prematurity
What do morbidity and mortality rates depend on?
Gestation
Birth weight
High/low income country of birth
List some risk factors for prematurity
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
Describe the clinical features from the history of prematurity
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
Describe examination of a preterm baby to check for gestational age
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
What physical features are assessed in the preterm?
Skin Lanugo (soft, thin hairs) Eye Ear Genital formation Neuromuscular assessment - posture and arm recoil
What investigations should be done in the preterm infant?
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
Describe the management of preterm infant
Start antenatally - tertiary level neonatal unit
Obstetric team should administer a course of antenatal steroids
Magnesium sulphate
Parents counselled
Resuscitation
Describe the effect of antenatal steroids on the baby
Reduce the risk of death, intraventricular haemorrhage and respiratory distress
Describe the effect of magnesium sulphate on the baby
Neuroprotective
Describe the guidelines on resuscitation of the preterm baby
<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
Describe the organs of a preterm
Immature and require assistance
What respiratory complications can occur?
Respiratory distress syndrome Surfactant deficient lung disease Chronic lung disease Bronchopulmonary dysplasia Recurrent apnoea
Describe the management of respiratory complications
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
Describe the cardiovascular complications
Hypotension
Perfusion abnormalities
PDA
Describe the management of cardiovascular complications
Inotrope infusions - dopamine, dobutamine, adrenaline and noradrenaline
Fluid management
Ibuprofen or indomethacin administration
Ligation of PDA
Describe the neurological complications
Intraventricular haemorrhage Seizures Post haemorrhagic ventricular dilation Neurodevelopmental delay Cerebral palsy
Describe the management of neurological complications
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
Describe the GI complications
Immature gut causing feed intolerance and necrotising enterocolitis
Describe the management of GI complications
TPN Nasogastric and orogastric feeds Maternal and donor expressed milk Feeding protocol Antibiotic therapy and surgical review if NEC suspected
Describe the renal complications
Immature renal function
Describe the management of immature renal function
Close monitoring of fluid and electrolyte balance
Electrolyte supplements
When indicated catheterisation
Describe the metabolic complications of prematurity
Jaundice
Hyperglycaemia
Hypoglycaemia
Inborn errors of metabolism
Describe the management of metabolic complications
Phototherapy
Exchange transfusion
Increase concentration or volume of glucose given via IV access
Baseline metabolic investigations - Guthrie card
Describe the skin complications of prematurity
Immature skin barrier leading to increased insensible losses and increased risk of infection
Describe the management of skin complications
Nurse in a warm, humid incubator, aseptic non touch technique during procedures
Describe the eye complications of prematurity
Retinopathy of prematurity
How is retinopathy of prematurity prevented/managed?
Avoid excessive O2 exposure
Screening by ophthalmology team
Laser treatment if indicated
What is the percentage survival for 26 weeks gestation?
75%
What is the percentage survival for 27 weeks gestation?
90%
What increases the chance of neurodevelopmental impairment
The earlier the baby is born
Describe the neurodevelopmental impairment
Gross motor
Fine motor
Speech and language
Learning and behavioural difficulties
