Prematurity Flashcards
Define prematurity
Birth before 37 weeks gestation
Prematurity classification
Under 28 weeks: extreme preterm
28-32 weeks: very preterm
32-37 weeks: moderate to late preterm
Prematurity associations/risk factors
Social deprivation
Smoking
Alcohol
Drugs
Overweight/underweight mother
Maternal co-morbidities
Twins
Personal or FHx of prematurity
Options for delaying birth
Prophylactic vaginal progesterone (suppository)
Prophylactic cervical cerclage (suture in cervix)
In which women do we aim to delay birth?
Women with a history of preterm birth
USS scan demonstrating cervical length of 25mm or less before 24/40
Options for improving outcomes if preterm labour suspected/confirmed
Tocolysis with nifedipine (a CCB that suppresses labour)
Maternal corticosteroids (offered before 35/40 to reduce neonatal morbidity and mortality)
IV magnesium sulphate (offered before 34/40 to protect baby’s brain)
Delayed cord clamping or cord milking (increases circulating blood volume and haemoglobin in baby)
Issues in early life
Respiratory distress syndrome
Hypothermia
Hypoglycaemia
Poor feeding
Apnoea and bradycardia
Neonatal jaundice
Intraventricular haemorrhage
Retinopathy of prematurity
Necrotising enterocolitis
Immature immune system and infection
Long term effects of prematurity
Chronic lung disease of prematurity
Learning and behavioural difficulties
Susceptibility to infections, particularly respiratory tract infections
Hearing and visual impairment
Cerebral palsy
Apnoea of prematurity definition
Periods where breathing stops spontaneously for more than 20 seconds, or shorter periods withoxygen desaturation orbradycardia
Pathophysiology of apnoea of prematurity
Occurs due to immaturity of the autonomic nervous system that controls respiration and heart rate
Management of apnoea of prematurity
Apnoea monitors
Tactile stimulation used to prompt baby to start breathing
IV caffeine to prevent apnoea and bradycardia in babies with recurrent episodes
Retinopathy of prematurity definition
Abnormal development of blood vessels in retina
Typically affects babies bore before 32/40
Retinopathy of prematurity screening
Babies born before 32/40 or under 1.5kg should be screened
Performed by ophthalmologist
30-31 weeks in babies born before 27 weeks
4-5 weeks in babies born after 27 weeks
Screening should happen at least every 2 weeks and can cease once retinal vessels enter zone 3
Treatment of retinopathy of prematurity
Systematically target areas of retina to prevent new blood vessels developing
First line: transpupillary laser photocoagulation
Other options: cryotherapy, injections of intravitreal VEGF inhibitors
Surgery if retinal detachment occurs
