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#Phase 2.2: Paediatrics > Prematurity > Flashcards

Prematurity Flashcards

1
Q

What is prematurity?

A

Birth before 37 weeks

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2
Q

What are the WHO classifications of prematurity? (3 things)

A
  1. Extreme preterm: 28- wks
  2. Very preterm: 28-32 wks
  3. Moderate to late preterm: 32-37 wks
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3
Q

What are the causes of Prematurity? (4 things)

A
  1. Planned prematurity (25%)
  2. Premature / prelabour rupture of membranes (40%)
  3. Emergency (25%)
  4. Unknown cause (40%)
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4
Q

What things can make you Plan a premature birth? (3 things)

A

Life threatening conditions for mother / foetus:

  1. Pre-eclampsia
  2. Renal disease
  3. Severe growth restriction
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5
Q

What things can cause an Emergency premature birth? (3 things)

A
  1. Placental abruption
  2. Eclampsia
  3. Severe infection
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6
Q

What are the RF for prematurity? (6 things)

A
  1. Prematurity Hx / FHx
  2. Smoking / Alcohol / Drugs
  3. Underweight / Overweight mother
  4. Early pregnancy (within 6 months of previous pregnancy)
  5. Cervix / Uterus / Placenta problems (e.g infection)
  6. DM / HTN
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7
Q

If it is a concealed / unknown pregnancy, how do you work out the gestational age? (2 things)

A
  1. Hx - Last Menstrual Period
  2. Examination
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8
Q

What examination can be done to work out gestational age?

A

Dubowitz/Ballard Examination

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9
Q

What features are included in the Dubowitz/Ballard examination? (2 things)

A
  1. Physical features: Skin / Lanugo (aka thin soft hairs) / Formation of Eye / Ear / Genitals
  2. Neuromuscular features: Posture / Arm recoil
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10
Q

What investigations should you for a premature baby? (7 things)

A
  1. FBC
  2. UnEs
  3. CRP
  4. Blood gas
  5. Blood culture
  6. Blood group
  7. Direct Coombs Test (aka direct antiglobulin test)
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11
Q

What are you checking for when you check a preterm baby’s FBC and why? (3 things)

A
  1. Infection (WBC)
  2. Thrombocytopaenia (platelets)
  3. Anaemia (RBC)

Because preterm babies are high risk for these things

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12
Q

What are you checking for when you check a preterm baby’s UnEs?

A

Renal function

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13
Q

Why should you check a preterm baby’s CRP? (3 things)

A

Bc high risk of infections bc:

  1. Immature immune system
  2. Multiple invasive procedures
  3. Lots of central lines
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14
Q

What are you checking for when you check a preterm baby’s Blood gas?

A

Respiratory / Metabolic state

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15
Q

Why do you need to check a preterm baby’s Blood group / Direct Coombs Test?

A

Because many preterm babies require Blood Transfusion

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16
Q

What imaging can you do for a preterm baby? (3 things)

A
  1. CXR
  2. AXR
  3. Cranial US
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17
Q

What signs in a preterm baby should prompt you to doing a CXR? (3 things)

A

Resp distress signs:

  1. Tachypnoea
  2. Increased work of breathing
  3. Oxygen dependency
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18
Q

All babies born before WHAT week number will require respiratory support?

A

32 weeks (aka all Extreme and Very preterm babies)

19
Q

What is the use of a CXR in a preterm baby that is intubated and ventilated?

A

Check position of endotracheal tube

20
Q

Why do preterm babies need beh Central lines inserted?

A

Bc need parenteral nutrition + IV infusions for first few days / weeks of life

21
Q

What is the use of an AXR in a preterm baby? (2 things)

A
  1. Check position of Central Venous + Arterial access (thru umbilical vein / artery)
  2. Check for signs of Necrotising Enterocolitis
22
Q

What are you looking for in an AXR when you sus Necrotising Enterocolitis? (3 things)

A
  1. Perforation signs, esp Football sign (massive pneumoperitoneum)
  2. Pneumatosis intestinalis (air in walls of bowels)
  3. Immobile bowel loops
23
Q

What are you checking for in a Cranial US of a preterm baby? (2 things)

A
  1. Signs of Intraventricular haemorrhage
  2. Signs of Ischaemic periventricular white matter damage
24
Q

In what preterm babies is Cranial US ROUTINELY done for?

A

Before 32 weeks (aka Extreme and Very preterm babies)

25
Q

What should you do later with the Cranial US results of a preterm baby?

A

Review it with an MRI @ later stage

26
Q

When does the management begin when sus preterm delivery pending?

A

Antenatally

27
Q

What can be done to try delay the birth of a preterm baby? (2 things)

A
  1. Prophylactic vaginal progesterone (progesterone suppository in vagina to discourage labour)
  2. Prophylactic cervical cerclage (suture in cervix to close it)
28
Q

What medication can you give to reduce Neonatal Mortality / Morbidity in a preterm?

A

Maternal corticosteroids

29
Q

What conditions do maternal corticosteroids reduce the risk of? (2 things)

A
  1. Intraventricular haemorrhage
  2. Resp distress syndrome
30
Q

When should you give Maternal corticosteroids?

A

Before 35 weeks gestation

31
Q

What can you give to PROLONG labour to give more time for the corticosteroids to work on the preterm baby?

A

Nifedipine (CCB) - can prolong labour by 2 - 7 days

32
Q

What can you give to protect the preterm babies brain?

A

Magnesium sulphate

33
Q

When should you give Magnesium sulphate?

A

Before 34 weeks gestation

34
Q

What do the guidelines say about resuscitating an Extremely preterm baby?

A
  • 23- weeks = DNR
  • 23 - 24 = Parents wishes
  • 24 - 25 = Resuscitate unless severely compromised
  • 25+ = Resuscitate + start intensive care
35
Q

What are the BRAIN complications of prematurity? (4 things)

A
  1. Intraventricular haemorrhage
  2. Periventricular leucomalacia (necrosis of white matter near ventricles) –> Epilepsy
  3. Post haemorrhagic hydrocephalus
  4. Cerebral palsy
36
Q

What is the EYES complication of prematurity?

A

Retinopathy

37
Q

Why do premature babies not retain heat well? (3 things)

A
  1. Increased s.a / volume ratio
  2. Immature skin
  3. Less subcut fat
38
Q

What are the RESP complications of prematurity? (4 things)

A
  1. Resp distress syndrome (surfactant deficiency)
  2. Apnoea
  3. Pneumothorax
  4. Chronic lung disease
39
Q

What are the CARDIAC complications of prematurity? (3 things)

A
  1. PDA (patent ductus arteriosus)
  2. HTN
  3. Bradycardia
40
Q

What are the GI complications of prematurity? (3 things)

A
  1. Necrotising enterocolitis
  2. Reflux
  3. Inguinal hernia (high risk of strangulation)
41
Q

What are the METABOLIC complications of prematurity? (4 things)

A
  1. Hypoglycaemia
  2. Hypocalcaemia
  3. Electrolyte imbalances (poor renal function)
  4. Osteopenia (risk of #)
42
Q

What are the INFECTION complications of prematurity? (3 things)

A
  1. Sepsis
  2. Pneumonia
  3. Central lines infection
43
Q

What are the BLOOD complications of prematurity? (2 things)

A
  1. Anaemia
  2. Jaundice
44
Q

What are the LONG TERM complications of prematurity? (6 things)

A
  1. Cerebral palsy
  2. Developmental delay
  3. Learning / behavioural difficulties
  4. Hearing / visual impairment
  5. Chronic lung disease
  6. Infection susceptibility

#Phase 2.2: Paediatrics (18 decks)

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