prematurity Flashcards
classification of prematurity based on GA
i. Late preterm = GA 34-37 weeks
ii. Moderate preterm = GA 32-<34 weeks
iii. Very preterm = GA 28-<32 weeks
iv. Extremely preterm = <28 weeks
classification of prematurity based on weight
i. LBW = <2500g
ii. VLBW = <1500g
iii. ELBW = <1000g
Rx if prem delivery is expected
tocolytic e.g. CCB nifedipine
Abx - benpen for GBS
MgSO4 for neuroprotection (if <30w)
steroids for respprotection (all <37w)
pathogenesis of ROP
initial insult > injury to new vessels
disruption of normal angiogenesis > retinal oedema from leaky vessels > haemorrhage
spastic diplegia = what basically
PVL
SGA vs FGR
SGA = infants with BM <10th centile for gestational age
FGR = estimated fetal weight <10th centile
what syndrome causes asymmetric IUGR
Russell-Silver = asymmetric growth impairment (head size is normal)
what is the barker hypothesis
IUGR increases risk of t2dm, insulin resistance, HTN, obesity, cvd, stroke
how does a foetus get vit D
1,25 dihydroxyvitamin D DOES NOT cross placenta
placental 24-hydroxylase, changes it to 24,25 dihydroxyvitamin D3 (a less active metabolite than its precursor)
which of the following causes neonatal withdrawal? which are teratogenic? which doesn’t reduce growth?
- nicotine
- alcohol
- THC
- opiates
- cocaine
withdrawal: alcohol, opiates (methadone > heroin), cocaine
teratogenic: alcohol, cocaine
THC only one that doesnt affect fetal growth
maternal smoking increases risk of
SIDS
T2DM
obesity
HTN
dyslipidaemia
behaviour / cognition / psychiatric issues
subcutaneous fat necrosis - appears like?
firm, indurated nodules and plaques on the back, buttocks, thighs, forearm and cheeks
Nodules and plaques may be erythematous, flesh coloured or blue
where are the following bleeds?
1. Caput
2. Cephalhaematoma
3. Subgaleal
4. Extradural
5. Subdural
6. Subarachnoid
- Caput – CT and aponeurosis
- Cephalhaematoma – periosteum and bone
- Subgaleal – aponeurosis and periosteum
- Extradural – periosteum/outer dura and bone
- Subdural – dura and arachnoid
- Subarachnoid – arachnoid and pia
caput succedanaeum vs cephalohaematoma
caput can cross midline, cephalo does not
cx of cephalohaematoma
calcification > deformity
25% underlying fracture
E.Coli infection
why important to differentiate a subgaleal
massive blood loss risk - its not bound by periosteum so can just bleed into the epidural space
subgaleal vs caput/cephalohaematoma
vs cephalo: subgaleal will expand, not bound by suture lines
vs cephalo: boggy, not firm
vs caput: caput is biggest at birth
most common fracture vs long bone fracture in delivery
clavicle most common
humerus most common long bone
presentation of erb’s palsy
- Limp arm in “waiter’s tip” position – arm held in adduction, elbow extended and forearm pronated with wrist flexed
- Absent biceps jerk
- +/- phrenic nerve involvement with diaphragmatic palsy in 5%
erb vs klumpke’s palsy
erb - c5-c7
klumpke - C8-T1: clawhand, wristdrop, no grasp
MOA of phototherapy
converts toxic native Z bilirubin to lumirubin (E bilirubin), a isomer that the kidneys can excrete
what kind of CP does kernicterus cause
choreoathetoid CP
NAS normally onset on what day
day 3***
naloxone in NAS - comment
NOOO can induce rapid withdrawal»_space; seizures
symptoms of NAS
CNS: high pitched cry, hypertonia, tremors, seizures
ANS: excoriation, diaphoresis, temp instability
GIT: poor feed, uncoordinated suck, vomits, excoriation
umbilical granuloma - what? presents as? NTBM
low-grade infection of umbilical stump
Presents soon after cord separation as red, friable granulation tissue in region of umbilicus.
Discharge of urine or faeces from umbilicus suggests Urachal or Vitello-intestinal duct anomalies
congenital clouding of cornea
- most common cause
- infectious cause
- stupid exam cause
most common = congenital glaucoma
infectious = herpes / rubella
all MPS
duodenal atresia, think what syndrome
T21
indomethacin and NEC - comment
• Indomethacin increases risk of spontaneous perforation but NOT NEC
nitric oxide and B12- comment
prolonged NO suppresses liver enzymes»_space; inactivates B12»_space; B12 neuropathy/myelopathy/encephalopathy
at what gestation does nutritive sucking occur
Between 32 weeks gestation and term, infants learn to coordinate sucking and swallowing with breathing, and develop adaptive aerodigestive protective mechanisms
some ddx for neonatal hypertension
renal
- congenital: pckd, obstructive
- acquired: AKI, nephrocalcinosis
vascular
- thrombi, RAS
resp = BPD
endocrine = CAH, hyperthyroid
define hydrops fetalis
2 or more abnormal fetal fluid collections
i. Ascites
ii. Pleural effusion
iii. Pericardial effusion
iv. Skin oedema = late sign of fetal hydrops
etiology of hydrops fetalis
immune (20%)
non-immune (80%)
- cardiovascular 40%
- anaemia 30%
- metabolic
- other: lymphatic obstructive issues, hypoproteinaemia
causes of raised antenatal AFP
Abdominal wall defects,
renal disease,
materno-fetal bleed,
annular pancreas,
duodenal atresia,
epidermolysis bullosa
clinical tetrad of chronic kernicterus
- Sensory neural hearing loss.
- Dental enamel hypoplasia.
- Choreoathetoid cerebral palsy.
- Oculomotor paresis of upward gaze.
explain paradoxical cyanosis in choanal atresia
when the infant begins crying, they unconsciously begin mouth breathing, usually leading to the signs of respiratory distress and cyanosis to disappear.
