Prematurity Flashcards
What defines prematurity
Birth before 37 weeks gestation
What is extreme preterm
> 28 weeks
What is moderate/late preterm
32-38 weeks
Associations with prematurity
Social deprivation, smoking, alcohol, drugs, overweight, underweight, maternal co-morbidities, twins, person or family history of prematurity
Options for trying to delay birth
Prophylactic vaginal progesterone or prophylactic cervical cerclage
Options when preterm labour is suspected or confirmed
Tocolysis with nifidipine, maternal corticosteroids, IV Mg sulfate, delayed cord clamping or cord milking.
Issues faced in early premature life
RDS
Hypothermia
Hypoglycaemia
Poor feeding
Apnoea
Bradycardia
Neonatal jaundice
Intraventricular haemorrhage
Retinopathy of maturity
Necrotising enterocolitis
Immature immune system
Infection
Long term complications of prematurity
Chronic lung disease
Learning and behavioural difficulties
Susceptibility to infections - particularly RTIs
Hearing and visual impairment
Cerebral palsy
What causes respiratory distress syndrome
Lack of surfactant, causing surface tension and alveoli to collapse
Symptoms of RDS
Blue coloured lips (cyanosis) fingers and toes, rapid shallow breathing, flaring nostrils, grunting sound when breathing
Management of RDS
Intratracheal instilation of artificial surfactant.
Glucocorticoids before delivery.
Long line put in.
MEchanical ventilation.
BPAP/high flow O2/nasal cannulae.
Ambient incubator oxygen.
What causes feeding difficulties
Immature gut resulting in feed intolerance
Management of feeding difficulties
Total parenteral nutrition.
Ng or OG tubes.
Maternal and donor expressed milk
Feeding protocols
What is IVH
Blood vessels in the brain of premature infants are not yet fully developed and are extremely fragile. Rarely presents at birth and happens in first several days of life
Symptoms of IVH
May be none, but can have breathing pauses, decreased muscle tone, decreased reflexes, excessive sleep, lethargy, weak suck
Diagnosis of IVH
Routine head US to all babies under 30 weeks. Head CT if there are symptoms
What is NEC
Condition in which bowel of premature infants becomes ischaemic and infarcted. It’s precise cause is unclear
Risk factors for NEC
Prematurity, low birth weight, non-breast milk feeds, sepsis, acute hypoxia, poor intestinal perfusion
Presentation of NEC
Usually presents in premature neonates in first 3 weeks of life. Vomiting, bloody stools, abdominal distension, absent bowel sounds, signs of systemic compromise such as acidosis on BG
Diagnosis of NEC
Abdominal XR. Bowel loops will be dilated, pneumatosis intestinalis (gas within bowel), portal venous gas, penumoperitoneum.
How is NEC staged
Using Bell’s classification, which is a mix of clinical and radiological signs and findings
Management of NEC
Patients made nil-by-mouth, NG tube passed and be admitted to neonatal unit. Broad spectrum antibiotics, total paental nutrition to rest bowel, supportive treatment with IV fluids and ventilation, surgery to resect necrotic sections of bowel may be necessary and essential in cases of bowel perforation.
What is retinopathy of prematurity
Abnormal development of blood vessels in the retina which can lead to scarring, retinal detachment adn blindness.
Main treatment of retinopathy of maturity
Systemically targetting areas of the retina to stop new blood vessels forming.
Transpupillary laser photocoagulation to halt and reverse neurovascularisation.
Other options for treatment of retinopathy of prematurity
Cryotherapy, injections of intravitreal inhibitors, surgery if retinal detachment occurs
What is apnoea of prematurity
Where breathing stops spontaneously for more than 20 seconds or shorter periods with oxygen desaturation or brachycardia
Management of apnoea of prematurity
Apnoea monitors, tactile stimulation, IV caffeine to prevent, episodes will settle as baby grows
Causes of apnoea of prematurity
Imaturity of ANS, infection, anaemia, airway obstruction, CNS pathology, GORD, neonatal abstinence syndrome
Why is there jaundice in a premature baby
Exaggerated due to immature liver, and increased risk of complicationss
What is Kernicterus
Brain damage due to high levels of bilirubin
Management of jaundice
Phototherapy or exchange transfusion is levels are really high
