Prematurity Flashcards
What is prematurity?
Birth before 37 weeks
What are the WHO classifications of prematurity? (3 things)
- Extreme preterm: 28- wks
- Very preterm: 28-32 wks
- Moderate to late preterm: 32-37 wks
What are the causes of Prematurity? (4 things)
- Planned prematurity (25%)
- Premature / prelabour rupture of membranes (40%)
- Emergency (25%)
- Unknown cause (40%)
What things can make you Plan a premature birth? (3 things)
Life threatening conditions for mother / foetus:
- Pre-eclampsia
- Renal disease
- Severe growth restriction
What things can cause an Emergency premature birth? (3 things)
- Placental abruption
- Eclampsia
- Severe infection
What are the RF for prematurity? (6 things)
- Prematurity Hx / FHx
- Smoking / Alcohol / Drugs
- Underweight / Overweight mother
- Early pregnancy (within 6 months of previous pregnancy)
- Cervix / Uterus / Placenta problems (e.g infection)
- DM / HTN
If it is a concealed / unknown pregnancy, how do you work out the gestational age? (2 things)
- Hx - Last Menstrual Period
- Examination
What examination can be done to work out gestational age?
Dubowitz/Ballard Examination
What features are included in the Dubowitz/Ballard examination? (2 things)
- Physical features: Skin / Lanugo (aka thin soft hairs) / Formation of Eye / Ear / Genitals
- Neuromuscular features: Posture / Arm recoil
What investigations should you for a premature baby? (7 things)
- FBC
- UnEs
- CRP
- Blood gas
- Blood culture
- Blood group
- Direct Coombs Test (aka direct antiglobulin test)
What are you checking for when you check a preterm baby’s FBC and why? (3 things)
- Infection (WBC)
- Thrombocytopaenia (platelets)
- Anaemia (RBC)
Because preterm babies are high risk for these things
What are you checking for when you check a preterm baby’s UnEs?
Renal function
Why should you check a preterm baby’s CRP? (3 things)
Bc high risk of infections bc:
- Immature immune system
- Multiple invasive procedures
- Lots of central lines
What are you checking for when you check a preterm baby’s Blood gas?
Respiratory / Metabolic state
Why do you need to check a preterm baby’s Blood group / Direct Coombs Test?
Because many preterm babies require Blood Transfusion
What imaging can you do for a preterm baby? (3 things)
- CXR
- AXR
- Cranial US
What signs in a preterm baby should prompt you to doing a CXR? (3 things)
Resp distress signs:
- Tachypnoea
- Increased work of breathing
- Oxygen dependency
All babies born before WHAT week number will require respiratory support?
32 weeks (aka all Extreme and Very preterm babies)
What is the use of a CXR in a preterm baby that is intubated and ventilated?
Check position of endotracheal tube
Why do preterm babies need beh Central lines inserted?
Bc need parenteral nutrition + IV infusions for first few days / weeks of life
What is the use of an AXR in a preterm baby? (2 things)
- Check position of Central Venous + Arterial access (thru umbilical vein / artery)
- Check for signs of Necrotising Enterocolitis
What are you looking for in an AXR when you sus Necrotising Enterocolitis? (3 things)
- Perforation signs, esp Football sign (massive pneumoperitoneum)
- Pneumatosis intestinalis (air in walls of bowels)
- Immobile bowel loops
What are you checking for in a Cranial US of a preterm baby? (2 things)
- Signs of Intraventricular haemorrhage
- Signs of Ischaemic periventricular white matter damage
In what preterm babies is Cranial US ROUTINELY done for?
Before 32 weeks (aka Extreme and Very preterm babies)