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)
What should you do later with the Cranial US results of a preterm baby?
Review it with an MRI @ later stage
When does the management begin when sus preterm delivery pending?
Antenatally
What can be done to try delay the birth of a preterm baby? (2 things)
- Prophylactic vaginal progesterone (progesterone suppository in vagina to discourage labour)
- Prophylactic cervical cerclage (suture in cervix to close it)
What medication can you give to reduce Neonatal Mortality / Morbidity in a preterm?
Maternal corticosteroids
What conditions do maternal corticosteroids reduce the risk of? (2 things)
- Intraventricular haemorrhage
- Resp distress syndrome
When should you give Maternal corticosteroids?
Before 35 weeks gestation
What can you give to PROLONG labour to give more time for the corticosteroids to work on the preterm baby?
Nifedipine (CCB) - can prolong labour by 2 - 7 days
What can you give to protect the preterm babies brain?
Magnesium sulphate
When should you give Magnesium sulphate?
Before 34 weeks gestation
What do the guidelines say about resuscitating an Extremely preterm baby?
- 23- weeks = DNR
- 23 - 24 = Parents wishes
- 24 - 25 = Resuscitate unless severely compromised
- 25+ = Resuscitate + start intensive care
What are the BRAIN complications of prematurity? (4 things)
- Intraventricular haemorrhage
- Periventricular leucomalacia (necrosis of white matter near ventricles) –> Epilepsy
- Post haemorrhagic hydrocephalus
- Cerebral palsy
What is the EYES complication of prematurity?
Retinopathy
Why do premature babies not retain heat well? (3 things)
- Increased s.a / volume ratio
- Immature skin
- Less subcut fat
What are the RESP complications of prematurity? (4 things)
- Resp distress syndrome (surfactant deficiency)
- Apnoea
- Pneumothorax
- Chronic lung disease
What are the CARDIAC complications of prematurity? (3 things)
- PDA (patent ductus arteriosus)
- HTN
- Bradycardia
What are the GI complications of prematurity? (3 things)
- Necrotising enterocolitis
- Reflux
- Inguinal hernia (high risk of strangulation)
What are the METABOLIC complications of prematurity? (4 things)
- Hypoglycaemia
- Hypocalcaemia
- Electrolyte imbalances (poor renal function)
- Osteopenia (risk of #)
What are the INFECTION complications of prematurity? (3 things)
- Sepsis
- Pneumonia
- Central lines infection
What are the BLOOD complications of prematurity? (2 things)
- Anaemia
- Jaundice
What are the LONG TERM complications of prematurity? (6 things)
- Cerebral palsy
- Developmental delay
- Learning / behavioural difficulties
- Hearing / visual impairment
- Chronic lung disease
- Infection susceptibility
