Prematurity

Question 1

Define premature infant

Answer 1

live-born prior to 37 weeks gestation

Question 2

Define low-birth weight infant

Answer 2

< 2500 grams

Question 3

Define very-low-birth weight infant

Answer 3

< 1500 grams

Question 4

What is the benefit of putting a premature neonate in a neutral thermal environment?

Answer 4

reduces calories burned

Question 5

Name some maternal contributors to premature births.

Answer 5

low socioeconomic status, preeclampsia, infections, chronic disease, drug use

Question 6

Name some obstetric contributors to premature births.

Answer 6

incompetent cervix, polyhydramnios, chorioamnionitis, PROM, placenta previa, placental abruption

Question 7

Name some fetal contributors to premature births.

Answer 7

multiple gestation, fetal distress, congenital anomalies

Question 8

What causes Respiratory Distress Syndrome?

Answer 8

immature type 2 alveolar cells = insufficient surfactant

Question 9

What is the pathophysiology of RDS?

Answer 9

the high surface tension of alveoli causes collapse, which leads to progressive atelectasis, intrapulmonary shunting, hypoxemia, cyanosis

Question 10

Signs and Sx of RDS?

Answer 10

w/in first 3 hours of birth: tachypnea, grunting, cyanosis

Question 11

How can surfactant production be accelerated?

Answer 11

maternal Betamethasone administration (24-48 hours prior to delivery)

Question 12

CXR shows fine, diffuse, ground glass pattern, and air bronchograms

Answer 12

RDS

also looks like congenital PNA

Question 13

Define Bronchopulmonary Dysplasia

Answer 13

AKA Wilson-Mikity Syndrome
Need for supplemental O2 after 28 days of life
squamous metaplasia, small airway hypertrophy

Question 14

CXR of neonate shows hyperaeration and atelectasis

Answer 14

think Bronchopulmonary Dysplasia

Question 15

What causes Necrotizing Enterocolitis?

Answer 15

bowel ischemia and bacterial invasion of intestinal wall

Question 16

Signs & Sx of NEC?

Answer 16

oral feeding intolerance, abd distention, temp instability, respiratory distress, acidosis, sepsis, shock

Question 17

Abdominal X-Ray shows Pneumatosis intestinalis, distended loops of bowel, air in portal vein

Answer 17

air bubbles w/in bowel wall, think NEC

Question 18

Tx of NEC?

Answer 18

NPO, NG tube, IVF, Antibiotics.

Possibly surgery.

Question 19

What is the risk of excessive oxygen in the premature neonate?

Answer 19

Retinopathy of Prematurity (can lead to retinal detachment and blindness)

Question 20

A premature infant is lethargic, has poor suck, a high-pitched cry, and bulging fontanelle.

Answer 20

Think Intraventricular hemorrhage (due to hypoxic or hypotensive injury)

Question 21

Why should very-low birth weight infants get a cranial ultrasound in the first week of life?

Answer 21

check for intraventricular hemorrhage

Question 22

Name signs & sx of Rickets of Prematurity

Answer 22

hypotonia, pathologic fractures, craniotabes (occipital flattening), Harrison’s groove (indentation of ribs at level of diaphragm), Rachitic rosary (swelling of costochondral junction)

Question 23

X-Ray shows cupping and fraying of metaphases, subperiosteal new bone formation, and osteopenia

Answer 23

Rickets

Question 24

Tx for Rickets?

Answer 24

Vitamin D, Calcium

Question 25

What is a good predictive serum marker for Rickets?

Answer 25

serum alkaline phosphatase

Question 26

What is the chance of survival after 24 weeks gestation?

Answer 26

50%

Question 27

In what respiratory infection do ex-premies especially have a severe course?

Answer 27

RSV