Prematurity

Question 1

What is the definition of prematurity?

Answer 1

• babies born <37 weeks

Question 2

when do immature lungs become a problem?

when do significant problems occur?

Answer 2

• baby born before 33 weeks

- before 28 weeks

Question 3

what effect can prematurity have on the eyes?

how is it treated?

Answer 3

• retinopathy of prematurity due to abnormal vascularisation of the developing retina
• laser treatment to prevent retinal detachment and blindness

Question 4

what effects can prematurity have on respiratory?

Answer 4

• respiratory distress syndrome (due to surfactant deficiency)
• apnoea and bradycardia
• pneumothorax
• chronic lung disease

Question 5

what cardiovascular effects do prematurity cause?

Answer 5

• PDA

- Hypotension

Question 6

Why is it harder for them to temperature control?

Answer 6

• increased surface area to volume ratio leads to loss of heat
• immature skin cannot retain heat and fluid efficiently
• reduced subcutaneous fat reduces insulation

Question 7

What metabolic issues may occur?

Answer 7

• hypoglycaemia is common
• blood glucose should be maintained above 2.6mmol to prevent neurological damage
• hypocalcaemia
• electrolyte imbalance
• osteopenia of prematurity

Question 8

what can happen to the brain?

Answer 8

• intraventricular haemorrhage
• posthaemorrhagic hydrocephalus
• periventricular leucomalacia
• increased risk of cerebral palsy

Question 9

what problems may occur with nutrition?

Answer 9

• may require parenteral nutrition
• NG tube until sucking reflex develops at 32-34 weeks
• difficult to achieve in-utero growth rates

Question 10

What GI problems may occur?

Answer 10

• Necrotising Enterocolitis, life threatening inflammation of the bowel wall due to ischaemia and infection leading to perforation
• GOR
• inguinal hernias (with high risk of strangulation)

Question 11

what infections do they tend to get?

Answer 11

• increased risk of sepsis (GBS and coliforms)
• pneumonia
• infection of central venous lines

Question 12

what problems can you get with blood in prematurity?

Answer 12

• anaemia of prematurity

- neonatal jaundice

Question 13

what is the survival rate for a 24 weeker?

27 weeks?

after 32 weeks?

Answer 13

• 45%
• 80%
• excellent

Question 14

what can periventricular leucomalacia lead to?

Answer 14

• caused by hypotension

- leads to cerebral palsy (Spastic diplegia)

Question 15

What might make a baby likely to need resuscitation after birth?

Answer 15

• prematurity
• foetal distress
• thick meconium stained liquor
• emergency c section
• instrumental delivery
• congenital abnormalities
• multiple births

Question 16

What does an Apgar score of 0-3 suggest?

Answer 16

• severely compromised infant, who may die without urgent resuscitation

Such babies will often require intubation and cardiac massage

Question 17

what are the markers of severe asphyxia during labour?

Answer 17

• cord blood sample pH <7.0
• Apgar score of <5 at 10 mins
• Delay in spontaneous respiration beyond 10 mins
• Development of HIE with abnormal neurological signs (convulsions)

Question 18

what technique can be used to prevent secondary neuronal damage?

Answer 18

• cooling to 33 degrees lowers the metabolic rate

Question 19

What is VKDB?

Answer 19

• persistent obstructive jaundice can lead to poor synthesis of vitamin K dependent clotting factors and subsequent bleeding

Question 20

what has more vitamin K, breast or bottle?

what happens to all newborn infants with regards to vitamin K?

Answer 20

• bottle, it is supplemented

- they are given a supplement via IM injection or by mouth at 1 and 6 weeks

Question 21

what is the antenatal management of prematurity?

Answer 21

• IM corticosteroids to mother
• 2 doses, 12 hours apart of beta or dexamethasone if <34 weeks gestation
• reduces mortality by 40%