Prematurity Flashcards
Immediate Mx of premature baby (2)
Delay cord clamping for 3 mins to promote placento-foetal transfusion
put hat on head and place in plastic bag
Short term problems of prematurity (7)
lungs-surfactant deficiency
heart-PDA
eyes:
- retinopathy of prematurity
- due to free radical damage from O2 during resuscitation
- therefore target sats in neonates are 88-92
GI:
- NEC
- jaundice
hypoglycaemia
Brain:
- cerebral palsy
- peri-ventricular haemorrhage
- peri-ventricular leucomalacia
metabolic bone disease of prematurity:
-decreased bone mineralisation due to reduced Ca and Po4 stores.
Long term complications of prematurity (4)
increased risk of:
- HTN
- DM
- cardiovascular disease
- stroke
Features, RFs, Ix and Mx of TTN (5)
commonest cause of respiratory distress in term neonate
due to impaired resorption of fluid in lungs
increased risk in C-section
CXR shows hyperinflated lungs and a fluid level
Mx w. O2, should resolve in a few days
RFs for RDS (6)
prematurity
maternal GDM
second twin
male
C-section
sepsis
Presentation of RDS (6)
<4hrs after birth
grunting
nasal flaring
RR>60
intercostal recession
cyanosis
CXR features of RDS (3)
ground glass
diffuse granular patterns +/- air bronchograms
may also have bilateral pleural effusions
Prevention of RDS
IM betamethasone/dexamethasone given to all women at risk from 23-35wks (36 if IUGR)
Mx of RDS (5)
surfactant therapy via ET tube (curosurf)
maintain sats at 85-92% to prevent retinopathy/bronchopulmonary dysplasia
if spontaneously breathing:
-CPAP via ET/NP/nasal cannulae to maintain alveolar patency at the end of expiration
if <28wks:
- intubate+curosurf+/- 2 further doses if ongoing O2 demand
- rock child to spread around bronchopulmonary tree
caffeine can help aid respiratory drive
Causes of bronchopulmonary dysplasia (3)
barotrauma
O2 toxicity
surfactant-related e.g. infections
(chronic lung disease due to inflammation and scarring>hypoxaemia)
Ix for bronchopulmonary dysplasia (3)
CXR:
- hyperinflation
- round, radiolucent areas alternating w. thin, denser lines
histology:
-necrotising bronchiolitis with alveolar fibrosis
Early sequelae of bronchopulmonary dysplasia (3)
low IQ
cerebral palsy
feeding problems
long term sequelae of bronchopulmonary dysplasia (3)
airway obstruction
hyper-reactivity
hyper-inflation
Prevention of bronchopulmonary dysplasia (3)
antenatal steroids
surfactant
high calorie feeds
Presentation of pulmonary hypoplasia (2)
persistent neonatal tachypnoea
feeding problems
(DDx: meconium aspiration, sepsis, RDS, pulmonary HTN)
RFs and prognosis of pulmonary hypoplasia (3)
antenatal oligohydramnios: PROM, Potter’s syndrome
diaphragmatic hernia:
- do not give rescue breaths at birth
- must intubate w. ET tube
- if air>stomach>further lung compression
post-natal catch-up growth occurs
RFs for NEC (6)
prematurity
wt. <1.8kg
enteral feeds
bacterial colonisation
rapid wt. gain
mucosal injury
Pathology of NEC
inflammatory bowel necrosis caused by serious intestinal injury following a vascular/mucosal/toxic insult to the immature gut
Presentation of NEC (4)
3-10d after birth
non-specific Sx, sepsis may be suspected
mild disease: abdo distension, bloody stool
severe disease:
- rapid abdominal distension
- tenderness +/-perforation
- shock
- DIC
- mucosal sloughing
(platelets mirror disease activity, <100=severe)
AXR features of NEC (6)
pneumatosis intestinalis: pathognemonic
football sign: air outlining falciform ligament. sign of pneumoperitoneum
air w/i portal vein
air outside bowel walls
oedema of bowel wall
dilated loops of bowel
Mx of NEC (5)
NBM
NGT w. orogastric suction
IV fluids+TPN
cefotaxime+vancomycin for 10-14d
laparotomy if severe distension/perforation
Prevention of NEC (5)
feeding w. human milk
probiotics
antenatal steroids for women going into premature labour
oral Abx
IgA supplementation
Pathology of intraventricular haemorrhage (2)
due to unsupported IMMATURE blood vessels in subepindymal germinal matrix
instability of BP assoc. w. birth trauma and RDS is a contributing factor (delayed cord clamping may reduce this)
Grading intraventricular haemorrhage (I-IV)
I and II: w/i ventricles only, no distension
III: w/i ventricles+ventricular distension
IV: parenchymal involvement
Presentation of intraventricular haemorrhage (4)
decreased Moro reflex, reduced muscle tone
lethargy, apnoea, seizures
bulging fontanelle
neurological depression may>coma
(suspect in neonates who deteriorate rapidly early on)
Long term problems of intraventricular haemorrhages (3)
cerebral palsy
low IQ, seizures
developmental delay
(most survive w/o LT complications)
Ix for intraventricular haemorrhage (2)
trans-fontanelle USS
CT
Mx of intrventricular haemorrhage
Rx underlying condition, supportive
Features of PDA (3)
DA=remnant of 6th aortic arch
normally closes 12-18h after birth
failure can>overloading of lungs due to L>R shunt
Mx of PDA (2)
can be closed w. indomethacin
ligation and division indicated if:
- symptomatic
- asymptomatic+L heart volume overload
(significant L heart volume load can>CCF and irreversible pulmonary vascular disease)
(small PDA has no overload risk, only risk of IE)
Complications of PDA (2)
L>R shunt
Eisenmenger’s
Major RFs for retinopathy of prematurity (2)
low birth wt. and prematurity
supplemental O2, esp. leading to fluctuation in PaO2
(careful titration of O2 reduces risk)
Rx of retinopathy of prematurity
peripheral retinal ablation
RFs for neonatal hypoglycaemia (7)
maternal DM/GDM
prematurity
IUGR/small for gestational age
sepsis
hyperinsulinaemic hypoglycaemia
macrosomia
inborn errors of metabolism
Mx of neonatal hypoglycaemia (4)
neonates w. RFs should be monitored for 48hrs
early feeding important
if persistent: 5/10% dextrose
if congenital hyperinsulinaemia, can resect part of pancreas
