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Neonatology > Prematurity > Flashcards

Prematurity Flashcards

1
Q

Immediate Mx of premature baby (2)

A

Delay cord clamping for 3 mins to promote placento-foetal transfusion

put hat on head and place in plastic bag

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2
Q

Short term problems of prematurity (7)

A

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.

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3
Q

Long term complications of prematurity (4)

A

increased risk of:

  • HTN
  • DM
  • cardiovascular disease
  • stroke
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4
Q

Features, RFs, Ix and Mx of TTN (5)

A

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

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5
Q

RFs for RDS (6)

A

prematurity

maternal GDM

second twin

male

C-section

sepsis

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6
Q

Presentation of RDS (6)

A

<4hrs after birth

grunting

nasal flaring

RR>60

intercostal recession

cyanosis

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7
Q

CXR features of RDS (3)

A

ground glass

diffuse granular patterns +/- air bronchograms

may also have bilateral pleural effusions

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8
Q

Prevention of RDS

A

IM betamethasone/dexamethasone given to all women at risk from 23-35wks (36 if IUGR)

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9
Q

Mx of RDS (5)

A

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

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10
Q

Causes of bronchopulmonary dysplasia (3)

A

barotrauma

O2 toxicity

surfactant-related e.g. infections

(chronic lung disease due to inflammation and scarring>hypoxaemia)

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11
Q

Ix for bronchopulmonary dysplasia (3)

A

CXR:

  • hyperinflation
  • round, radiolucent areas alternating w. thin, denser lines

histology:
-necrotising bronchiolitis with alveolar fibrosis

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12
Q

Early sequelae of bronchopulmonary dysplasia (3)

A

low IQ

cerebral palsy

feeding problems

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13
Q

long term sequelae of bronchopulmonary dysplasia (3)

A

airway obstruction

hyper-reactivity

hyper-inflation

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14
Q

Prevention of bronchopulmonary dysplasia (3)

A

antenatal steroids

surfactant

high calorie feeds

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15
Q

Presentation of pulmonary hypoplasia (2)

A

persistent neonatal tachypnoea

feeding problems

(DDx: meconium aspiration, sepsis, RDS, pulmonary HTN)

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16
Q

RFs and prognosis of pulmonary hypoplasia (3)

A

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

17
Q

RFs for NEC (6)

A

prematurity

wt. <1.8kg

enteral feeds

bacterial colonisation

rapid wt. gain

mucosal injury

18
Q

Pathology of NEC

A

inflammatory bowel necrosis caused by serious intestinal injury following a vascular/mucosal/toxic insult to the immature gut

19
Q

Presentation of NEC (4)

A

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)

20
Q

AXR features of NEC (6)

A

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

21
Q

Mx of NEC (5)

A

NBM

NGT w. orogastric suction

IV fluids+TPN

cefotaxime+vancomycin for 10-14d

laparotomy if severe distension/perforation

22
Q

Prevention of NEC (5)

A

feeding w. human milk

probiotics

antenatal steroids for women going into premature labour

oral Abx

IgA supplementation

23
Q

Pathology of intraventricular haemorrhage (2)

A

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)

24
Q

Grading intraventricular haemorrhage (I-IV)

A

I and II: w/i ventricles only, no distension

III: w/i ventricles+ventricular distension

IV: parenchymal involvement

25
Q

Presentation of intraventricular haemorrhage (4)

A

decreased Moro reflex, reduced muscle tone

lethargy, apnoea, seizures

bulging fontanelle

neurological depression may>coma

(suspect in neonates who deteriorate rapidly early on)

26
Q

Long term problems of intraventricular haemorrhages (3)

A

cerebral palsy

low IQ, seizures

developmental delay

(most survive w/o LT complications)

27
Q

Ix for intraventricular haemorrhage (2)

A

trans-fontanelle USS

CT

28
Q

Mx of intrventricular haemorrhage

A

Rx underlying condition, supportive

29
Q

Features of PDA (3)

A

DA=remnant of 6th aortic arch

normally closes 12-18h after birth

failure can>overloading of lungs due to L>R shunt

30
Q

Mx of PDA (2)

A

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)

31
Q

Complications of PDA (2)

A

L>R shunt

Eisenmenger’s

32
Q

Major RFs for retinopathy of prematurity (2)

A

low birth wt. and prematurity

supplemental O2, esp. leading to fluctuation in PaO2

(careful titration of O2 reduces risk)

33
Q

Rx of retinopathy of prematurity

A

peripheral retinal ablation

34
Q

RFs for neonatal hypoglycaemia (7)

A

maternal DM/GDM

prematurity

IUGR/small for gestational age

sepsis

hyperinsulinaemic hypoglycaemia

macrosomia

inborn errors of metabolism

35
Q

Mx of neonatal hypoglycaemia (4)

A

neonates w. RFs should be monitored for 48hrs

early feeding important

if persistent: 5/10% dextrose

if congenital hyperinsulinaemia, can resect part of pancreas

Neonatology (5 decks)

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