Prematurity Flashcards
Transition to extrauterine life reuqres many __ for infant
tend to have difficulty w \_\_ vulnerable to \_\_ more l\_\_ and \_\_ more i\_\_\_ and h\_\_\_ potential for \_\_ related injuries high risk for developing \_\_
avoid __ during ressu
reduce __ if resus not req
preterm infants may require __ and __ after birth
physio changes
transition cold stress lung immaturity/RDS intracranial hemorrhage, hypoGly O2 related injuries NEC
rough handling
heat loss
endotracheal intubation/surfactant admin
Administer __ slowly
follow __ carefully
__ may be dec, infant may experience __ secondary to perinatal compromise
maintain normal __ after resus
Major physio problems of prematurity R, B, A, C P, H, R \_\_ that inc risk of infection prevent \_\_\_
meds
glucose
glycogen, hypoGly
O2 range
RDS, BPD, Apnea of prematurity, chronic lung dz
PDA, hypoTN, ROP
immune system immaturity
IVH
Addtl problems skin \_\_/\_\_ T and G issues F/E imbalances due to immature \_\_ fxn \_\_ disorders \_\_ manage developmental issues of \_\_
RDS risk factors low _ M born to \_\_ born after \_\_ before birth born after \_\_-\_\_ hemorrhage Multiple \_\_
immaturity/fragility thermoregulation/GI fluid/electrolyte, renal acid-base pain CNS
gestational age male diabetic mother asphyxial insult maternal-fetal hemorrhage gestation
RDS characterized by diffuse __ of the lungs
primarily due to def of __
leads to higher __ at surface of alveoli, interfering w exchange of __/__
Sx
Difficulty in establishing __, esp if pt has __ for RDS
__ while infant is not crying
__/__ retractions due to inc __ and dec ___
Nasal __
C and T
alveolar atalectasis, surfactant
surface tension, O2/CO2
normal resp, RF expiratory grunting intercostal/sternal, rib cage comp, lung compliance Nasal flaring Cynosis/tachypnea
RDS
give __ to all preg women at __ wks at risk for __ w/in 7 days
can use __ or ___
repeat course of __ should not routinely be given to __
Tx- Thermo__
__ balance and __
__/___/__ care
__ assessment
focus to __/__ atalectasis
minimize effects of __ and ___/__
treat underlying __/__/__ probs
maintain blanaced __ enviro
antenatal steroids, 24-34 wks, perterm delivery
betamethasone, dexamethasone
CS
thermoregulation
fluid, nutrition
skin/develop/family
pain
prevent/minimize
O2, barotrauma/volutramua
CV, infect, phsio
phsio
Surfact therapy surfactant coats inside of \_\_ prevents \_\_\_ and keeps alveoli open at end of _ given via \_\_ \_\_ appears more beneficial than \_\_ \_\_ leads to improved clinical outcomes
Adjunct tx for RDS CPAP- assists \_\_ w continuous \_\_\_ valuable when \_\_ is adequate and \_\_ is not excesive inc \_\_ and improves \_\_/\_\_ reduces \_\_/\_\_
alveoli atalectasis, expiration endotracheal tube prophylactic, resuce multiple doses
lung expansion, distending pressure
spontaneous breathing, pulm dz
TP pressure, oxygen/ventilation
tachypnea/grunting
Adjunct tx for RDS
HFV- allows use of small ___ and high ___
limits __ and wide __ swings assc w __/__ caused by trad mech vent
O
tidal volumes, freq
large tidal volumes, ventilator
pressure, volu/barotrauma
oscillation
BPD- uncommon after __
secondary disease that develops in neonates tx w ___ and __ for primary lung problems (aka RDS)
Sx \_\_ w prolonged O2 req H/T w inc work of \_\_ Episodic \_\_ w wheezing C/C abnormal postures of \_\_/_
Therapy is __/__
preventative measures begin __ and prevent __ using single course of __
Early/careful mx of __ w low __ and careful use of __/__
32wks
PPV and O2
hypoxemia hypercapnia/tachypnea, breathing bronchospasm CHF, cor pulmonale neck/upper trunk
preventive/supportive
prenatally, prematurity, antenatal steroids
RDS, vent pressures, O2/exo surfactant tx
post natal steroids- systemic admin of __ to mech ventilated premature infants dec inc of __ and __
does not dec ___
__ tx for VLBW infants assc w impaired __/__ delay
__ does not have benefits
__ use of dex is not supported
outside of trials, use of ___ should be limited to infant on max __
dexomethasone, CLD/extubation failure
overall mortality
dexamethasone, growth/neurodevelopmental
inhaled CS
routine
postnatal CS, ventilatory support
BPD care
prevent ___
wean __ and ___ slowly
stressful situtations can __ hypoxemia inducing events
use __ w notnutritive __ before painful procedures to reduce __
__ (inc FiO2 before suction) may prevent __ w suction
__ is helpful to parent
use __ or premature __ for WG
__ promotes bonding
further lung damage
ventilator, o2 support
minimize
sucrose, pain
preoxygenation, hypoxemia
consistent caregiver
fortified breastmlk, specialty formula
kangaroo care
__ improves gas exchange and __ in premies
NO __ on physio stability
improved __ in mothers wishing to ___
positive impact on ___
kangaroo care, temp
AE
lactation, breastfeed
parenting process
MC cardiac comp in premies is __
more likely w ___
sx
__, inc need for __, inability to __ from ventilator
widened __, active __, Bounding __ and ___ w/wout gallop
__ is most useful to eval
initial approach w __ and __/__
__ is effective in closing PDA
PDA
severe prematurity
CHF, O2, wean
pulse presure, precordium, peripheral pulses, tachycardia
echo
med management, fluid restriction/diuretics
indomethacin
PDA care
contine to assess __ for pulse/pressure/perfusion and ausculation for __
assess infant after indomethacin for __, dec __, __
ROP- significant cause of __ initiated by delay in ___ growth
more __ the infant, more likely __ is
RF
low __
prolonged __ and __ admin
H/H/S/A/S
high risk infants, murmur
ductal closure, urine output, thrombocytopenia
blindness, retinal vasc
premature, ROP
birth weught
mech vent, O2
hyperoxia/hypoxia/sepsis/acidosis/shock
ROP patho
normal retinal blood vessel development needs __
if baby gets lots of __, __ dec
when stop giving O2, _ inc and new __ develop
nrormal retinal vasc occurs from _ to __
nasally by ___
temporally by ___
Normal- choroid vascularises at __
retinal vascularization starts at __ at 16w. proceeds toward __
__ is almost complete by term
__- primitive plexus formed from ___ (VEGF __)
angiogenesis- new vessels from __, (VEGF __)
central 1/3 formed by __
VEGF
O2, VEGF
VEGF, vessels
optic disc to periphery
36wks
40wks
6wks
optic nerve head, periphery
vascularisation
vasculogenesis, precursor cells, independent
pre existing vasc, dependent
vasculogensis
Premature delivery interrupts normal ___
Phase 1: delayed __ (birth- 32 wks)
developing retina exposed to __ enviro
reduces __ factors delaying ___
Phase 2: N__
neuroretina continues to delveop causing __ w overprod of __ esp VEGF
causes uncontrolled __ growth
vasc growth
retinal vascularization
hyperoxic
angiogenic, retinal vasc
neurovascularization
hypoxia, angiogenic factors
retinal BV
Long term comps of ROP M\_\_ (N\_\_) S\_\_ (c\_\_) A\_\_ (L\_\_) A G Late \_\_ B
screening exam at __ w after birth or __ to __ post conception
Two exams after __ using indirect __ if
weight at birth less than __ g or GA less than __w
high risk event and w at birth bw __ to __g and GA bw __ and __w
myopia, nearsighted strabismus, corssed eye amblyopia, lazy eye astigmatism glaucoma retinal detachment blindness
4-6w. 31-33w
pupillary dilation, opthalmoscopy
1500g, 28w
1500-2000g, 29-36w
Goal of tx of ROP ___
surgery includes L/C
NEC- most common emergency
characterized by ___, usually of the ___
factors: bowel wall __, bacterial invasion of __ and __ feedings
Tx- \_\_ neonate \_\_ infection \_\_ intestinal tract Disctoniue \_\_\_ initiate \_\_ for fluids/Ab \_\_ to decompress GI tract
prevent blindness
laser photocoag, cryothreapy
intestinal ischemia, terminal ileum
ischemia, bowel wall, enteral
stabilize treat rest feedings IV access NG tube
3 stages of NEC
Sx of __ including __, L, A, B, F, A, Stools positive for _
Severe __ and tenderness, visible __, grossly __, metabolic ___, poor __ and __ skin color
fulminant signs of SIRS w __ and mixed __, D, N
monitor __/__/__
examine for __, __, __ bloody stools, temp instabiloty, __ and __ and __
encourage mother to __ and freeze ___
sepsis, temp instability, lethargy, apnea, bradycardia, feeding intolerance, ab distension, occult blood
ab distension, bowel loops, bloody stools, acidsos, perfusion, mottled
shock, acidosis, DIC, neutropenia
vital signs, blood gas, pH
ab distension, tenderness, emesis, met acid, apnea, bradycardia
pump breasts, breastmilk
IVH assc W ___
infants less than __w GA at greastest risk
Intraascular patho
impaired ___
fluctuating __ related to fluctuating ___
inc __ due to hyperCO2/volume expansion
inc cerebral ___ w PTX/asphyia
H and R`
__ abnorms
prematuriy
28w
cerebral autoregulation
cerebral blood flow, ABP
cerebral blood flow
venous pressure
hypoTN, reperfusion
coag
vasc patho
Germinal matrix is __ w poor __
present at less than __w and is critical for __ develop
__ capillaries are __ to hypoxic ischmic injury
___ acute transition from __ to capillary network wout __
V__ hairpin loop configuration in germinal mtrix conducive to __ and important in __
highly vascular, capillary support
35w, IVH
germinal matrix, vulnerable
arterial delopment, large vessels, arborization
venous drainage, outflow obstruction, PVH
Extravasc patho
preterm infants have inc __
poor __ in cerebral tissue
inc risk of __ and __ and __
due to immature __
IVH grade 1 is isolated __ hemorrhage
IVH grade 2 is __ w normal __
Moderate G3 is IVH w __
Severe G4 is IVH w ___
fibrinolytic activity
vasc support
hypoxia, hypercarbia, acidosis
respiratory system
germinal matrix
IVH, ventricular size
ventricular dilation
parenchymal hemorrhage
Sx of IVH
maybe just dec __/__ levels
dec __, H, altered __, _ disturb
S, dec __ and fixed ___
Tx is \_\_ minimize \_\_ minimize \_\_\_, \_\_, \_\_, \_\_ maintain normal \_\_ elevate head to \_\_ use \_\_ and \_\_ for procedures
Hct/Hb
activity, hypotojnia, conciousness, resp
seizure, posturing, pupils
prevention brain tissue destrxn cryin/suctioning/infusion neutral thermal enviro 30 degrees sucrose pacifiers, topical anesthetics
Prevent IVH
administer __
optimal __ mx
admin antenatal __ for preterm __
maintain temp around __ C
maintain __ while admin surfactant
avoid __ when ess than 72hrs old
use ___
Use __/____
antenatal steroids
peripartum
ab, rupture of membranes
36
CP stability
lumbar punctture
narcotic sedation/care
indomethacin/dexamethasone
