Prematurity

Question 1

What is the definition of prematurity?

Answer 1

Birth before 37 weeks gestational age

Question 2

Prematurity classification

Answer 2

Late preterm <37 wks
Very preterm <33
Extremely preterm <29
Micropremature <26

Question 3

What are risks associated with prematurity?

Answer 3

Neurologic complications leading to structural neuroanatomical changes and increased morbidity/mortality
Compromise in brain function
Disruption of futrue development

Question 4

What is the proxy for gestational age?

Answer 4

Birth weight

Question 5

What is a common progression of neurologic complications associated with prematurity?

Answer 5

Hypoxic-ischemic encephalopathy (HIE) to
INtraventricular hemorrhage (IVH) to
Periventricular hemorrhagic infarction (PVH) to
Periventricular leukomalacia (PVL)

Question 6

What are risk factors for premature birth?

Answer 6

Maternal hx of previous preterm birth
Multiple birth pregnancy
Maternal age <16 and >35
Maternal health problems: diabetes, obesity, HTN, kidney/heart disease, infections during pregnancy
Uterus/cervix abnormalities
Maternal alcohol, drug, alcohol use
Low SES
Lack of prenatal care
AA ethnicity

Question 7

Classification of birth weight

Answer 7

Low BW <2,500g (5 lbs, 8 oz)
Very low BW <1,500 g (3 lbs, 5 oz)
Extremely low BW <1000g (2 lbs, 3 oz)
Micropremature <750g (1 lb, 10 oz)

Question 8

What is the incidence of PM and low BW?

Answer 8

12.3% and 8.2% low BW

Rate steadily declined since 2006, primarily in late preterm births

Question 9

What is PM survival rate?

Answer 9

80% at 26 wks, 25% will develop severe long-term disabilities (blindness, CP), 50% learning and behavioral problems

96% 28-31 wks
98% 32-33 wks
99% 34-36 wks

Question 10

What is the current threshold of biological viability?

Answer 10

23 weeks GA

Question 11

What are causes of PM?

Answer 11

45-50% idiopathic
30% premature rupture of membranes
15-20% medically indicated preterm delivery

Question 12

What are neurological sequalae of IVH?

Answer 12

Grade i - bleeding in germinal matrix
Grade II - bleeding into ventricles w/o dilation
Grade III - bleeding resulting in v dialtion
Grade IV - large Hem with PHI in parenchyma

Question 13

What are predictors of functional outcome in PM?

Answer 13

Severity of neurologic complications
Use of steroids
Care center factors, transfer to NICU in first 24 hrs, availability of neonatologist
SES, maternal edu level and mental health, quality of responsive care, environmental stimulation
Male sex
Length of NICU stay
Reduced W and G matter volumes, lg ventricle size

Question 14

What is the critical period?

Answer 14

First 24 hrs - 50% IVH in first 6-8 hours

Question 15

What is Cranial ultrasound?

Answer 15

Most common imaging technique in the context of prematurity used to detect neurologic events and abnormalities, useful to detect IVH

Question 16

What method is used to detect white M abnormalities like PVL?

Answer 16

MRI

Question 17

What is the purpose of surfactants?

Answer 17

To keep air sacs in the lings open during respiration, naturally produced btw 24-28 wks

Question 18

What are risks of postnatal steroid use?

Answer 18

Chronic hypoxia, reduced cerebral volume, neurodevelopmental delay

Question 19

What are basic physiologic functions that should be monitored in neonates?

Answer 19

Body temp, oxygenation and pressure, and cardiac function

Question 20

What is the purpose of NIDCAP?

Answer 20

To replicate intrauterine environment to the extent possible

Question 21

What are some assessment measures in infants?

Answer 21

Neonatal behavioral assessment scale
Bayley scales of infant and toddler development-III
Mullen scales of early learning

Question 22

What are incidence rates of CP in PM?

Answer 22

6% born <1500g
4% 1500-2500
1% >2500

Question 23

What are neuropsychological findings in PM?

Answer 23

Functional outcomes vary by cohort year

Lower IQ, higher with increasing gestational age
Slower rate of academic problem, mostly in math and written output
Attention - increased rates of ADHD
Slowed processing speed
Lg -problems with fluid verbal skills, comprehension, fluency, pragmatics
VS - particularly vulnerable! due to proximity of PV region to optic rediations

Memory - decreased acquisition and retrieval, reduced hippocampal volumes
EF problems

Sensorimotor deficits are common - dexterity, coordination, visuomotor integration

Question 24

What are behavioral findings?

Answer 24

Both externalizing and internalizing problems
Poor social skills
Increased rates of anxiety, reduced adaptive skills
Increased prevalence of ASD in extremely preterm and low BW children

Question 25

What is the age correction?

Answer 25

Age correction if made until 24 months

Question 26

What is apnea or prematurity?

Answer 26

Unexplained cessation of breathing due to immature respiratory control system

Question 27

What is bronchopulmonary dysplasia?

Answer 27

Chronic lung disease due to ventilator support or high levels of oxygen for long periods shortly after birth

Question 28

What is CP?

Answer 28

Group of disorders affecting movements/coordination

Caused by abnormal brain development before birth within 2 years of life

Question 29

What is germinal matrix?

Answer 29

Highly vascularized region of brain below lateral ventricle

Question 30

What is IVH?

Answer 30

Hemorrhage due to increased vascular pressure and vessel rupture

Question 31

What is intrauterine growth restriction?

Answer 31

Poor growth of fetus during pregnancy, mostly associated with insufficient oxygen/nutrition from placenta

Question 32

What is necrotizing enterocolitis?

Answer 32

Death of intestinal tissue

Question 33

What is neonatal septicemia?

Answer 33

Severe infection/sepsis cased by pregnancy complications

Question 34

What is patent ductus arteriosus?

Answer 34

Heart condition resulting in abnormal blood flow between the aorta and pulmonary arteries

Question 35

What is the definition of small for gestaitonal age?

Answer 35

<10th %ile compared to babies of equal GA

Question 36

What is PVL?

Answer 36

focal necrotic lesions in hte border end zones of MCA, ACA, and PCA
Increased risk for CP, particularly spastic diplegia

Question 37

What is retinopathy of PM?

Answer 37

Abnormal development of retina blood vessels