prematurity

Question 1

why is neonatology important?

Answer 1

because the greatest mortality in life is the first day and a high mortality rate characterises the entire first month

Question 2

at what stage can organ formation go wrong?

Answer 2

from conception to 23 wks

Question 3

at what stage can fetus maturation and growth go wrong?

Answer 3

23wks - 40wks

Question 4

what is prematurity?

Answer 4

less than 37 wks

extreme premature = <28wks

Question 5

what is low birth weight?

Answer 5

<2500g
very low birth weight <1500g
extremely low birth weight < 1000g

Question 6

why are babies born premature?

Answer 6

maternal illness - pregnancy induced hypertension
placental failure - poor growth, abruption
preterm Labour - mechanical, inflammation/infection

Question 7

why s it important to keep a premature baby warm?

Answer 7

as SA:weight ratio is large

babies are put in plastic bag to keep warm

Question 8

what are the stages of lung development?

Answer 8

pseudogandular phase = 6-16 wks
canalicular phase = 16 - 26 wks
saccular phase = 26 - 32 wks
alveolar stage >32wks

Question 9

what are some enemies of the lung?

Answer 9

oxygen
over distension - high pressure ventilation
collapse of alveoli then reinflation
inflammation - infection

Question 10

how does inflammation in alveoli occur?

Answer 10

cell death - increased permeability -> influx of plasma into alveoli -> white cell invasion -> organisation of plasma exudate

Question 11

how is RDS treated?

Answer 11

surfactant replacement therapy

Question 12

what are some short-term complications of RDS?

Answer 12

death
air leaks = pneumothorax, pulmonary interstitial emphysema, pneumomediastinum, pneumopericardium, pneumoperitoneum
uncontrollable hypoxia

Question 13

what is preterm medicine a balance of?

Answer 13

supporting the immature function of an organ system

and managing the complications of that support

Question 14

what 2 pathways can RDS take?

Answer 14

1. RDS -> resolution and repair -> normal lung

2. RDS -> chronic inflammation -> impaired lung growth -> chronic lung disease

Question 15

what happens to the lung architecture in chronic lung disease?

Answer 15

septal hypertrophy

small alveoli

Question 16

what is chronic lung disease of prematurity? and what are the long term consequences?

Answer 16

severe inflammatory changes
fibrosis
atelectasis
hyperexpansion

long term oxygen
right heart failure
reduced exercise tolerance

Question 17

what are the current approaches to managing RDS?

Answer 17

less it more:
intubation and ventilation
CPAP therapy
high flow oxygen

Question 18

what can intracranial haemorrhage cause?

Answer 18

episodes of hypoxia, hypercarbia, acidosis, hypotension, hypertension
poor cerebral auto regulation
fluctuations in cerebral perfusion

Question 19

what types of intracranial haemorrhage are there?

Answer 19

subependymal 
subependymal haemorrhage with blood in ventricles 
intraventricular haemorrhage 
post haemorrhage hydrocephalus 
intracerebral haemorrhage 
extensive parenchyma haemorrhage 
porencephalic cyst 
periventricular leukomalacia

Question 20

what is retinopathy of prematurity? what are the consequences?

Answer 20

hyperoxic insult - arrest of normal vascular growth 
fibrous ridge forms 
vascular proliferation 
retinal haemorrhages 
retinal detachment 
blindness

Question 21

what is TPN?

Answer 21

total parental nutrition

= CHO, proteins, lipids, electrolytes, vits

Question 22

what are the gastrointestinal tract problems seen in prematurity?

Answer 22

slow development of intrinsic activity - delayed feed tolerance, delayed passage of stool, GI reflux, necrotising enterocolitis

Question 23

how does NEC occur?

Answer 23

ischaemia (infection, early feeds, plasticisers, activated T cells) -> mural oedema -> intramural gas -> perforation

Question 24

what is the survival of 23wk babies?

Answer 24

30-40%