Prematurity

Question 1

what is term?

Answer 1

37 weeks to 42 weeks gestation

Question 2

what is premturiy?

Answer 2

less than 37 weeks gestation

Question 3

causes of prematurity?

Answer 3

• maternal illnesses (pre-eclampsia)
• placental failure (poor growth, abruption)
• preterm labour (mechanical, inflammation/infection)

Question 4

short term problems of pre term labour?

Answer 4

respiratory 
neurological 
gastrointestinal 
retinal 
iatrogenic

Question 5

long term problems of preterm birth?

Answer 5

neurological 
developmental 
behavioural 
respiratory 
growth 
programming

Question 6

what are the stages of management for preterm birth?

Answer 6

antenatal 
resuscitation 
intensive care 
high dependency care 
special care 
transitional care 
neonatal follow up 

keep baby warm using a plastic bag under radiant heater

Question 7

what are the stages of lung development?

Answer 7

Pseudoglandular phase – 6 to 16 weeks gestation
Canalicular phase – 16 to 26 weeks gestation
Saccular phase – 26 to 32 weeks gestation
Alveolar stage

Question 8

what is given to premature babies for respiratory problems?

Answer 8

surfactant replacement therapy

Question 9

what are the short term complications of respiratory distress syndrome in preterm infants?

Answer 9

Death
Air leaks
– Pneumothorax
– Pulmonary interstitial emphysema – Pneumomediastinum
– Pneumopericardium
– Pneumoperitoneum
Uncontrollable hypoxia

Question 10

in preterm medicine what is there a balance between?

Answer 10

supporting the immature function of the organ system and managing the complications of that support.

Question 11

what are the two outcomes of RDS?

Answer 11

• resolution and repair –> normal lung

- chronic inflammation and impaired lung growth –> chronic lung disease

Question 12

what does chronic lung disease of prematurity cause?

Answer 12

severe inflammatory changes
fibrosis
atelectasis
hyper-expansion

the need for long term oxygen
weight heart failure
reduced exercise tolerance

Question 13

what are the current approaches to management of RDS?

Answer 13

• incubation
• CPAP therapy
• high flow oxygen

Question 14

what are the types of intracranial haemorrhage in premature babies?

Answer 14

subependymal
bilateral subependymal haemorrhage
subependymal haemorrhage with blood in the ventricles
blood filling and distending the ventricles
post haemorrhage hydrocephalus
intracerebral haemorrhage
extensive parenchymal haemorrhage

Question 15

what is periventricular leukomalacia?

Answer 15

is a type of brain injury that is most common in premature babies. the white matter surrounding the ventricles of the brain is deprived of blood and oxygen leading to softening

Question 16

what problems arise with the gastrointestinal tract in premature babies?

Answer 16

slow development of intrinsic activity
(delayed feed tolerance, delayed passage of stool)
gastrointestinal reflux
necrotising enterocolitis

Question 17

patio physiology of necrotising enterocolotis?

Answer 17

ischaemic repercussion
infection, early feeds, plasticisers and activated T cells –> ischaemic re-perfusion

Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in premature infants. The pathophysiology is likely secondary to innate immune responses to intestinal microbiota by the premature infant’s intestinal tract, leading to inflammation and injury.

Question 18

what other morbidities can premature babies have>

Answer 18

increased need for special monitoring in school
increased need for learning support
predisposition to depressive and psychotic illness in later life?

problems with speaking, listening, writing, fine motor, maths, reading, physical education