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Paediatrics > Prematurity > Flashcards

Prematurity Flashcards

1
Q

What counts as premature?

A

born before 36 wks

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2
Q

What is low birth weight?

A

birth weight <2.5kg

regardless of gestational age (50% are pretern)

(norm = 2.5-4.5kg)

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3
Q

What weights cound as very low birth weight and extremely low birth weight?

A

VLBW = <1.5kg regardless of age

ELBW = <1kg regardless of age

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4
Q

What may cause prematurity (risk factors)?

A
  • Cervical incompetence
  • intrauterine stretch
  • intrauterine bleeding
  • maternal medical conditions
  • foetus
  • trauma
  • PMhx preterm birth
  • SMOKING”
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5
Q

What can cause intrauterine stretch making it a RF for prematurity?

A
  • multiple foetueses
  • polyhydramnios
  • uterine abnormality
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6
Q

What can cause intrauterine infection making it a RF for prematurity?

A
  • chorioamnionitis
  • bacterial vaginitis
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7
Q

What can cause intrauterine bleeding making it a RF for prematurity?

A

Abruption

APH (bleeding from or into the genital tract occuring from 24+0 weeks of pregnancy)

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8
Q

What can cause maternal medical conditions are a RF for prematurity?

A

PET or HTN

pyelonephritis

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9
Q

What can cause foetal conditions are a RF for prematurity?

A

congenital malformations

IUGR

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10
Q

What can trauma is a RF for prematurity?

A

where emergency section is indicated e.g. PROM

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11
Q

What general care problems can prematurity cause?

Rx?

A
  • hypothermia from:
  • large surface area:mass ratio,
  • thin skin &
  • little subcut fat

hypothermia leads to increased energy consumption –> hypoxia, hypoglycaemia, failure to thrive & death

  • incubator/radiant heaters!
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12
Q

Respiratory distress syndrome

pneumothorax

apnoea, bradycardia and desaturation episodes

are all what?

A

problems / complications of prematurity

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13
Q

when a baby takes their first breath there is supposed to be a fall in pulmonary vascular resistance

if this doesnt happen what conditon does it result in?

A

-> pulmonary HTN!

this interrruption of normal fall in pulm vasc resistance w/1st reath is can be due to:

  • meconium aspiration
  • pneumonia
  • RDS
  • diaphragmatic hernia
  • GBS infection
  • pulmonary hypoplasia
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14
Q

You suspect pulmonary hypertension in a neonate.

What test do you (Ix) do and what would it show?

A

Echo

  • shows R–>L shunting (cyanotic, due to high pressure) at ductus arteriosis
  • IN ABSENCE of structural heart disease
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15
Q

What is ECMO?

A
  • Extra-corporeal membrane oxygenation - complex procedure available in 3o units - can be used in pulmonary HTN
  • Providing life support for respiratory failure (&cardiac)
    • for those whose heart and lungs are unable to provide adequete life sustatining gas exchange
  • obviates the need for lung gas exchange
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16
Q

What are very low birth weight babies particularly at risk of? [VLBW = <1.5kg regardless of age[

A

Apnoea / desaturation

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17
Q

This neonatal condition can be spontaneous or have an underlying cause including:

  • infection,
  • hypoxia,
  • anaemia,
  • electrolyte disturbance,
  • hypoglycaemia,
  • seizures,
  • heart failure,
  • aspiration due to GORD

what condition is it? & Rx?

A

Apnoea / desaturation

Prevention: maternal corticosteroids (23-34wks gestation)

management is that it is mostly self limiting, if not:

  1. Airway: Check airway
  2. Breathing:
    • Gentle tactile stimulation
    • CPAP
    • Methylxanthine e.g. caffeine (used in babies <28wks to stim breathing)
    • Mechanical ventilation if the above do not succeed
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18
Q

A CXR of a neonate shows areas of opacification and cystic chenge also hyperinflation and radiolucent areas alternanting with thin, denser lines.

What condition is this related to & its Rx?

A

its is bronchopulmonary dysplasia caused by pressure & volume trauma from artificial ventilation, O2 toxicity & infection.

The neonate is @ risk of developing chest infections

–> Rx: give monoclonal abtibody to RSV (commonest cause of bronchiolitis)!

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19
Q

What do patent ductus arteriosus and shock represent regarding newborn conditions?

A

PDA and shock are both cardiac problems/complications of prematurity

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20
Q

A neonate has raised HR, low BP, low UO & is in a coma. What is this?

What could have caused it?

A

SHOCK!

  • Blood loss
    • placental haemorrhage, Twin-twin transfusion, intraventricular haemorrhage, lung haemorrhage
  • capillary plasma leaks
    • sepsis, hypoxis, acidosis, necrotising enterocolitis,
  • fluid loss
    • D&V, inappropriate diuresis
  • cardiac causes
    • hypoxia, L-R shunts, valve disease, coarctation
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21
Q

a neonate is vomiting, has distended abdomen, blood in stools and appears septic/shock

What could be causing this and why?

A

Necrotising enterocolitis

younger gest. age = more likely to have this

possible causes =

  • bowel infection,
  • milk feeds (6x greater risk compared to breast milk),
  • hypoxia-ischaemia of bowel
22
Q

an AXR of a neonate shows:

distended bowel loops,

thickened bowel walls,

intramural gas & air in portal tract

what condition is this? & its complications?

A

necrotising enterocolitis

short term complications:

  • necrosis & bowel perforation
    • will see air under diaphragm on AXR if bowel perforation

long term complicatons:

  • malabsorption & strictures (25% mortality!)
23
Q

How do you manage neonatal shock?

A
  • ABCDE,
  • colloid 10-20mL/kg IV as needed,
  • inotropies e.g. Dopamine, dobutamine
24
Q

How do you Rx necrotisin enterocolitis?

A
  • ABC support
  • Broad spectrum abx
  • parenteral nutrition (as gut isnt functioning!)
  • surgical correction if bowel perforates
25
Q

What do the following conditions relate to?

  • Jaundice
  • Cholestatic obstructive jaundice
  • Acute renal failure
A

renal/liver complications of prematurity

26
Q

What do the following conditions relate to?

  • Hypoglycaemia
  • Electrolyte abnormalities
  • Osteopenia
A

metabolic conditions/complications of prematurity

27
Q

A premature neonate presents with visual loss what condition causes this and what is the management?

A

retinal detachment caused by abnormal fibrovascular proliferation of retinal vessel = retinopathy of prematurity

RF: premature, low birt weight (<2.5Kg), supplemental oxygen especially with large fluctuations in PaO2

Rx: diode laser therapy (causes less myopia (short sightedness) than cryotherapy

28
Q

A baby is born at <27wks old when should they be screened for retinopathy of prematurity using indirect opthamoscopy?

if they were born at 27-32 weeks when should they be screened using indirect opthalmoscopy?

A

~4 weeks after both times

  • so if < 27 wks do it at 20-31 wks age
  • if 27-32 wks do the check at 28-35 days of life –> repeat 2 weekly depending on severity of disease
29
Q
  • sensorineural hearing loss
  • retinopathy

are related to what?

A

vision and hearing impact of prematurity

30
Q
  • Neurodevelopmental problems - cognitive delay, seizures, education difficulties, behavioural problems, cerebral palsy
  • Hydrocephalus
  • intraventricular haemorrhage
  • hypoxic-ischemic encephalopathy
  • neonatal seizures

are related to what?

A

neurological complications of prematurity

31
Q
  • anaemia
  • Impaired leucocyte function
  • Septicaemia, meningitis
  • Urinary tract infection
  • Fungal and viral infections

are related to what?

A

haematology and infection complications of prematurity

+ anaemia of prematurity

32
Q

How do you treat anaemia of prematurity?

A

Anaemia of prematurity -

iron supplementation is required for up to 6 months to correct

33
Q
  • Parental anxiety and distress
  • Family relationship disruption

are related to what?

A

social complicatons of prematurity

34
Q

What causes mortality in prematurity?

A

mortality in prematurity is mainly due to:

  1. infection of the resp tract (from impaired leucocyte function) or
  2. brain injury
35
Q

unsupported blood vessels in the brain and unstable BP (can get this from birth trauma & resp distress) in can cause 1/4 premature babies to have what?

risk factors: include perinatal asphyxia, RDS & pneumothorax

A

intraventricular haemorrage

  • bulging fontanelle
  • seizures
  • cerebral irritability
  • asymptomatic
36
Q

How do you investigate intraventricular haemorrhage in neonate?

A
  • USS through fontanelle (sx: is bulging fontanelle)
  • MRI
37
Q

What does delayed cord clamping help prevent?

A

Intraventricular haemorrhage!

complications of IBH = lower IQ, CP, hydrocephalus Rx (LP, ventricular tap, VP shunt)

38
Q

hydrocephalus is a complication of IVH. What is the Rx for hydrocephalus?

A

hydrocephalus Rx:

  • LP,
  • ventricular tap,
  • VP shunt
39
Q

What do you call brain injury secondary to hypoxic-ischaemic insult? and what can cause the hypoxic-ischemic insult?

A

Hypoxic-ischemic encephalopathy (HIE)

can be caused antenatal, intrapartum or postpartum e.g.

  • cord prolapse
  • placental abruption
  • maternal hypoxia
  • inadequate postnatal CPR
40
Q

After placental abruption a woman gives birth to a baby who is experiencing respiratory depression, is acidotic within 24h of birth. What is this?

Rx?

A

hypoxic ischaemic encaphalopathy

(sx: of neonate encephalopathy - dc consciousness, seizures, difficulty maintaining and initiating respiration, depression of tone and reflexes)

Rx:

  • resucitation,
  • avoid hyperthermia - therapeutic hypothermia in term babies reduces death and disability,
  • exclude other causes of encephalopathy, monitoring and rx of seizures.
41
Q

When do neonatal seizures commonly occur?

A

12-48hrs after birth

they can be generalised, focal, tonic, clonic or myoclonus

42
Q

What do these all represent?

  • Hypoxic-ischaemic encephalopathy (antenatal or intrapartum hypoxia)
  • Infection - meningitis, encephalitis
  • Intracranial haemorrhage/ infarction
  • Structural CNS lesions - focal cortical dysphasia, tuberous sclerosis
  • Metabolic disturbance - hypoglycaemia, low Ca, high Na, low Mg
  • Metabolic disorders - urea cycle disorders, amino acid metabolism
  • Neonatal withdrawal from maternal drugs or substance abuse
  • Kernicterus
  • Idiopathic e.g. Being 5th day fits
A

they are all causes of neonatal seizures

43
Q

How do you diagnose neonatal seizures?

A

:there are subtle signs, TF–> EEG can confirm seizure activity

also look for cause (part of Rx for neonatal seizures)

  • Cerebral function analysis monitoring (CFAM) if available
  • US or MRI head
  • Toxicology screening,
  • serum ammonia, urine organic acid, (urea cycle disorders)
  • serum amino acids, (amino acid metabolism)
  • karyotype,
  • TORCH screen (neonatal infections screen)
44
Q

How do you rx neonatal seizures?

A

ABCDE, turn on side

  1. Rule out reversible causes e.g. Hypoglycaemia
  2. Commence empirical abx
  3. IV access & bloods - FBC, U&E, LFTs, calcium, Mg, glucose, blood gas
  4. Treat cause
    • STATUS (>5mins) *see notes*
    • HYPOCALCAEMIA - calcium glauconite, monitor ECG
    • HYPOMAGNESAEMIA - MgSO4 IV
45
Q

Where should peterm babies be looked after?

whats their prognosis at >32 weeks and at 23-26wks?

A

Delivery should take place in a centre capable for caring for preterm babies

Adequate resuscitation once born –> NICU/SCBU

  • >32 weeks have excellent prognosis
  • 23-36 weeks, babies will develop many problems & will have to remain in hospital for many weeks - overall mortality is high
46
Q

What feeding do neonates/preterm <1.5kg need?

A

<1.5kg =

  • phosphate supplementation + supplemental calories,
  • protein,
  • vit D,
  • calcium
47
Q

What feeding do babies <2kg need?

A

<2kg:

supplemental breast milk or low-birth-weight formula

[if under <1.5kg phosphate supplementation + supplemental calories, protein, vit D, calcium }

48
Q

What age preterm baby needs an oro- or nasogastric tube?

A

if <35weeks

if very premature (<30wks) = need parenteral feeding

49
Q

What monitoring does a neonate have?

A
  • Vitals
    • Temp,
    • pulse,
    • BP (intra-arterial if critical)
    • respirations,
  • Bloods:
    • blood gasses,
    • U&E,
    • bilirubin,
    • FBC,
  • General
    • weight ,
    • weekly Head Circumference
50
Q

Regarding the ethics of intervention in extreme premature neonates.

What is considered so premature/small that it has a negligible chance of survival and with parents permission a ventilator can be switched off?

A
  • Neonate <24wks or <500g has a negligible chance of survival
  • With parents’ permission a ventilator can be switched off
  • [NB: >32weeks have excellent prognosis

23-36weeks, babies will develop many problems & will have to remain in hospital for many weeks - overall mortality is high]

Paediatrics (16 decks)

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