Prematurity Flashcards
Risk factors for Premature Babies
AA > W > AP
less than 16 years old, HTN/DM/Hyperthyroid, Smoking, Infections, Alcohol, Drugs, Nutrition, Stress
Systemic Issues of Prematurity
increases susceptibility to infection because of immature immune system
Respiratory Distress Syndrome (RDS): 80% born less than 27 weeks and 5% mortality and can lead to chronic lung disease
Patent Ductus Arteriosus
fails to close and allows oxygenated blood flow back to lungs
can lead to heart failure and lowered blood flow from PA to aorta
IVH
Interventricular Hemorrhage
bleeding starts in germinal matrix and bleeds into ventricles which increases ICP (developmental delays)
PVL
Periventricular Leukomalacia
single to multiple lesions with fluid-filled cavities can lead to neurodevelopmental delay, CP, or cortical vision impairment (eye problem due to brain)
Myopia Issue with Premature Babies
around 5-6D
the earlier the term, the more myopia
non-axial: thickened lens, shallow AC, steeper K
no progression (diff type of myopia)
ROP
why does it happen?
- fetus development
Retinopathy of Prematurity
the retina is avascular until the 4th month
CRA: ON to Far Periphery
- 5 mos at equator and by 8 mos at nasal periphery
immature temporal retina at birth is possible (by 9-10 mos)
this happens more often when O2 is administered
Risk factors for ROP
gestational age, oxygen (concentration, duration, ventilation) and weight
Screening Criteria for ROP
30 or less weeks old + 1500g or less
1st screening at 31 weeks gestational or 4 wks post-natal age
- whichever is later option!
Ex: if you have a premature baby born at 25 weeks, the 31 weeks gestational age is later than 4 weeks later so we would do it at 31 weeks gestational age
OR
if you have a baby at 28 weeks, we would do the 4 weeks post-natal age since that is later than 31 weeks gestational age
Zone 1
Posterior pole with Disc Center and radius is 2x distance of fovea to disc
Zone 2
Ora serrata nasally to equator temporally
Zone 3
residual temporal and medial retina
Stages of ROP
1: demarcation line at junction
2: demarcation ridge (elevated)
3: Extraretinal Fibrovascular Proliferation and Neovascularization at Ridge
4: Partial RD (can or cannot involve fovea)
5: Total RD: funnel shaped
“Plus Disease”
marked dilation and tortuosity of vasculature in posterior pole
high vascular activity and shunting
indicates treatment
CRYO-ROP ‘88
Freezing the retina so it doesn’t detach
- 50% decrease in RD rate but poor VA and structural outcomes in groups
