Prematurity and Common Problems with Premature Newborns Flashcards
(29 cards)
What is the official definition for premature infants?
< 37 weeks gestation
What is the weight difference between Low Birth Weight (LBW), Very low birth weight (VLBW), and Extremely low birth weight (ELBW)?
LBW: < 2500 grams
VLBW: < 1500 grams
ELBW: < 1000 grams
What is the definition of an Extremely low gestational age neonate (ELGAN)?
< 28 weeks gestation
What gestation age is at greatest risk of RDS development?
< 34 weeks gestation
At what gestational age does surfactant production start, and what age does a child produce mature levels of surfactant?
Starts = 24-29 weeks gestation
Mature lvls = 34-35 weeks gestation
What is the pathophysiology of Respiratory Distress Syndrome in a premature infant?
caused by insufficiency of lung surfactant due to immaturity of type 2 pneumocytes = alveoli collapse due to high surface tension
What maternal risk factor puts premature newborns at a higher risk of developing RDS?
Maternal DIABETES
- maternal glucose crosses placenta (NOT INSULIN) and fetus increases insulin production
- fetal insulin levels rise and cause negative feedback on surfactant production (glucose important in surfactant synthesis)
What testing can be done to predict a developing fetus’s likelihood of developing NRDS?
FLM = Fetal Lung Maturity testing
- measures concentration of surfactant components in amniotic fluid
- obtained through amniocentesis
Why can C-sections increase the risk of neonatal RDS?
Removes the stress placed on the neonate during birth
- stress = increased cortisol levels = increased surfactant production
What is an air bronchogram?
air-filled bronchi seen on radiograph within spaces of consolidation
“black bronchi on white lung consolidation”
What are the PaO2, PaCO2, and pH ranges that an infant with NRDS should be maintained within?
PaO2 = 50-80 mmHg
PaCO2 = 40-55 mmHg
pH = > 7.25
What is seen on CXR of a child with NRDS?
“ground glass” opacities and air bronchograms
What are the mainstay treatment options for NRDS patients?
CPAP –> intubation/mechanical ventilation (refractory to CPAP)
Exogenous surfactant (through ETT)
What are the goal SpO2 and PaCO2 ranges for NRDS patients receiving CPAP?
SpO2 = 90-95%
PaCO2 = 45-65 mmHg
What is the pathophysiology of Bronchopulmonary Dysplasia (BPD)?
How is it diagnosed?
barotrauma and reactive oxygen species damage lung tissue in premature lungs, causing exaggerated inflammatory response that impairs normal lung development
Dx: need for supplemental oxygen > 28 days of life
Which neonates are more likely to develop BPD?
those born 23-32 weeks or that weight < 1250 grams at birth
What is the typical treatment for newborns with BPD?
- increase calorie intake and limit fluid intake
- NONINVASIVE oxygen support (wean over 2-4 months)
- can consider diuretics, systemic corticosteroids, or bronchodilators
What is the most common GI emergency in premature infants?
Necrotizing Enterocolitis
What week(s) of life is NEC most likely to develop?
2nd-3rd week of life
What is the reason that causes NEC to develop in premature infants?
likely due to immaturity of the gut, leading to inflammation, bowel ischemia, and possible perforation of the bowel wall
- typically develops following introduction of feeds
What is the management of NEC patients without signs of perforation?
NPO, nasogastric decompression, IV fluids + TPN, Blood cultures + Abx (cover anaerobes)
- surgery if perforation, pneumoperitoneum, failure of medical treatment
What are the two biggest risk factors for the development of NEC in premature infants?
prematurity and formula feeding
- human milk is PROTECTIVE against NEC
Ophthalmology evaluation is necessary for all premature infants with what two criterion, in order to screen for Retinopathy of Prematurity?
- weight < 1500 grams
- gestational age < 30 weeks
What are some of the treatment modalities that can be used to treat retinopathy of prematurity?
cryotherapy, PHOTOABLATION, anti-VEGF agents
