Prematurity and Neonatal Diseases (Dagle)

Question 1

preterm is defined as birth before ___ weeks gestation.

Answer 1

37

Question 2

what percentage of premature births are spontaneous?

Answer 2

75%. The other 25% are induced.

Question 3

True or false: late, moderate and very preterm birth rates have been dropping steadily over the last 5 years.

Answer 3

False. Only late preterm birth rates have been falling, and it is likely due to a change in practice and policy over elective inductions. Very preterm birth rates have remained steady at about 2% of all live births over the last decade.

Question 4

what is the strongest predictor of future preterm delivery?

Answer 4

history of preterm delivery. 20-40% of preterm birth is thought to be genetic.

Question 5

as birth approaches, receptors for this hormone are downregulated, leading to lack of signalling and increased contractility potential, while levels of this hormone increase and begin preparing the fetus for transition to extra-uterine life.

Answer 5

progesterone; glucocorticoids

Question 6

if the placenta starts to bleed (decidual hemorrhage), progesterone receptors are downregulated and there is an increase in these enzymes that degrade collagen and lead to dilation of the cervix.

Answer 6

matrix metalloproteinases (MMPs); inflammation also causes these changes.

Question 7

SGA infants are associated with later ____ diseases, such as diabetes, obesity, and dyslipidemia.

Answer 7

metabolic

Question 8

describe how bilirubin is made.

Answer 8

when a baby is born, red blood cells that are no longer needed are broken down into heme and globin. the globin is recycled into amino acid synthesis and the heme is converted by heme oxygenase to biliverdin. Biliverdin reductase converts the biliverdin to unconjugated bilirubin. Conjugated bilirubin bound to protein is water soluble and can be excreted by the liver into the bile or reabsorbed by the kidney. Unconjugated bilirubin cannot. It goes to the brain and can cause damage at high enough concentrations.

Question 9

phototherapy, gavage feeding and exchange transfusion are all strategies for managing what condition that affects 75% of babies born?

Answer 9

hyperbilirubinemia

Question 10

symptoms of this condition include high pitched cry, lethargy, kernicterus, hypotonia with intermittent arching and seizures

Answer 10

bilirubin encephalopathy

Question 11

what are the 3 most common causes of hypoglycemia in an infant?

Answer 11

hyperinsulinemia (ie, kids of diabetic mothers)
inadequate glycogen stores
hormonal abnormalities

less common = thermogenic stress, metabolic errors, endocrine abnormalities

Question 12

clinical signs, population based definitions, acute metabolic changes and long-term neurologic outcomes are all ways people attempt to define what condition, that affects fetal growth and development?

Answer 12

hypoglycemia

Question 13

the treatment of hypoglycemia relies most on what factor?

Answer 13

whether the baby is symptomatic or not

Question 14

why are so many signs of hypoglycemia neurologic in origin?

Answer 14

glucose is the main source of energy for the brain

Question 15

how should a baby be treated if it is showing signs of sepsis but the blood culture is negative?

Answer 15

antibiotics (clinical sepsis)

Question 16

Which of these is NOT a risk factor for sepsis?

A. Black race
B. Birth asphyxia
C. Congenital skin abnormalities
D. Prematurity
E. Female sex

Answer 16

E. Sepsis and meningitis are more common in males, especially gram negative infections.

Question 17

name 3 early onset organisms associated with neonatal sepsis and how they’re treated

Answer 17

GBS, Listeria (not common anymore), E. Coli; treat with ampicillin and gentamycin