Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Prematurity and NIC > Flashcards

Prematurity and NIC Flashcards

1
Q

Define preterm and extreme preterm

A

Preterm = born at less than 37 weeks

Extreme preterm = before 28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define Low birth weight, very low birth weight and extremely low birth weight

A

Low birth weight baby = <2.5kg at any gestational age (LBW baby may not be SGA)
Very low birth weight baby = <1.5kg
Extremely low birth weight baby = <1kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define small for gestational age

A

SGA = below the 10th centile for their gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When do the insults that cause symmetric vs asymmetric birth weight occur?

A

Symmetric SGA usually due to insult early on in pregnancy whilst asymmetric is usually later and includes IUGR. Asymmetric babies have higher risk of complications.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How long does it take SGA babies to catch up?

A

The majority of SGA babies will catch up to a normal size in the first 2 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the complications of LBW and SGA?

A
  • Foetal death
  • Congenital infections
  • Hypoglycaemia
  • Hypothermia
  • Polycythaemia
  • NEC
  • Meconium aspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What causes prematurity?

A
  • PROM most common accounting for 30-40%
  • Planned due to life threatening conditions effecting mother or child
  • Emergency i.e. placental abruption, eclampsia or sepsis
  • Idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the risk factors for prematurity?

A
  • Smoking
  • Multiple pregnancy
  • Previous preterm
  • High or low BMI
  • Closely spaced pregnancies
  • Uterine, cervical, placental problems including infection
  • Pre-eclampsia
  • Diabetes
  • Physical injury or trauma
  • Polyhydramnios
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is the decision as to whether resuscitation takes place in a premature baby made?

A

23-23+6 weeks baby – combined decision as to whether to resuscitate
24-24+6 weeks baby – resuscitation should be commenced unless severely compromised
After 25 weeks resuscitation is always appropriate

If born before 23 weeks there is a very high rate of mortality and if surviving disability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What examination is used to determine neonatal maturity?

A

After delivery of a preterm baby the Dubowitz/Ballard examination can be used to determine neonatal maturity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are neonates managed immediately after birth when premature?

A

Resuscitation if needed then take to NICU or SCBU.

Supplemental breast milk or low birth weight formula should be given if under 2kg.

Monitor blood glucose closely. Encourage mother to express from day 1 and tube feed if not tolerating oral feeds.

All preterm neonates admitted to a NICU should have a routine FBC and CRP as infection, anaemia and thrombocytopenia are common.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When must a paediatrician or nurse be present at a birth?

A

Paediatrician or nurse should always attend the following birth: any, where the health of foetus is under concern, CS, breech, twins, instrumental delivery, prematurity, eclampsia and meconium stained liquor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the process of checking a baby once it is born?

A
  • Prior to birth the resuscitaire should be checked and heated with at least 2 towels available.
  • If baby pink and crying give back to mother.
  • If not pink and crying, then rub vigorously
  • If no spontaneous breathing, then bag + mask ventilation should be started with air
  • If chest is not expanding readjust the head and get help to create a better seal and try airway manoeuvres
  • After 5 inhalations have caused chest expansion check if breathing is spontaneous
  • If not, aim for 40-60 breaths per minute and add oxygen stepwise if not pinking up
  • Check heart rate – if <60 then start compressions at 100bpm
  • If HR doesn’t improve give IV or IO adrenaline 0.3ml if no response try 1ml followed by 20ml bolus saline
  • Check glucose and treat any hypoglycaemia with 10% dextrose
  • If meconium and baby unresponsive suction under direct vision both oropharynx and vocal cords
  • Failing all this endotracheal intubation may be necessary
  • Note CPR shouldn’t be initiated unless HR falls below 60
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the APGAR3 score?

A

Scores 2, 1 or 0 for each category

Pulse
>100
<100
0

Respiration
Strong cry
Slow irregular
Nil

Muscle tone
Active
Limb flexion
Absent

Colour
Pink
Blue limbs
Blue or white

On suction?
Coughs well
Depressed cough
No response

APGAR3 scoring should be done at 1, 5 and 10 minutes after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the biggest problems for neonates in NICU?

A
  • Hypothermia
  • Hypoxia
  • Hypoglycaemia
  • RDS
  • Infection
  • Necrotising enterocolitis
  • Cardiac abnormalities e.g. PDA or hypotension
  • Apnoea
  • Retinopathy of prematurity
  • Intraventricular haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What causes apnoea in premature babies and how should it be managed?

A

Apnoea – very common in LBW babies. Commonly caused by prematurity, infection, hypothermia, aspiration and congenital heart disease. Caffeine can be used in babies under 28weeks. Prevention is via corticosteroids to mature their lungs in utero.

17
Q

What is intraventricular haemorrhage

A

Intraventricular haemorrhage – common in low birth weight babies. This occurs due to unsupported blood vessels, labile blood pressure due to birth trauma and respiratory distress. Delayed cord clamping can decrease the risk of this.

18
Q

What are the signs, symptoms and long term complications of intraventricular haemorrhage?

A

Signs include: seizures, bulging fontanelles, cerebral irritability but could be asymptomatic. Can be diagnosed with a CT or MRI.

Long term complications include reduced IQ, cerebral palsy and hydrocephalus but many lead normal lives.

19
Q

What is retinopathy of prematurity and how is it treated?

A

Retinopathy of prematurity – occurs due to abnormal fibrovascular proliferation in the retina which leads to retinal detachment and vision loss. Exposure to oxygen can increase the risk of this especially large fluctuations in concentration. It can be split into 5 stages depending on the location and degree of retinal detachment. Treatment is with a diode laser.

20
Q

When is retinopathy of prematuirty screened for?

A

Screening for retinopathy of prematurity – occurs with indirect ophthalmology (light on a headband and handheld lens). If <27 weeks, then screen at 30-31 weeks postmenstrual age. If born between 27 and 32 weeks, then screen at day 28-35 of life. Repeat screening 2 weekly depending on severity.

21
Q

Why does pulmonary hypertension sometimes occur - what commonly causes this?

A

Normally as we take our first breath pulmonary vascular resistance decreases partially mediated by NO. This allows changes in foetal circulation so that it moves towards an adult system. This process can be interrupted leading to pulmonary hypertension e.g. meconium aspiration, pneumonia, RDS, diaphragmatic hernia, group B strep infection and pulmonary hypoplasia.

22
Q

How is pulmonary hypertension diagnosed?

A

Pulmonary hypertension is diagnosed when there is an underlying cause and persistent desaturation despite adequate oxygen use. Investigate with echo which should show right to left shunt at the DA in absence of a structural heart defect.

23
Q

How is pulmonary hypertension managed?

A

Ventilate gently
Correct reversible factors such as hypothermia, hypoglycaemia and electrolyte imbalances
Inhaled NO helps promote adult circulation

24
Q

What is necrotising enterocolitis?

A

Inflammatory bowel conditions and one of the leading causes of death among premature babies. Cause is thought to be linked to poor blood supply and infection

25
Q

What are the risk factors for NEC?

A 
Prematurity
Low weight
Enteral feeds
Bacterial colonisation
Mucosal injury
26
Q

How does NEC usually present?

A 
Feeding intolerance 
PR bleeding
Sudden abdominal distension
Tenderness with or without perforation and consequence pneumoperitoneum 
Shock
DIC
Mucosal sloughing
Pneumatosis intestinalis – intramural gas (x-ray finding that is pathognomonic)
27
Q

How is suspected NEC investigated?

A

Abdominal X-ray
Culture faeces
Cross match

28
Q

How is NEC managed?

A

Stop oral feeding (except oral probiotics)
Barrier nurse
Antibiotics - ceftriaxone and vancomycin
Surgical referral - laparotomy if increasing distention or perforation

29
Q

What usually causes an infant to be floppy?

A 
Sepsis 
Hypoglycaemia 
Dehydration 
Hypothermia 
Trauma 
Myopathy 
Poor nutrition 
Maternal drugs
30
Q

What differentials should be considered in a floppy infant?

A

Cerebral: Down’s, Prader-Willi, hypothyroidism, Sepsis and encephalopathy (HIE)
Brainstem: syringomyelia and birth trauma
Anterior horn cell: SMA, Polio/Coxsackie
Peripheral nerve: hereditary motor/sensory neuropathies and Guillain-Barre
Neuromuscular junction: myasthenia gravis and botulism
Muscle: Dystrophies, metabolic myopathies and congenital myopathies

Paediatrics (50 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions