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Paediatrics > Prematurity and Small for Date > Flashcards

Prematurity and Small for Date Flashcards

1
Q

What classes a baby as being premature?

A

gestational age from last menstrual period is <37 weeks

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2
Q

What would class any baby (regardless of gestational age at birth) as being of low birth weight?

A

<2.5kg

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3
Q

What would class any baby (regardless of gestational age at birth) as being of very low birth weight?

A

<1.5kg

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4
Q

What would class any baby (regardless of gestational age at birth) as being of extremely low birth weight?

A

<1kg

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5
Q

What does small for gestational age refer to?

A

a birth weight below the 10th percentile for their gestational age

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6
Q

What is intrauterine growth restriction?

A

failure of growth in utero

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7
Q

Symmetric SGA.

A
  • all growth parameters are symmetrically small suggesting that the foetus was affected from early pregnancy
  • in babies with chromosomal abnormalities and the constitutionally small
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8
Q

Asymmetric SGA.

A
  • the weight centile is less than length and head circumference
  • usually due to IUGR and an insult later in pregnancy e.g. pre-eclampsia
  • these babies have a high risk of complications
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9
Q

What are some causes of being small for dates?

A
  • poverty/poor social support
  • constitutional factors
  • twins
  • chromosomes e.g. Edward’s syndrome
  • foetal infection e.g. CMV
  • placental insufficiency e.g.due to maternal smoking, diabetes, pre-eclampsia, partial abruption
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10
Q

What are complications of being a SGA or premature baby?

A
  • increased risk of death
  • hypoglycaemia
  • hypothermia
  • polycythaemia (secondary to chronic intrauterine hypoxia)
  • necrotising entero-colitis secondary to ischaemia
  • meconium aspiration
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11
Q

What are possible long term effects of being SGA or premature?

A
  • hypertension
  • reduced growth
  • obesity
  • ischaemic heart disease
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12
Q

What makes a baby extremely preterm?

A

born less than 28 weeks gestation

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13
Q

What is the rough incidence of prematurity?

A

about 10%

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14
Q

What respiratory problems can a preterm baby have?

A
  • respiratory distress syndrome (RDS)
  • bronchopulmonary dysplasia (BPD)
  • apnoea
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15
Q

What is respiratory distress syndrome?

A

deficiency of alveolar surfactant means it is more difficult for the baby to inflate its lungs and there is more effort involved with breathing

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16
Q

What pathophysiology occurs if respiratory distress syndrome is not addressed?

A

respiratory failure—hypoxia leads to decreased cardiac output—hypotension, acidosis and renal failure

17
Q

What would be included in a differential diagnosis of RDS?

A
  • transient tachypnoea of the newborn (due to fluid on lungs-usually resolves after 24hrs)
  • meconium aspiration
  • congenital pneumonia (due to group B strep)
18
Q

What are signs of RDS?

A
  • increased work of breathing shortly after birth (first 4 hours)
  • tachypnoea
  • grunting
  • nasal faring
  • intercostal recession
  • cyanosis
19
Q

What can we do to prevent RDS?

A

administer steroids to mothers at risk of preterm delivery e.g. dexamethasone

20
Q

How would you treat RDS when the baby was born?

A
  • oxygen input and measure sats

- intubate and give surfactant an extubatne as soon as possible to use N-CPAP

21
Q

What is broncho-pulmonary dysplasia?

A
  • when treatments for maintaining premature lungs result in damage to the baby’s lungs e.g. get O2 toxicity, pressure from ventilation causes issues
  • get inflammatory changes with tissue repair leading to scarring
22
Q

What might you see on chest x ray that would be suggestive of BPD?

A

hyperinflation (horizontal ribs)

23
Q

How would BPD be treated?

A
  • steroids

- nutrition!!! e.g. high calorie feeding

24
Q

What is a minor respiratory problem that can occur if you are born premature and how is it treated?

A
  • apnoea/ irregular breathing/ desaturations

- treated with caffeine and possibly N-CPAP

25
Q

What brain problems can a premature baby have?

A
  • intraventricular haemorrhage (IVH)
  • periventricular leucomalacia (PVL)
  • post haemorrhagic hydrocephalus (PHH)
26
Q

How is intraventricular haemorrhage graded?

A

1-4 (1 best, 4 worst)

27
Q

What causes intraventricular haemorrhage in preterm babies?

A

blood vessels in the brains of babies (especially preterm babies) are immature and fragile and can bleed into the ventricles

28
Q

How can IVH be prevented?

A

antenatal steroids in women at risk of premature birth

29
Q

How would IVH be treated?

A
  • symptomatic

- drainage?

30
Q

What is periventricular leucomalacia (PVL)?

A

The white matter (leuko) surrounding the ventricles of the brain (periventricular) is deprived of blood and oxygen leading to softening (malacia).

31
Q

What causes PVL?

A

If the blood supply to an area of the brain is stopped or reduces, this causes tissue damage e.g. due to IVH

32
Q

What is post-haemorrhagic hydrocephalus (PHH)?

A

defined as progressive ventriculomegaly caused by disturbances in cerebrospinal fluid flow or absorption following intraventricular haemorrhage. e.g. due to blood coagulation blocking ventricle outflows

33
Q

What circulatory problems can a preterm baby have?

A

patent ductus arteriosus

34
Q

What gastrointestinal problems can a preterm baby have?

A
  • necrotising enterocolitis (NEC)

- huge nutritional requirements

35
Q

What is NEC?

A
  • ischaemic and inflammatory changes in the bowel
  • necrosis of the bowel
  • may be due to ischaemia related to PDA
36
Q

What may be signs of NEC?

A

huge, swollen and shiny abdomen in preterm baby

37
Q

How would NEC be managed?

A
  • surgery

- sometimes conservative management possible with antibiotics and parenteral nutrition

38
Q

What is the prognosis of a premature child?

A
  • unpredictable even when the baby is discharged
  • 1/3 die
  • 1/3 have normal life or mild disability
  • 1/3 have moderate or severe disability for lifetime

Paediatrics (25 decks)

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