Premie problems Flashcards by American Mouse

Premature survival

10% survival without major problems at 23 weeks

60% survival at 24 weeks, half have moderate neuro-disability

Survival at 26 weeks 80-90%,

How well did you know this?

Not at all

Perfectly

RDS 3 main problems

– Surfactant deficiency
– Immature lung structure
– Weakness of chest wall

How well did you know this?

Not at all

Perfectly

Synagis/ Palivizumab is ?

anti-RSV monoclonal antibody, expensive, need injection once a month during RSV season

How well did you know this?

Not at all

Perfectly

Premature risk factors for infection

–	Poor cell mediated responses
–	Poor humoral responses
–	Poor innate immunity
–	Little passive immunity
–	Limited oral intake in some
–	Invasive lines and tubes
–	Staff and parents

How well did you know this?

Not at all

Perfectly

IVH grade 1

In germinal matrix only

How well did you know this?

Not at all

Perfectly

IVH Grade 2

Within ventricles, no distension

How well did you know this?

Not at all

Perfectly

IVH Grade 3

Distended ventricle

How well did you know this?

Not at all

Perfectly

IVH Grade 4

Parenchymal involvement

How well did you know this?

Not at all

Perfectly

premie age

4 wk old 24 week =28 weeks

so an 8 month old 24 week =

4 months

How well did you know this?

Not at all

Perfectly

Vaccinate from when baby is born at

2,4,6 months

How well did you know this?

Not at all

Perfectly

Discharge if

feed,
maintain temp, 
breathe by yourself
>35 weeks
>1.8kg

How well did you know this?

Not at all

Perfectly

Preterm
Late preterm
Very Preterm
Extreme Preterm

<37 weeks
34-36 weeks
<32 weeks
<28 weeks

How well did you know this?

Not at all

Perfectly

Low birth weight
Very low birth weight
Extremely low birth weight

<2.5Kg
<1.5kg
<1kg

How well did you know this?

Not at all

Perfectly

Preterm delivery causes
top three
Other

spontaneous PTL
Infection
PPROM

elective
APH
Cervical incompetence
multiple pregnancy

How well did you know this?

Not at all

Perfectly

Prematurity complications

Respiratory
	Respiratory Distress Syndrome
	Apnoea of prematurity
	Bronchopulmonary dysplasia 
Cardiovascular
	Patent ductus arteriosus
Fluids/Electrolytes
	Immature kidneys
	Hypoglycaemia
	Hypocalcaemia
	Infectious Disease
	Sepsis
GI
	Necrotising enterocolitis 
	Jaundice
	Ileus &amp; feeding difficulties
Hematological
	Anaemia
Neurological
	Intraventricular haemorrhage
	Periventricular leucomalacia 
Other
	Hypothermia
	Retinopathy of prematurity

How well did you know this?

Not at all

Perfectly

Before birth, give ?

steroids
magnesium sulphate
antibiotics if PPROM

at birth give

surfactant if under <28 weeks

VLBW 4 main problems

PDA
NEC
ROP
Cholestatic jaundice

Resp distress signs

Respiratory rate >60 bpm
Retractions (inter/subcostal,sternal)
Grunting
Cyanosis
Low SpO2 on Pulse Oximeter

Apnoea of prematurity tx

Stimulation
O2/ CPAP
Caffeine

PDA Tx

Paracetamol or Ibuprofen (indomethacin)

Surgical or catheter ligation if vent dependent

NEC: clinical & x-ray features

Abdominal distension
Failure to tolerate feeds
Bile-stained gastric aspirate
Blood stained stools
Abdominal x-rays shows dilated bowel loops with gas in the bowel walls

term babies develop NEC within first few days of life. Babies born earlier develop NEC at a later age. Average age onset:

2 days for babies born less than 30 weeks
8 days for babies born at 31-33 weeks’ EGA
4 days for babies born after 34 weeks gestation.

NEC: treatment & prevention

Stop oral feeds, give IV fluids/TPN
Commence IV antibiotics including metronidazole
Nasogastric aspiration
Blood pressure support if the baby becomes hypotensive
Surgery if severe NEC or bowel perforation.
Prevention: Probiotics

Risk of neuro handicap by weight

> 1500 grams: outcome very good 1000 – 1500 grams: 7% handicap < 1000 grams (and particularly < 750 grams): risk handicap is greater

PVL affects the white matter around the lateral ventricles long tract fibres particularly affected, risk cerebral palsy (especially spastic diplegia) Secondary to

hypotension leading to cerebral ischaemia Hypocarbia ( paCO2 < 4 kPa) Hypoglycaemia Sepsis / inflammation

Early complications of IVH

``` acute deterioration Apnoea, bradycardia, seizures, shock ```

Late complications of IVH

hydrocephalus = post haemorrhagic ventricular dilation

Hydrocephalus Sx

Inappropriate increase in head circumference Lethargy & drowsiness Vomiting Tense fontanelle, widely spaced sutures

Hydrocephalus Tx

Tap CSF May require ventriculo-peritoneal shunt +/- reservoir until VP shunt

IVH Dx

clinical | U/S

clinical presentation IVH 50% may be “silent” unexplained deterioration

hypotonia poor colour reduced movements ``` Cerebral irritability Shock Bulging fontanelle +/- expanding head An exaggerated or absent Moro reflex Fits / seizures Deteriorating feeding skills ```

risk factors for IVH

``` Prematurity Birth asphyxia RDS Bleeding disorders Pneumothorax PDA Birth trauma Breech delivery ```

Tell me about the germinal matrix

site of embryonal neurons/fetal cells which migrate to cortex highly cellular and very vascular, esp preterm IVH mostly in < 3 days, 90% in first week

BPD aetiology

``` Prematurity (immature lungs) Ventilation (stretch, collapse, O2 ) Infection Fluid overload / PDA Poor response to inflammation Gastro-oespophageal reflux ```

BPD histology

Peribronchial fibrosis thickening of the bronchial walls with muscular hypertrophy

BPD CXR

streaky interstitial markings atelectasis hyperinflation cysts