Preterm Flashcards
What is considered preterm?
Babies born before 37 weeks gestation
What is considered late preterm?
32 - 37 weeks
What is considered very preterm?
28 - 32 weeks
What is considered extremely preterm?
Less than 28 weeks
Risk factors of preterm babies?
- History of preterm babies
- Infection
- Smoking/drug use
- IUGR
- 2nd trimester miscarriages
- Anaemia
- Abnormal uterine anatomy
- Placenta abruption
- Multiple gestation
- Placenta praevia
- Premature rupture of membranes
- Young mothers
Characteristics of preterm baby?
- Lack of tone
- Large head in proportion to the baby
- Soft skull bones
- Ribs visible
- Thin limbs
- Nails not fully formed
- Normal reflexes
- Small genitalia
- Lanugo
- Small narrow chest
- No breast tissue
What concerns would you anticipate with a preterm baby?
- Cold stress cycle (Hypoglycaemia, Hypoxia, Hypothermia)
- Underdeveloped lungs, reduced surfactant = anticipate resus
- Respiratory distress = grunting, nasal flaring, chest recession, increased RR and HR
- Feeding/suckling reflex may be absent
- Increased risk of jaundice
- Immature immune system = more susceptible to infection
- Developmental problems
When is a foetus viable?
24 weeks gestation
When does the alveoli duct develop?
By 24 weeks gestation
When are lungs fully developed?
36 weeks gestation
What is the concerns with less surfactant?
Surfactant phospholipids reduce alveoli surface tension allowing the mechanical stretch of the lungs for breathing. When surfactant is reduced, there are fewer phospholipids to reduce the surface tension meaning more surface tension in the lungs making inflation difficult. Also that they may develop respiratory aspiration syndrome as result.
What are some major common complications for preterm babies?
- Respiratory distress syndrome
- Persistent ductus arteriosus
- Infections
- Cold stress cycle
- Jaundice
- Poor temperature control = less brown fat, greater SA to body weight ratio
- Anemia
- Bradycardia
- Apnoea
What would be the management of a preterm baby in labour and birth?
- Consider prophylactic corticosteroids (use from 22+5 until 34+6)
- Continuous monitoring with CTG
- Call and inform paediatrics to attend birth
- Consult with obstetrics
What gestation is resus of a newborn possible?
- From 23 weeks
What would the ongoing care of a preterm newborn born between 35 and 37 weeks be if they are above 2000g?
- Care in maternity ward
- Weight plotted on customised grow chart
- O2 saturation monitoring
- O2 therapy
- Ensuring effective, frequent feeding to prevent cold stress cycle (hypothermia, hypoxia, hypoglycaemia)
- Top ups if required
- Keep warm
- Early skin to skin
- Pre-feed temperature check
- Full obs (RR, T, HR, WOB, colour, behaviour, feeding, O2, blood glucose)
What obs and timeframes would be completed as per the news chart?
RR, T, HR, WOB, colour, behaviour, feeding = At 1 hour, 4 hours, 12 hours, and 24 hours
O2 sats = once between 12 and 24 hours
Blood glucose = 3 consecutive pre feed blood glucose levels 2.6mmol/L or above done every 3 hours
Why are preterm babies more at risk of developing jaundice?
- Due to higher levels of fetal haemoglobin that break down after birth and overwhelm and immature liver
- A delayed in feeding due to lack of energy or suckling reflex = slow bowel peristalsis = slow excretion of bilirubin as output reduced = conjugated bilirubin becomes unconjugated and is reabsorbed
What is necrotising enterocolitis?
Inflammatory disease of the bowel normally associated with septicaemia that can cause the intestinal tissue to die. Can cause a hole (perforation) in babies intestine where bacteria can leak into the abdomen or bloodstream. Requires surgery.
Signs in newborn of necrotising enterocolitis?
- Distended abdomen
- Blood per rectum
- Bile stained aspirate
What is retinopathy of prematurity?
Disease of the developing retinal blood vessels (in the eye) causing risk of O2 excess or fluctuating levels of what is required. This can cause hyperoxia that cause normal vascularisation to cease followed by rebound hypoxia that cause opaque fibrous tissues to form behind the lens causing impairment or blindness.
