*Preterm

Question 1

Risk factors for preterm?

WUMA-MP

Answer 1

• Pre-pregnancy weight <50kg
• Uterine/cervical abnormalities
• Lifestyle factors
• Medical conditions
• Mother < 20yo or > 40yo
• Multiple pregnancy
• Previous preterm birth
• IVF
• 6-9 months between pregnancies

Question 2

Physical appearance: preterm?

Skin, hair, ears, eyes, feet, muscle, fat, activity

Answer 2

Skin: dark red & shiny
Lanugo - body hair
Minimal plantar creases
Minimal ear cartilage
Eyelids fused until 25 weeks
Decreased alertness
Reduced muscle tone
Decreased subcutaneous fat

Question 3

Management of the pre-term baby: WARM

Answer 3

• Use warm wraps/blankets to support skin to skin
• Maintain room temperature at least 25C and avoid drafts
• If required, use radiant warmer
• Apply a hat
• Consider prone positioning if <34 weeks or experiencing respiratory distress

Question 4

Management of the pre-term baby: PINK

Answer 4

Oxygenation (maintain saturations)
Observe for respiratory distress
Perfusion: observe capillary refill, colour

Question 5

Management of the pre-term baby: SWEET

Answer 5

Early feed 1-2hr of birth
Feed regularly - min 3hrly
How to feed rules of thumb based on RR
Maintain PGL >or=2.5 mmol/L-6
Consider daily weight, weekly head circumference and general assessment of hydration (ie 5-6 wet nappies/day etc)
Further investigation if hypoglycemia persistent, recurrent or severe

Question 6

Management of the pre-term baby: CLEAN

Answer 6

• Prevention, detection and treatment of infection
• Broad spectrum ABs - Gentamicin and Amoxycillin
• Daily CRP
• Septic screen if req’d

Handwashing, clean environment, visiting policy

Question 7

Management of the pre-term baby: FAMILY

Answer 7

• Acknowledge emotional reaction of parents
• Discuss symptoms, management and treatment plan
• Maintain communication of changes
• Provide access to support
• Breastfeeding/breastmilk provision assistance

Question 8

Why are all newborns are more susceptible to infection? And additional factors for preterm?

Answer 8

All newborns are more susceptible to infection:
* Immature immune system
* Lack of resident ‘good’ flora
* Umbilical stump portal for infection

Preterm
* Physically stressed
* Invasive procedures
* Cross infection
* Environment
* Delayed feeding

Question 9

Signs of hypoglycaemia in newborn

Answer 9

Lethargy
Pallor
Hypotonic
Hypotension
Poor feeding
Irritability
Temperature instability
Sweating
Tachycardia
Apnoea
Seizures

Signs of hypoglycaemia can be vague and non specific. Therefore it is also prudent to check the PGL if you believe a neonate is at increased risk of hypoglycaemia eg vomiting/poor feeding, respiratory distress, cold stress, sepsis, preterm/SGA