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Appreciating Complex Midwifery Care > Preterm and LBW Babies > Flashcards

Preterm and LBW Babies Flashcards

1
Q

What is a neonatal death?

A

Death in the first 28 days of life

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2
Q

What are corticosteroids used for?

A

Lung maturity

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3
Q

What is magnesium sulphate used for?

A

Protects the brain and decreases the risk if cerebral palsy

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4
Q

What are some ways in which parents should be supported?

A
  • Excellent communication
  • Reduced separation
  • Provision of accommodation
  • Skin to skin
  • Psychological and financial support
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5
Q

What is the other name for skin to skin?

A

Kangaroo care

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6
Q

How many week is moderately preterm, very preterm and extremely preterm?

A 
Moderately = 32-37
Very = 28-32
Extremely = <28
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7
Q

What percentage of preterm birth are moderately, very and extremely?

A 
Moderately = 85%
Very = 11%
Extremely = 5%
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8
Q

What are the chances of survival?

A 
<22 = close to 0
22 = 10%
24 = 60%
27 = 89%
31 = 95%
34 = same as term baby
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9
Q

What are the main causes of neonatal death?

A
  • Prematurity
  • Birth asphyxia and birth truama
  • Sepsis and other infections
  • Acute lower respiratory infections
  • Congenital anomalies
  • Other
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10
Q

What antenatal care should be given for preterm births?

A
  • Consider transfer to appropriate care
  • Corticosteroids (<34/40)
  • MgSO4 (<30/40)
  • Room temperature
  • Tour of NNU
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11
Q

What is the difference in appearance between a preterm baby and an IUGR baby?

A 
Preterm = poor tone, lethargic
IUGR = Good tone, more alert, extra skin
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12
Q

What is the difference in airway and breathing between preterm and IUGR babies?

A 
Preterm = Surfactant deficiency, pulmonary immaturity
IUGR = Lungs in alveolar stage producing surfactant
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13
Q

What is the difference in the GI tract between preterm and IUGR babies?

A 
Preterm = Poor suck/ swallow reflex, unable to feed PO
IUGR = Able to suck and swallow, often very hungry
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14
Q

What is the difference in the foot sole between preterm and IUGR babies?

A 
Preterm = smooth
IUGR = creases evident
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15
Q

What is the difference in skin between preterm and IUGR babies?

A 
Preterm = red and shiny, fragile, lacks keratin
IUGR = formed skin, may be baggy due to reduced SC fat
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16
Q

What are some common causes of premature delivery?

A
  • Smoking/alcohol
  • High parity
  • Low/high mat age
  • Infection
  • Prev. premature birth
  • 40% no identified cause
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17
Q

How does prematurity affect circulation?

A
  • CBV = 100ml/kg
  • Fragile blood vessels
  • Difficult to control BP
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18
Q

How should nutrition be managed with premature babies?

A

EBM is important to provide antibodies, fed through IV

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19
Q

How does prematurity affect blood sugar?

A
  • Increased stress = increased cortisol = increased blood sugar
  • May require insulin infusion
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20
Q

How does prematurity affect the electrolyte balance?

A
  • Sodium leaks from kidneys

- Premature EBM contains more sodium

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21
Q

What are some other issues associated with prematurity?

A
  • Breathing problems
  • Infection
  • Jaundice
  • Intolerance of handling
  • Ventricular haemorrhage
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22
Q

What are the advantages of delayed cord clamping?

A
  • Increases haematocrit
  • Decreased need for transfusions
  • Decreased risk of NEC
  • Decreased risk of IVH by 50%
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23
Q

What does IVH stand for?

A

Intraventricular haemorrhage

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24
Q

What is NEC?

A

Necrotising Enterocolitis (portion of the bowel dies)

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25
Q

What is the difference between LBW, VLBW and ELBW?

A

LBW = <2500g
very LBW = <1500g
extremely LBW = <1000g

26
Q

What are some of the characteristics of a LBW baby

A
  • Could be born term or preterm
  • Weight below 10th centile
  • Low blood sugar
  • Polcythaemia
  • Organ failure
27
Q

What is polycythaemia?

A

Increased Hb concentration

28
Q

What are some of the causes of IUGR?

A
  • PIH
  • Smoking, alcohol, drugs
  • Diabetes
  • Chromosomal abnormalities
  • Infection
  • Placenta praevia
29
Q

What is the TORCH research for?

A 
T = toxoplasmosis
O = other (syphylis, varicella-zoster, parvovirus, B19, hepB)
R = rubella
C = cytomegalovirus
H = herpes
30
Q

What is the difference in causes (etiology) of symmetric and asymmetric IUGR?

A 
Sym = usually a syndrome (congenital infections/disorders)
Asym = due to reduced oxygen and nutrient transfer (placental insufficiency)
31
Q

What is the difference in onset of symmetric and asymmetric IUGR?

A 
Sym = early in utero
Asym = late onset
32
Q

What is the difference in pathophysiology of symmetric and asymmetric IUGR?

A 
Sym = impaired cell division, decreased cell number, irreversible
Asym = impaired cellular hypertrophy, decreased cell size, reversible
33
Q

What is the difference in clinical features of symmetric and asymmetric IUGR?

A 
Sym = inadequate growth of head and baby, head:abdomen ratio normal
Asym = brain is spared, head:abdomen ratio increased
34
Q

Which has a worse prognosis out of symmetric and asymmetric IUGR?

A

Symmetric

35
Q

What are some clinical features of IUGR?

A
  • Anxious and hyper alert infant
  • Absence of buccal fat
  • Poor breast bud formation
  • Loose, dry, easily peeled skin
  • Thin umbilical cord
  • Thin arms and legs
36
Q

What is an LNU?

A

Local Neonatal Unit = full care, including short periods of intensive care, for majority of babies >27/40

37
Q

What is a NICU?

A

Neonatal Intensive Care Unit = long term/ complex intensive care

38
Q

What is a SCBU?

A

Special Care Baby Unit = provide special care for their own population and some high dependency services but may need transferring to NICU for more complex care

39
Q

What is TCU?

A

Transitional Care Unit = for mothers to stay in hospital with their baby after they leave SCBU/NICU for extra support before they go home

40
Q

What are some common causes of Respiratory Distress Syndrome?

A
  • Prematurity
  • C Section
  • Monozygotic twins
41
Q

What are the antenatal precautions for RDS?

A
  • Corticosteroids

- Artifical surfactant (<28/40)

42
Q

When does surfactant production begin?

A

24-28 weeks

43
Q

How is artifical surfactant administered?

A
  • Injected into lungs using endotracheal tube

- Made from pig fat - may be issue for Muslims/Jews/Vegans (may accept as treatment as it is not being ingested)

44
Q

Give 6 common signs of RDS

A
  1. Recessions
  2. Grunting
  3. Tachypnoea
  4. Apnoea
  5. Nasal flaring
  6. Dusky/ cyanosed
45
Q

Describe the process of thermoregulation

A
  • Minimal metabolic rate and oxygen consumption maintains a normal body temp
  • Normal body temp = 36.5-37.3
46
Q

When does grunting occur?

A

On expiration only

47
Q

What are the 4 ways that heat is lost from the body of a baby?

A

Radiation - lose heat through skin into cooler outside temp
Convection - draught
Evaporation
Conduction - loss of body heat to cooler objects that come in contact with skin

48
Q

What are the first 5 steps of the WHO warm chain?

A
  1. Warm delivery room (25-28)
  2. Immediate drying (unless <30/40)
  3. Skin to skin
  4. Breastfeeding (within 1 hr)
  5. Bathing and weighing postponed
49
Q

What are the last 5 steps of the WHO warm chain?

A
  1. Appropriate dry clothing
  2. Mother and baby together
  3. Warm transportation
  4. Warm resuscitation
  5. Training and awareness raising
50
Q

Why do preterm/LBW babies get cold?

A
  • Large SA:V ratio
  • Less SC fat
  • Increased water content
  • Immature skin
  • Poor response to cold stress
  • Unabe to maintain peripheral vasoconstriction
51
Q

What is the process of cold stress in relation to peripheral vasoconstriction?

A

Cold = >o2 consumption = >RR = >peripheral vasoconstriction = anaerobic glycolysis and metabolic acidosis

52
Q

What is the process of cold stress in relation to pulmonary vasoconstriction?

A

Cold = >o2 consumption = >RR = pulmonary vasocontriction =

53
Q

How can cold stress be prevented?

A
  • Warm room
  • Polyethylene wrap (<30/40)
  • Dry baby
  • Radiant warmer
  • Incubator (<1.5kg)
  • Hot cot (<2.5kg)
  • Skin to skin
  • Early feeding
54
Q

How does domperidone support lactation?

A

Used for oesophageal reflux, can be used to produce milk, if doesn’t work in first week stop using

55
Q

How can we support lactation?

A
  • Consistent advice
  • Support and encouragement
  • Privacy
  • Skin to skin
  • Breast pumps
56
Q

What is non-nutritive sucking?

A
  • From 30/40, encourage sucking without giving food to aid a quicker transition to suck feeding
  • Need parental consent as may involve use of passifier
57
Q

How many premature babies end up with a permanent disability?

A

1/10

e.g. lung disease, cerebral palsy, blindness, deafness

58
Q

In the EPICURE study, what % of children born before 26/40 had a severe disability?

A

22%

  • Cerebral palsy and not walking
  • Low cognitive scores
  • Blindness
  • Profound deafness
59
Q

In the EPICURE study, what % of children born before 26/40 had a moderate disability?

A

24%

  • Cerebral palsy and walking
  • IQ/cognitive scores in special needs range
  • Less degree of visual/hearing impairment
60
Q

In the EPICURE study, what % of children born before 26/40 had a mild disability?

A

34%

  • Low IQ/cognitive scores
  • Squint
  • Require glasses
61
Q

In the EPICURE study, what % of children born before 26/40 had no disability?

A

20%

62
Q

In the EPICURE study, what were the survival rates in 2006?

A 
22/40 = 2%
23/40 = 19%
24/40 = 40%
25/50 = 66%
26/40 = 77%

Appreciating Complex Midwifery Care (14 decks)

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