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
What is the difference between LBW, VLBW and ELBW?
LBW = <2500g very LBW = <1500g extremely LBW = <1000g
26
What are some of the characteristics of a LBW baby
- Could be born term or preterm - Weight below 10th centile - Low blood sugar - Polcythaemia - Organ failure
27
What is polycythaemia?
Increased Hb concentration
28
What are some of the causes of IUGR?
- PIH - Smoking, alcohol, drugs - Diabetes - Chromosomal abnormalities - Infection - Placenta praevia
29
What is the TORCH research for?
``` T = toxoplasmosis O = other (syphylis, varicella-zoster, parvovirus, B19, hepB) R = rubella C = cytomegalovirus H = herpes ```
30
What is the difference in causes (etiology) of symmetric and asymmetric IUGR?
``` Sym = usually a syndrome (congenital infections/disorders) Asym = due to reduced oxygen and nutrient transfer (placental insufficiency) ```
31
What is the difference in onset of symmetric and asymmetric IUGR?
``` Sym = early in utero Asym = late onset ```
32
What is the difference in pathophysiology of symmetric and asymmetric IUGR?
``` Sym = impaired cell division, decreased cell number, irreversible Asym = impaired cellular hypertrophy, decreased cell size, reversible ```
33
What is the difference in clinical features of symmetric and asymmetric IUGR?
``` Sym = inadequate growth of head and baby, head:abdomen ratio normal Asym = brain is spared, head:abdomen ratio increased ```
34
Which has a worse prognosis out of symmetric and asymmetric IUGR?
Symmetric
35
What are some clinical features of IUGR?
- 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
What is an LNU?
Local Neonatal Unit = full care, including short periods of intensive care, for majority of babies >27/40
37
What is a NICU?
Neonatal Intensive Care Unit = long term/ complex intensive care
38
What is a SCBU?
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
What is TCU?
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
What are some common causes of Respiratory Distress Syndrome?
- Prematurity - C Section - Monozygotic twins
41
What are the antenatal precautions for RDS?
- Corticosteroids | - Artifical surfactant (<28/40)
42
When does surfactant production begin?
24-28 weeks
43
How is artifical surfactant administered?
- 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
Give 6 common signs of RDS
1. Recessions 2. Grunting 3. Tachypnoea 4. Apnoea 5. Nasal flaring 6. Dusky/ cyanosed
45
Describe the process of thermoregulation
- Minimal metabolic rate and oxygen consumption maintains a normal body temp - Normal body temp = 36.5-37.3
46
When does grunting occur?
On expiration only
47
What are the 4 ways that heat is lost from the body of a baby?
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
What are the first 5 steps of the WHO warm chain?
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
What are the last 5 steps of the WHO warm chain?
6. Appropriate dry clothing 7. Mother and baby together 8. Warm transportation 9. Warm resuscitation 10. Training and awareness raising
50
Why do preterm/LBW babies get cold?
- Large SA:V ratio - Less SC fat - Increased water content - Immature skin - Poor response to cold stress - Unabe to maintain peripheral vasoconstriction
51
What is the process of cold stress in relation to peripheral vasoconstriction?
Cold = >o2 consumption = >RR = >peripheral vasoconstriction = anaerobic glycolysis and metabolic acidosis
52
What is the process of cold stress in relation to pulmonary vasoconstriction?
Cold = >o2 consumption = >RR = pulmonary vasocontriction =
53
How can cold stress be prevented?
- Warm room - Polyethylene wrap (<30/40) - Dry baby - Radiant warmer - Incubator (<1.5kg) - Hot cot (<2.5kg) - Skin to skin - Early feeding
54
How does domperidone support lactation?
Used for oesophageal reflux, can be used to produce milk, if doesn't work in first week stop using
55
How can we support lactation?
- Consistent advice - Support and encouragement - Privacy - Skin to skin - Breast pumps
56
What is non-nutritive sucking?
- 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
How many premature babies end up with a permanent disability?
1/10 | e.g. lung disease, cerebral palsy, blindness, deafness
58
In the EPICURE study, what % of children born before 26/40 had a severe disability?
22% - Cerebral palsy and not walking - Low cognitive scores - Blindness - Profound deafness
59
In the EPICURE study, what % of children born before 26/40 had a moderate disability?
24% - Cerebral palsy and walking - IQ/cognitive scores in special needs range - Less degree of visual/hearing impairment
60
In the EPICURE study, what % of children born before 26/40 had a mild disability?
34% - Low IQ/cognitive scores - Squint - Require glasses
61
In the EPICURE study, what % of children born before 26/40 had no disability?
20%
62
In the EPICURE study, what were the survival rates in 2006?
``` 22/40 = 2% 23/40 = 19% 24/40 = 40% 25/50 = 66% 26/40 = 77% ```