Preterm and LBW babies lecture Flashcards
What is involved in antenatal care?
Antenatal care
Consider transfer for appropriate care if safe
Corticosteroids if less than 34 weeks
Magnesium sulphate if less than 30 weeks (RCOG 2011)
Communication with parents and appropriate healthcare professionals
Room temperature
Tour of NNU
What are the risk factors for preterm birth?
Trauma Multiple pregnancy Abruption Smoking – nicotine constricts blood vessels Infection Drinking alcohol, especially binge drinking Stress Blood flow to fetus decreases when BP rises Low or high maternal age Maternal illness/injury 25% no identifed cause Previous premature birth Substance use
What is premature?
<37/40
What is moderate premature?
35-37 wks
What is very premature?
29-34 wks
What is extremely premature?
24-28 wks
What are the issues involved with prematurity?
Breathing
Circulation
Nutrition- can’t really suck, those that can often can’t do that and breathe at the same time
Blood sugar- cortisol rises due to stress which caused blood sugar to rise
Infection- immune system develops in 3rd trimester- don’t have the ability to fight infection
Jaundice
Electrolyte imbalance- excrete a lot of sodium due to immature kidneys
Intolerance of handling-nervous system and brain aren’t linked and developed properly to handle it
Skin integrity- low
Ventricular Haemorrhage- scanned regularly, first one within 72 hours and then on a weekly basis
Retinopathy- O2 dilates blood vessels, giving babies too much O2 can cause the eye to over dilate and blindness
Less surface area in the lungs to absorb the oxygen the baby needs
What are the benefits of delayed cord clamping in premature infants?
If condition allows delay cord clamping for 30-60s ↑ haematocrit ↓ need for transfusions ↓ NEC ↓ incidence of IVH by 50
Non-nutritive sucking
From 30 weeks- presence of sucking reflex Parental consent Quicker transition to suck feeding ↓ incidence of GOR Parental consent to use a pacifier
What is GOR? What causes it?
Some of the mixture of food, drink and acid travels back up the foodpipe, instead of going to the large and small intestines. As the food and drink is mixed with acid from the stomach, it can irritate the lining of the foodpipe, making it sore.
Sphincter (ring of muscle) at the base of the oesophagus has not matured yet
Some (e.g. CP or DS) continue into early childhood- maybe a wider than usual opening in the diaphragm around the oesophagus and a weakened sphincter
How and why do we encourage non-nutritive sucking?
From 30 weeks- presence of sucking reflex Parental consent Quicker transition to suck feeding ↓ incidence of GOR Parental consent to use a pacifier
In terms of the GI tract what is the difference between pre-term and IUGR babies?
PT: Poor suck/swallow reflexUnable to feed orally
IUGR: Able to suck and swallow and feed normally. Often very hungry
What are the issues involved with LBW babies?
Temperature control Low blood sugar Feeding Polycythaemia (high RBC production) Organ failure
