Preterm and small babies

Question 1

What is a preterm baby?

Answer 1

Calculate gestational age from the last menstrual period is <37 completed weeks

Extreme preterm before 28 weeks
Very preterm 28-32 weeks
Moderate to late preterm 32-37 weeks

Question 2

What does low birth weight mean?

Answer 2

Birth weight of <2500g (2.5kg) regardless of gestational age.
Thus a LBW baby may not be small for gestational age if they are born preterm.

Question 3

What is very low birth weight?

Answer 3

Birth eight of <1500g regardless of gestational age

Question 4

What is extremely low birth weight?

Answer 4

Birth weight <1000g regardless of gestational age

Question 5

What is small for gestational age?

Answer 5

Birth weight below the 10th percentile for gestational age

Question 6

What is intrauterine growth restriction?

Answer 6

Failure of growth in utero which may or may no result in baby being small for gestational age

Question 7

What are the types of small for gestational age?

Answer 7

Symmetrical (proportional)

Asymmetric (disproportional

Question 8

What is symmetric small for gestational age? What does this suggest?
When is this seen?

Answer 8

All growth parameters are symmetrically small, suggesting the foetus was affected from early pregnancy
Seen in babies with chromosomal abnormalities and the constitutionally small

Question 9

What is asymmetric small for gestational age? What is this due to?

Answer 9

Weight centile is < length and head circumference

Usually due to IUGR and an insult later in pregnancy e.g. pre-eclampsia

Question 10

What are risk factors for prematurity?

Answer 10

Poverty
Constitutional factors
Malformation
twins
Congential infection
Placental insufficiency 
(Maternal heart disease, hypertension, diabetes, sickle-cell, smoking, pre-eclampsia

Question 11

What are causes of prematurity

Answer 11

Unknown
Smoking tobacco
Poverty
Malnutrition

Past hx of prematurity
Pre-eclampsia
DM,
Polyhydramnios
Multiple pregancny
Premature rupture of membranes
Abruption
Placenta praaevia

Question 12

What is the management for premature baby?

Answer 12

Delivery in centre for preterm babies
Adequate resuscitation
Plan supplemental breast milk or low-birth-weight formula if < 2kg
Monitor and maintain blood glucose
Encourage mother to express breast milk
Tube feeds if oral feeds not tolerated
Support parents

Question 13

What investigations might be needed in a premature infant?

Answer 13

Blood gas - to assess respiratory/metabolic state
FBC - risk of infection, thrombocytopenia, anaemia
U&E
Blood culture
CRP for infection
Direct Coomb’s test/direct antiglobulin test
Blood group