Preterm baby Flashcards
What are four problems that pre-term babies have
- get cold faster
- fragile lungs
- breathe ineffectively
- fewer reserves
-pulse oximetry is often indicated and many preterm babies need help with transition to air breathing
What is different about cord clamping in pre-term babies?
- if baby = ok and can be kept warm
- pause for at least 1 min to allow placental transfusion to take place
How are pre-term babies kept warm?
-place immediately, while still wet, in a suitable plastic bag and then later under a radiant heater
What does mechanical ventilation in pre-term babies predispose to? what is seen on CXR?
-lungs are fragile and this pre-disposes to bronchopulmonary dysplasia AKA chronic lung disease of prematurity
=oxygen dependence at 36 weeks gestation as the working definition for BPD.
The most common clinical scenario is of a 23- to 26-weeks of gestation baby who over a period of 4-10 weeks progresses from needing ventilation to CPAP through to requiring supplemental oxygen. They commonly have initial RDS and needed ventilation/CPAP.
CXR:
CXR changes with development of diffuse haziness and coarse interstitial pattern which reflects atelectasis, inflammation and/or pulmonary oedema. Areas of gas trapping may alternate with areas of atelectasis.
Why is thermal regulation ineffective in babies?
- low BMR
- minimal muscular activity
- high ratio s/a to body mass
- negligable subcut fat insulation
what methods are used to increase body temperature of babies?
- wraps/bags
- transwarmer mattress
- skin to skin care
- pre-warmed incubator
What is gestatational correction?
40 - gestational age baby = x weeks premature
What is the difference in organisms that cause:
- early onset sepsis
- Late onset sepsis
early onset (EOS) mainly due to bacteria acquired before and during delivery
late onset (LOS) acquired after delivery (nosocomial or community sources
What organisms typically cause neonatal sepsis?
ν Group B streptococcus (GBS)
ν Gram negative organisms
♦ Klebsiella, Escherichia coli, Pseudomonas, and Salmonella
ν Gram positive organisms
♦ Staphylococcus aureus, Coagulase negative staphylococci (CONS), Streptococcus pneumoniae, Streptococcus pyogenes
What is included in the prevention of neonatal sepsis?
ν Prevention ν Hand washing ν Super vigilant and infection screening ν Judicial use of Antibiotics ν Optimum supportive measures
What is the cause and clinical features of RDS?
- Grunting
- Tachypnoea
- Intercostal recessions
- Nasal flaring
- Cyanosis
Cause: surfactant deficiency
What is the management of RDS?
ν Maternal steroid
ν Surfactant
ν Ventilation
o Invasive / non invasive ventilation
What is a patent ductus arteriosis? what condition does this exacerbate?
ν Premature infants at risk
ν Duct does not respond to “close” signals
ν Leads to symptoms of congestive heart failure
ν Oxygen requirements are high
ν Exacerbates RDS
What type of intracranial haemorrhage can preterm infants get?
Interventricular haemorrhage:
ν a form of intracranial haemorrhage that occurs in preterm infants, which begins with bleeding into the germinal matrix.
ν 80% of cases the GMH leads to an intraventricular bleed.
What are the 2 major risk factors for intraventricular haemorrhage in preterm infants?
Inverse relationship between the incidence and gestational age at birth
There are 2 major risk factors:
Prematurity – GM is still present and cerebral autoregulation is immature
Respiratory distress syndrome – hypoxia, acidosis and hypotension makes it more likely to have an unstable cerebral circulation
Most occurs in the first day of life,
up to 90% of neonates who will get GMH-IVH, the insult is present by 72 hours.
