Preterm Bby Flashcards
Preterm bby is born before _______
37 weeks of gestation
Premature births fell by ______ after ______
10%
Smoking Ban
What strongly influences deaths in the 1st year of childhood?
- Pre-term Delivery
- Low Birth Weight
—other risk factors: Maternal Age, Smoking, poverty, ethnicity
Why are pre-term deliveries rising every year?
- incr. Maternal age
- incr. rate in pregn.-related complications
- greater use of INFERTILITY
- more C-sections before term
What are the top 3 causes of pre-term births?
- Spontaneous
- Multiple pregn
- PPROM (preterm prelabour rupture of membranes)
- pregn. associated Hypertension
- cervical malformation incompetence
- anterpartum hemorrhage
- IUGR
What are 3 risk factors of pre-term deliveries?
- > 2 pre-term deliveries= incr. risk of another by 70%
- ABNORMALLY shaped uterus incr. risk by 19%
- 9x more likely with multiple bbies
- IVF
- smoking, drinking, drugs
- <6 months interval btw pregnancies
- poor nutrition/multiple miscarriages
What is diff. in managing a pre-term bby vs a term bby?
- needs MORE help with warmth
- can’t breathe effectively (fragile lungs)
- fewer reserves
- DELAY cord clamping !
How is the bby kept warm?
- using PLASTIC bag under a radiant heater
What are common problems with prematurity ?
- T* control
- feeding
- SEPSIS
- system immaturity: RDS (respir. distress $) , PDA, IVH (intraventricular hemorrhage in brain), NEC (necrotising enterocolitis)
What incr. ALL pre-term morbidities?
hypothermia !
Why is thermal regulation diff. in a newborn?
- LOW BMR
- Minimal Muscular activity
- Preterm: v. low subcutaneous FAt insulation
- high ratio of S.A to body mass
Name methods/equipment used to keep preterm bbies warm?
- Wraps/bags
- Skin-to-skin care
- Transwarmer mattress
- Prewarmed incubator
Why does a preterm bby have an incr. risk of Nutritional compromise?
- LIMITED nutrient reserves
- GUT immaturity
- immature metabolic pathways
- incr. nutrient demands
What are the 2 types of Neonatal sepsis?
- Early Onset (EOS) - d.t bacteria acquired BEFORE and DURING delivery
- LOS (late onset)- acquired after delivery (community acq.)
Causes of EO Sepsis?
- Gr. B streptococcus
- Gram (-)ves
Causes of LOS?
- Gram (-ves)
- Coagulase -ve Staph
- Staph. aureus
Why are premature bbies at a high risk of complications?
- immature immune system
- intensive care env.
- indwelling TUBES and LINES
How do you ensure pre-term bby is not put at risk of other complications?
- handwashing
- super vigilant and INFECTION screening should be done
- judicious use of antibiotics
- supportive measures
What respiratory conditions may occur wtih prematurity?
- RDS- respiratory distressed $
- Apnoea of prematurity
- Bronchopulmonary Dysplasia
What is the pathophysiology of THE RDS?
- Primary: Surfacant deficiency, structural immaturity
> alveolar damage d.t exudate from leaky capillaries> INFLAMMATION and REPAIR
How common is RDS in bbies born before 29 wks?
75% vs only 10% in those born after 32 wks
What are the clinical fts of RDS?
- respir. distress
- tachypnoea (grunting/nasal flaring/cyanosis/ intercostal recessions)
- worsening over MINS to HRS
- Natural hx
How to manage RDS?
- maternal steroid
- surfactant
- ventilation (invasive/non-invasive ventilation)
How to grade intraventricular hemorrhage?
- Grades 1 and 2: neurodevelop. delay up to 20%
- Grades 3 and 4: neurdevelop. delay up to 80% (mortality 50%)
How does NEC present as?
- poor feeding
- bile stained vomitus
- abdominal distension
- blood-stained stools
- +/- explosive diarrhoea
- respiratory distress with acidosis
- sepsis
Risk factors of NEC?
- premature bby (50-80%)
- congenital heart disease
- perinatal asphyxia
- decr. umbilical flow
What are other complications of preterm bby?
- retinopathy of prematurity (6-8wks after delivery)
- metabolic: Hypoglycemia and hyponatremia –EARLY
osteopenia of prematurity — LATE
