Preterm Infant

Question 1

extreme pre-term?

Answer 1

<28 weeks

Question 2

very preterm?

Answer 2

28-32 weeks?

Question 3

late preterm?

Answer 3

32-37 weeks?

Question 4

what increases risk of infant mortality?

Answer 4

<32 weeks
twins
poverty
older mum
smoking etc

Question 5

majority of neonatal deaths are due to what?

Answer 5

pre-term birth

Question 6

how many births are pre-term?

Answer 6

more than 1 in 10 (world wide)

more like 7-8% in scotland

Question 7

causes of pre-term?

Answer 7

spontaneous
multiple pregnancy
rupture of memrbanes
…..

Question 8

riskf actors for preterm?

Answer 8

> 2 preterm deliveries increases risk to 70%>???
<6 months between pregnancies
IVF
smoking, drinking etc

Question 9

are all pre-term infants in danger?

Answer 9

no

34+ weeks generally fine and managed same as term

Question 10

what pre-term babies should you be worries about?

Answer 10

30 weeks and below

Question 11

general problems in preterm?

Answer 11

need help to stay warm
fragile lungs
dont breathe effectively
fewer reserves

Question 12

how to keep baby warm?

Answer 12

plastic bag under heater

Question 13

delayed cord clamping in preterm?

Answer 13

yes

Question 14

general approach to managing preterm infant?

Answer 14

delayed clamping and assess baby > keep baby warm (pastic bag, heater and hat) > gentle lung inflation (PEEP important) > use saturation monitor (to make sure not doing too much)

Question 15

what resp problems might you anticipate in preterm?

Answer 15

resp distress syndrome
lack of surfactant
TTN
apnoea

Question 16

what cardio problems might you anticipate in preterm?

Answer 16

PDA

hypotension

Question 17

what GI problems might you anticipate in preterm?

Answer 17

necrotising enterocolitis

Question 18

other problems anticipated?

Answer 18

jaundice
poor feeding
cerebral palsy risk
hypoglycaemia 
sepsis
hypothermia

Question 19

what neuro problems might you anticipate in preterm?

Answer 19

intraventricular haemorrhage

Question 20

hypothermia risk in preterm?

Answer 20

independent risk factor for neonatal death

increases severity of all preterm morbidities

Question 21

why is temp control poor in preterm?

Answer 21

low BMR
minimal muscle activity
s/c fat insulation is negligable
high surface area to body mass ratio

Question 22

what can hypothermia lead to?

Answer 22

hypoglycaemia
hypoxia
(can cause each other?)

Question 23

methods to keep baby warm?

Answer 23

wrap/bag
transwarmer matress
pre-warmed incubator
skin to skin

Question 24

why is there an increases risk of nutritional compromise in preterm?

Answer 24

limited nutrient reserves
gut immaturity
immature metabolic pathways
increased nutrient demand

Question 25

normal term birth weight?

Answer 25

3-4kg (generally)

Question 26

how can nutrition be maintained?

Answer 26

TPN often used | mothers milk or donor milk used to help mature the digestive system

Question 27

cause of early onset sepsis?

Answer 27

usually bacteria acquired before and during delivery (group B strep common cause)

Question 28

cause of late onset sepsis?

Answer 28

acquired after delivery

Question 29

early onset organisms

Answer 29

group B strep | gram -ves

Question 30

late onset organisms?

Answer 30

gram -ve staph aureus commensals???? probs not wtf

Question 31

risks of infection in preterm?

Answer 31

/// immature immune system immature gut etc what in fucking gods name is going on

Question 32

resp complications in prematurity?

Answer 32

RDS apnoea bronchopulmonary dysplasia

Question 33

primary pathology in RDS?

Answer 33

surfactant deficiency | structural immaturity

Question 34

secondary apthology?

Answer 34

due to medical intervention (ventilation, suctioning etc)

Question 35

what happens in RDS?

Answer 35

alveolar damage leading to leaky capillaries and exudate leakage causing inflammation and fibrosis from repair

Question 36

clinical features of RDS?

Answer 36

resp distress tachypnoea worsens over mins - hrs natural history (grunting, recessions, nasal flaring etc)

Question 37

management of RDS?

Answer 37

maternal steroid before birth surfactant ventilation (invasive/non-invasive)

Question 38

how is surfactant given?

Answer 38

using laryngoscope and catheter while having CPAP support

Question 39

how can IV haemorrhage be seen in preterm?

Answer 39

US in anterior fontanelle

Question 40

grade 1-2 IV haemorrhage?

Answer 40

neurodevelopmental delay up to 20% | 10% mortality

Question 41

grade 3-4 IV haemorrhage?

Answer 41

50% mortality | neurodevelopmental delay up to 80%

Question 42

classic features of necrotising enterocolitis?

Answer 42

distended, discoloured tummy | child is sick

Question 43

how does necrotising enterocolitis occur?

Answer 43

..... | reduced blood flow to gut wall.........

Question 44

other complications in preterm ?

Answer 44

retinopathy of prematurity (6-8 weeks after delivery)

Question 45

metabolic complications?

Answer 45

``` early = hypoglycaemia, hyponatraemia late = osteopenia of prematurity ```