Preterm Infant Flashcards
extreme pre-term?
<28 weeks
very preterm?
28-32 weeks?
late preterm?
32-37 weeks?
what increases risk of infant mortality?
<32 weeks twins poverty older mum smoking etc
majority of neonatal deaths are due to what?
pre-term birth
how many births are pre-term?
more than 1 in 10 (world wide)
more like 7-8% in scotland
causes of pre-term?
spontaneous
multiple pregnancy
rupture of memrbanes
…..
riskf actors for preterm?
> 2 preterm deliveries increases risk to 70%>???
<6 months between pregnancies
IVF
smoking, drinking etc
are all pre-term infants in danger?
no
34+ weeks generally fine and managed same as term
what pre-term babies should you be worries about?
30 weeks and below
general problems in preterm?
need help to stay warm
fragile lungs
dont breathe effectively
fewer reserves
how to keep baby warm?
plastic bag under heater
delayed cord clamping in preterm?
yes
general approach to managing preterm infant?
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)
what resp problems might you anticipate in preterm?
resp distress syndrome
lack of surfactant
TTN
apnoea
what cardio problems might you anticipate in preterm?
PDA
hypotension
what GI problems might you anticipate in preterm?
necrotising enterocolitis
other problems anticipated?
jaundice poor feeding cerebral palsy risk hypoglycaemia sepsis hypothermia
what neuro problems might you anticipate in preterm?
intraventricular haemorrhage
hypothermia risk in preterm?
independent risk factor for neonatal death
increases severity of all preterm morbidities
why is temp control poor in preterm?
low BMR
minimal muscle activity
s/c fat insulation is negligable
high surface area to body mass ratio
what can hypothermia lead to?
hypoglycaemia
hypoxia
(can cause each other?)
methods to keep baby warm?
wrap/bag
transwarmer matress
pre-warmed incubator
skin to skin
why is there an increases risk of nutritional compromise in preterm?
limited nutrient reserves
gut immaturity
immature metabolic pathways
increased nutrient demand
normal term birth weight?
3-4kg (generally)
how can nutrition be maintained?
TPN often used
mothers milk or donor milk used to help mature the digestive system
cause of early onset sepsis?
usually bacteria acquired before and during delivery (group B strep common cause)
cause of late onset sepsis?
acquired after delivery
early onset organisms
group B strep
gram -ves
late onset organisms?
gram -ve
staph aureus
commensals???? probs not wtf
risks of infection in preterm?
///
immature immune system
immature gut etc
what in fucking gods name is going on
resp complications in prematurity?
RDS
apnoea
bronchopulmonary dysplasia
primary pathology in RDS?
surfactant deficiency
structural immaturity
secondary apthology?
due to medical intervention (ventilation, suctioning etc)
what happens in RDS?
alveolar damage leading to leaky capillaries and exudate leakage causing inflammation and fibrosis from repair
clinical features of RDS?
resp distress
tachypnoea
worsens over mins - hrs
natural history (grunting, recessions, nasal flaring etc)
management of RDS?
maternal steroid before birth
surfactant
ventilation (invasive/non-invasive)
how is surfactant given?
using laryngoscope and catheter while having CPAP support
how can IV haemorrhage be seen in preterm?
US in anterior fontanelle
grade 1-2 IV haemorrhage?
neurodevelopmental delay up to 20%
10% mortality
grade 3-4 IV haemorrhage?
50% mortality
neurodevelopmental delay up to 80%
classic features of necrotising enterocolitis?
distended, discoloured tummy
child is sick
how does necrotising enterocolitis occur?
…..
reduced blood flow to gut wall………
other complications in preterm ?
retinopathy of prematurity (6-8 weeks after delivery)
metabolic complications?
early = hypoglycaemia, hyponatraemia late = osteopenia of prematurity
