Preterm infant Flashcards
when a baby pre term
before 37 weeks
Extremely preterm
before 27weeks
very preterm
before 31 weeks
What are the risks and factors which contribute to neonatal death
smoking maternal age being born before 32 weeks twins poor social circumstances
how many deaths occur among babies born at term
1 in 3
What are the most common causes for preterm birth
Spontaneous
Multiple pregnancy
Preterm rupture of membrane
Name other risk factors for preterm birth
more than 2 preterms before increases the risk of another premature baby by 70 percent abnormally shaped uterus multiple pregnancies short interval between pregnancies (less than 6 months) IVF Smoking alcohol and drugs Nutrition poor Diabetes and high BP Multiple miscarriages or abortions
What is the difference between a term and preterm baby
Preterms get cold faster Most fragile lungs Don't breathe well Fewer reserves Pulse oximetry often indicated
Why are preterm babies not often resuscitated?
The need help to transition to air breathing rather than because they are asphyxiated like a term baby might be
Why is cord clamping ‘paused’ in preterms
If the baby can be kept warm then pause for a minute to allow placental transfusion and assess baby.
How are preterm babies kept warm
A plastic bag under a radiant heater
Immediately
Name problems that can occur in preterms due to system immaturity
Resp distress syndrome Patent ductus arteriosis Intraventricular haemorrhage Nectrotising enterocolitis Retinopathy of prematurity
Why are preterms not able to thermoregulate effectively
Low BMR
Minimal muscular activity
Subcutaneous fat insulation is negligible
High ratio of surface area to body mass
Why might preterms run into problems with growth and nutrition
Increased risk of potential nutritional compromise
Limited nutrient reserves
Immature metabolic pathways
Increased nutrient demands
What is gestational correction
Adjustemtn of the plot of measurement of growth charts to account for the number of week a baby was born early
When should gestational correction be used until
1 year for prems born 32-36 weeks
2 years for prems born before 32 weeks
What is early onset neonatal sepsis usually caused by
Mainy due to bacteria acquire before or during delivery
What is the most common cause of neonatal sepsis
Group B strep
What is an important risk factor for neonatal sepsis
Incubation
Incubators increase infection
What causes respiratory distress syndrome
Surfactant deficiency or structural immaturity (Primary)
Secondary pathology - alveolar damage, build up of exudate, inflammation, repair
How common is RDS
75 percent of babies born before 29 weeks
what are the clinical features of RDS
Tachypnoea Grunting Intercostal recessions nasal flaring cyanosis
Worsen over minutes to hours
How is RDS managed
Maternal steroid before delivery
Surfactant
Ventilation
What is a complication of RDS
Bronchopulmonary dysplasia (BPD) is a long-term lung condition that can affect some children with NRDS. It develops when the ventilator used to treat NRDS causes scarring to the lungs
what are the symptoms of patent ductus arteriosis
heart failure - congestive
poor weight gain
exacerbated RDS
Where does intraventricular haemorrhage in infants begin
germinal matrix
what are the two major rsik factors for IVH
prematurity
respiratory distress syndrome
When do most IVH occur
first day of life
How can IVH be prevented
antenatal steroids
What percentage of grade 1-2 IVH will have neurodevelopmental delay or die
NDD- up to 20 percent
death- 10 percetn
What percentage of grade 3-4 IVH will have neurodevelopmental delay or die
NDD- up to 80 percent
mortality- 50 percent
What is the most common neonatal surgical emergency
necrotizing enterocolitis
What is the clinical features of NEC
Usually after RDS
Lethargy, gastric residuals
Bloody stool , temp instability, apnoea, bradycardia
