Preterm infant Flashcards
preterm defiintion
<37 weeks
term birth definition
between 27-42 weeks
post term definition
> 42 weeks
below 31 weeks is what
very preterm
below 27 weeks is what
extremely preterm
why do half of deaths in childhood occur during the first year of a child’s life
strongly influenced by prefer delivery and low brith weight
causes of preterm birth
cervical incompetence/uterine malformation
antepartum haemorrhage
IUGR
preg assoc htn
premature pre labour rupture of membranes
multiple pregnancy
spontaneous preterm labour
what does >2 preterm deliveries increase the risk of
another preterm baby by 70%
how much does an abnormally shaped uterus increase the risk of giving birth early by
19%
how many more times likely are women to give birth early if they have multiple pregnancy
9x more likely
risk factors of preterm birth
interval of <6 months between pregnancies
conceiving through in vitro fertilisation
smoking, alcohol, drugs
poor nutrition, chronic conditions (BP, DM), multiple miscarriages or abortions
different between a term baby and a preterm baby when they are first born
get cold faster - smaller
have more fragile lungs so don’t breathe effectively
have fewer reserves
pulse oximetry often indicated
do preterm babies need assistance or resuscitations
most very preterm babies need help with transition to air breathing - assistance
when should cord clamping be done in preterm babies
if the baby is okay and can be kept warm pause for at least a minute to allow placental transfusion
how are preterm babies kept warm
using a plastic bag or a heater
prewarm incubators
skin to skin
trans warmer mattress
risks of lung inflation
lungs are fragile so over inflation can cause damage leading to inflammation and long term morbidity - can lead to bronchopulmonary dysplasia
concerns in a preterm baby
temp control
feeding/nutrition
sepsis
systemic immaturity - RDS, PDA, ibraventricular haemorrhage, necrotising enterocolitis
hypothermia is a risk factor for what
what does it increase
neonatal death
increases severity of all preterm morbidities
why is thermal regulation ineffective in a preterm baby
low BMR
minimal muscle activity
subcut fat insulation is negligible
high ratio of surface area to body mass
why is there an increased risk of potential nutritional compromise
limited nutritional reserves
immature metabolic pathways
increased nutritional demands
what is gestational correction
adjusts the plot of measurement on the graph to account for the number of weeks a baby was born early
when should gestational correction not be used for under 40 weeks baby
for 37+ weeks
when should gestational correction be used till
1 year for infants born 32-36 weeks
2 years for infants born before 32 weeks
what are the two types of neonatal sepsis
early onset mainly due to bacteria acquired before and after delivery
late onset acquired after delivery
which organisms cause neonatal sepsis
group b strep
gram neg - klebsiella, EColi, pseudomonas, salmonella
gram pos - SA, coag neg staph, strep pneumonia, strep pyogenes
management of neonatal sepsis
prevention hand washing super vigilant and infection screening judicial use of antibiotics optimum supportive measures
what increases infection
incubators
what are some of the respiratory complications of prematurity
RDS
apnoea of prematurity
bronchopulmonary dysplasia
NRDS pathology
primary - surfactant deficiency, structural immaturity
secondary - alveolar damage, formation of exudate from leaky capillaries, inflammation, repair
when is RDS common
75% in <29 weeks born
10% in >32 weeks gestation
clinical features of RDS
resp distress - tachypnoea, grunting, intercostal recession, nasal flaring, cyanosis
worsening over minutes to hours
usually improves over 2-4 days with active treatment
management of RDS
maternal steroids
surfactant
ventilation - invasive or non invasice
CVS complications in preterm
PDA
systemic hypotension
PDA is what who is at risk what does it lead to oxygen requirements exacerbates what
when DA doesn't close premature infants symptoms of congestive HF are high RDS
intraventricular haemorrhage is what
form of intracranial haemorhhage which begins with bleeding in the germinal matrix and 80% of the cases leads to bleeding intraventricular
clinical presentation of a intraventricular haemorrhage
clinically silent 25-50%
intermittent deterioration
catastrophic deterioration
most occur in first day of life - up to 90% of GMH-IVH insult is present by 72 hours
risk factors for IVH
prematurity
RDS
IVH preventive measures
antenatal steroids
prompt and appropriate resuscitation
avoid haemodynamic instability
avoid hypoxia, hypercarbia, hyperopia and hypocardia
IVH grade 1 and 2
neurodevelopment delay up too 20% and mortality is 10%
IVH grade 3 and 4
neurodevelopment delay up to 80% and mortality is 50%
NEC is the most common what
what is it
high incidence in who
neonatal surgical emergency
widespread necrosis in the small and large intestine
in premature infants
clinical picture of NEC
usually after recovering form RDS
early signs: lethargy and gastric residuals
bloody stool, temp instability, apnoea and bradycardia
other complications of prematurity
retinopathy - usually 6-8 weeks after delivery
hypoglycaemia and hyponatraemia early cx
osteopenia of prematurity later cx
