Preterm Infant Flashcards
What is Preterm?
Birth before 37 weeks gestation
What is Term?
Birth between 37 and 42 weeks gestation
What is Post term?
Birth after 42 weeks gestation?
What are risk factors for child death?
Maternal age Smoking Disadvantaged circumstances Preterm delivery Low Birth weight
What age is the most common for child death?
Birth to 1 year
What are risk factors for preterm delivery?
> 2 preterm deliveries in the past
Abnormally shaped uterus
Multiple pregnancies
<6 month interval between pregnancies
In vitro fertilisation
Smoking, drug taking, alcohol during pregnancy
Poor nutrition and diabetes, High BP etc.
What problems do preterm babies have?
Get colder quicker More fragile lungs Don't breathe well Fewer reserves Pulse oximetry often indicated
What should be done while waiting for placental transfusion?
Keep the baby warm
How do you keep the baby warm effectively?
Keep baby in a plastic bag under a radiant heater.
Do immediately, even while the baby is still wet
Why is the baby having fragile lungs an issue?
Over-inflation causes damage leading to inflammation and long term morbidity
- Bronchopulmonary dysplasia
What are common concerns in preterm infants?
Temp control feeding/Nutrition Sepsis System immaturity/dysfunction Other e.g. metabolic, Retinopathy of prematurity
Give 4 examples of System immaturity/Dysfunction?
Resp distress syndrome (RDS)
Patent ductus arteriosus (PDA)
Intraventricular haemorrhage (IVH)
Necrotising enterocolitis
Why is hypothermia very very bad in infants?
Is an independent risk factor for neonatal death
Increases severity of all pattern morbidities
Give 4 reasons why thermal regulation may be ineffective?
Low BMR
Minimal muscular activity
Subcut fat insulation is negligible
High ratio of surface area to body mass
Name 4 ways a baby can be kept warm?
Wrap or bags
Skin to skin care
Transwarmer mattress
Prewarmed incubator
Why would an preterm baby have growth and nutrition issues?
Limited nutrient reserves
Immature metabolic pathways
Increased nutrient demands
How long should gestational correction be used for a baby born at 32-36 weeks gestation?
1 year
How long should gestational correction be used for a baby born before 32 weeks?
2 years
What could cause Early Onset Neonatal Sepsis?
Mainly bacteria acquired before and during delivery
What could cause Late Onset Neonatal Sepsis?
Acquired after delivery, usually nosocomial or community sources
What organisms can cause neonatal sepsis?
Group B strep (GBS)
Gram -ve organisms (Klebsiella, E.coli, Pseudomonas, Salmonella)
Gram =ve (Staph aureus, Coagulase -ve staphylococci (CONS), Strep pneumoniae, Strep pyogenes)
What 5 things are good managements of infection?
Prevention Hand washing Super vigilant and infection screening Judicial use of ABx Optimum supportive measures
What is important to know about incubators?
Incubators Increase Infection
Name 3 respiratory complications of prematurity?
RDS
Apnoea of prematurity
Bronchopulmonary dysplasia
What disease is assoc. with Hyaline Membrane Disease?
RDS
What is primary pathology Hyaline membrane disease?
Surfactant deficiency/immaturity
What is secondary pathology hyaline membrane disease?
Alveolar damage
Formation of exudate from leaky capillaries
Repair
Is hylaine membrane disease common?
75% of infants born before week 29
10% born after 32 weeks
What are clinical features of RDS?
Tachypnoea Grunting Intercostal recessions Nasal flaring Cyanosis Worsen over minutes to hours
In RDS, when is Nadir?
Day 2-4
What is the management of RDS?
Maternal steroid to help with surfactant production in the fetus
Ventilation (Invasive vs non-invasive)
Name 2 cardiovascular concerns in preterm infants
Patent ductus arteriosus
Systemic hypotension
What duct problem can occur in pretermers?
Duct doesn’t respond to “close” signals
In IVH in pretermers, where does the bleeding begin?
Into the germinal matrix
How many germinal matrix haemorrhage (GMH) lead to an IVH?
80%
When is the insult of an IVH present by?
72 hours
What can help prevent an IVH?
Antenatal steroids
Prompt and appropriate resuscitation
Avoid haemodynamic instability
What should be avoided to help prevent an IVH?
Hypoxia
Hypercarbia
Hyperoxia
Hypocarbia
What happens in a Grade 1 and 2 IVH?
Neurodevelopment delay in up to 20%
10% mortality
What happens in a Grade 3 and 4 IVH?
Neurodevelopmental delay in up to 80%
50% mortality
What is the most common neonatal surgical emergency?
Necrotising Enterocolitis (NEC)
What is NEC?
Necrosis across small and large intestine
What is the clinical picture of NEC?
Usually after recovering from RDS
Early signs = lethargy and gatric residuals
Bloody stool, temp instability, apnoea and bradycardia
What are other complications of prematurity?
Retinopathy of prematurity (Usually 6-8 wks after delivery)
Early = hypoglycaemia and hyponatraemia
Late = Osteopenia of prematurity
Can being born prematurely have an effect on the infants adult life?
Yes - Insulin resistance, hypertension, vascular changes,
