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Repro > Preterm Infant > Flashcards

Preterm Infant Flashcards

1
Q

What is Preterm?

A

Birth before 37 weeks gestation

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2
Q

What is Term?

A

Birth between 37 and 42 weeks gestation

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3
Q

What is Post term?

A

Birth after 42 weeks gestation?

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4
Q

What are risk factors for child death?

A 
Maternal age
Smoking
Disadvantaged circumstances
Preterm delivery
Low Birth weight
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5
Q

What age is the most common for child death?

A

Birth to 1 year

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6
Q

What are risk factors for preterm delivery?

A

> 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.

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7
Q

What problems do preterm babies have?

A 
Get colder quicker
More fragile lungs
Don't breathe well
Fewer reserves
Pulse oximetry often indicated
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8
Q

What should be done while waiting for placental transfusion?

A

Keep the baby warm

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9
Q

How do you keep the baby warm effectively?

A

Keep baby in a plastic bag under a radiant heater.

Do immediately, even while the baby is still wet

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10
Q

Why is the baby having fragile lungs an issue?

A

Over-inflation causes damage leading to inflammation and long term morbidity
- Bronchopulmonary dysplasia

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11
Q

What are common concerns in preterm infants?

A 
Temp control
feeding/Nutrition
Sepsis
System immaturity/dysfunction
Other e.g. metabolic, Retinopathy of prematurity
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12
Q

Give 4 examples of System immaturity/Dysfunction?

A

Resp distress syndrome (RDS)
Patent ductus arteriosus (PDA)
Intraventricular haemorrhage (IVH)
Necrotising enterocolitis

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13
Q

Why is hypothermia very very bad in infants?

A

Is an independent risk factor for neonatal death

Increases severity of all pattern morbidities

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14
Q

Give 4 reasons why thermal regulation may be ineffective?

A

Low BMR
Minimal muscular activity
Subcut fat insulation is negligible
High ratio of surface area to body mass

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15
Q

Name 4 ways a baby can be kept warm?

A

Wrap or bags
Skin to skin care
Transwarmer mattress
Prewarmed incubator

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16
Q

Why would an preterm baby have growth and nutrition issues?

A

Limited nutrient reserves
Immature metabolic pathways
Increased nutrient demands

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17
Q

How long should gestational correction be used for a baby born at 32-36 weeks gestation?

A

1 year

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18
Q

How long should gestational correction be used for a baby born before 32 weeks?

A

2 years

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19
Q

What could cause Early Onset Neonatal Sepsis?

A

Mainly bacteria acquired before and during delivery

20
Q

What could cause Late Onset Neonatal Sepsis?

A

Acquired after delivery, usually nosocomial or community sources

21
Q

What organisms can cause neonatal sepsis?

A

Group B strep (GBS)
Gram -ve organisms (Klebsiella, E.coli, Pseudomonas, Salmonella)
Gram =ve (Staph aureus, Coagulase -ve staphylococci (CONS), Strep pneumoniae, Strep pyogenes)

22
Q

What 5 things are good managements of infection?

A 
Prevention
Hand washing
Super vigilant and infection screening
Judicial use of ABx
Optimum supportive measures
23
Q

What is important to know about incubators?

A

Incubators Increase Infection

24
Q

Name 3 respiratory complications of prematurity?

A

RDS
Apnoea of prematurity
Bronchopulmonary dysplasia

25
Q

What disease is assoc. with Hyaline Membrane Disease?

A

RDS

26
Q

What is primary pathology Hyaline membrane disease?

A

Surfactant deficiency/immaturity

27
Q

What is secondary pathology hyaline membrane disease?

A

Alveolar damage
Formation of exudate from leaky capillaries
Repair

28
Q

Is hylaine membrane disease common?

A

75% of infants born before week 29

10% born after 32 weeks

29
Q

What are clinical features of RDS?

A 
Tachypnoea
Grunting
Intercostal recessions
Nasal flaring
Cyanosis
Worsen over minutes to hours
30
Q

In RDS, when is Nadir?

A

Day 2-4

31
Q

What is the management of RDS?

A

Maternal steroid to help with surfactant production in the fetus
Ventilation (Invasive vs non-invasive)

32
Q

Name 2 cardiovascular concerns in preterm infants

A

Patent ductus arteriosus

Systemic hypotension

33
Q

What duct problem can occur in pretermers?

A

Duct doesn’t respond to “close” signals

34
Q

In IVH in pretermers, where does the bleeding begin?

A

Into the germinal matrix

35
Q

How many germinal matrix haemorrhage (GMH) lead to an IVH?

A

80%

36
Q

When is the insult of an IVH present by?

A

72 hours

37
Q

What can help prevent an IVH?

A

Antenatal steroids
Prompt and appropriate resuscitation
Avoid haemodynamic instability

38
Q

What should be avoided to help prevent an IVH?

A

Hypoxia
Hypercarbia
Hyperoxia
Hypocarbia

39
Q

What happens in a Grade 1 and 2 IVH?

A

Neurodevelopment delay in up to 20%

10% mortality

40
Q

What happens in a Grade 3 and 4 IVH?

A

Neurodevelopmental delay in up to 80%

50% mortality

41
Q

What is the most common neonatal surgical emergency?

A

Necrotising Enterocolitis (NEC)

42
Q

What is NEC?

A

Necrosis across small and large intestine

43
Q

What is the clinical picture of NEC?

A

Usually after recovering from RDS
Early signs = lethargy and gatric residuals
Bloody stool, temp instability, apnoea and bradycardia

44
Q

What are other complications of prematurity?

A

Retinopathy of prematurity (Usually 6-8 wks after delivery)
Early = hypoglycaemia and hyponatraemia
Late = Osteopenia of prematurity

45
Q

Can being born prematurely have an effect on the infants adult life?

A

Yes - Insulin resistance, hypertension, vascular changes,

Repro (46 decks)

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