Preterm Infant

Question 1

What is the average numbers of preterm births in Scotland?

Answer 1

6-7%

Question 2

Who are most at risk of stillbirths and neonatal deaths?

Answer 2

Black or Black British Asian or Asian British
Teenage mothers & mothers over 40yo
Mothers living in poverty

Question 3

What are the causes of preterm birth?

Answer 3

Spontaneous
Multiple pregnancy
Preterm prelabour rupture of membranes
Pregnancy associated HT
Cervical incompetence/uterine malformation
APH
IUGR

Question 4

What are the RFs for preterm birth?

Answer 4

>2 preterm deliveries (70%)
Abnormally shaped uterus (19%)
Multiple pregnancy (9x)
Interval of <6/12 between pregnancies
Conceiving through IVF
Smoking, drinking and use of illicit drugs
Poor nutrition
Chronic conditions (high BP, DM)
Multiple miscarriages or abortions

Question 5

What do most very preterm babies need help with?

Answer 5

Assistance with transition to air breathing, not resuscitation

Question 6

Describe cord clamping in preterm birth

Answer 6

If baby is OK and can be kept warm, pause for at least 1min to allow placental transfusion

Question 7

How can preterm babies best be kept warm?

Answer 7

Whilst still wet place them in a suitable plastic bag and later under a radiant heater

Question 8

What can overinflation of the lungs of a preterm infant cause?

Answer 8

Damage leading to inflammation and long-term morbidity

Can cause cascade which will predispose to bronchopulmonary dysplasia

Question 9

What are common concerns in the preterm infant?

Answer 9

Temp control
Feeding/nutrition
Sepsis
System immaturity/dysfunction- RDS, PDA, intraventricular haemorrhage (IVH), NEC
Others- metabolic, ROP

Question 10

What is low admission temperature an independent risk factor for?

Answer 10

Neonatal death- increases severity of all preterm morbidities

Question 11

What is gestational correction?

Answer 11

Adjusts the plot of a measurement to account for the number of weeks a baby was born early (40wks-gestational age)

Question 12

How long should gestational correction be carried out?

Answer 12

1y for infants born 32-36wks

2y for infants born before 32 weeks

Question 13

What is early onset sepsis (EOS) mainly due to?

Answer 13

Bacteria acquired before and during delivery

Question 14

What is LOS due to?

Answer 14

Acquired after delivery (nosocomial or community sources)

Question 15

What organisms can cause neonatal sepsis?

Answer 15

GBS
Gram -ve organisms: Klebsiella, E. coli, Pseudomonas and Salmonella
Gram +ve organisms: S. aureus, CONS, Strep, pneumonia, Strep. pyogenes

Question 16

What do incubators increase the risk of?

Answer 16

Infection

Question 17

What is the primary pathology of Hyaline Membrane Disease?

Answer 17

Surfactant deficiency

Structural immaturity

Question 18

What is the secondary pathology of Hyaline Membrane Disease?

Answer 18

Alveolar damage
Formation of exudate from leaky capillaries
Inflammation
Repair

Question 19

What are the clinical features of RDS?

Answer 19

Tachypnoea
Grunting
Intercostal recessions
Nasal flaring
Cyanosis
Worsen over minutes to hours
Natural history (nadir at 2-4 days then improvement)

Question 20

How should RDS be managed?

Answer 20

Maternal steroid
Surfactant
Ventilation- invasive/non-invasive

Question 21

What are some CV concerns in preterm infants?

Answer 21

PDA

Systemic hypotension

Question 22

What can PDA cause?

Answer 22

Symptoms of CHF
High oxygen requirements
Exacerbates RDS

Question 23

What is Intraventricular Haemorrhage?

Answer 23

A form of intracranial haemorrhage that occurs in preterm infants, which begins with bleeding into the germinal matrix

Question 24

What do 80% of cases of Germinal Matrix Haemorrhage (GMH) lead to?

Answer 24

An intraventricular bleed

Question 25

What is the clinical presentation of IVH?

Answer 25

Inverse relationship between incidence and gestational age at birth
Most occurs in first day, 90% by 72hrs

Question 26

What are the 2 major RFs for IVH?

Answer 26

Prematurity

RDS

Question 27

What are some preventive measures for IVH?

Answer 27

Antenatal steroids
Prompt and appropriate resuscitation
Avoid haemodynamic instability, hypoxia, hypercarbia, hyperoxia, hypocarbia

Question 28

How is IVH classified?

Answer 28

Grades 1-4

Question 29

What is the outcome for Grade 1 and 2 IVH?

Answer 29

Neurodevelopmental delay in up to 20%

Mortality 10%

Question 30

What is the outcome for Grade 3 and 4 IVH?

Answer 30

Neurodevelopmental delay in up to 80%

Mortality 50%

Question 31

What is necrotising enterocolitis?

Answer 31

Widespread necrosis in the small and large intenstine

Question 32

What is the clinical picture of NEC?

Answer 32

Usually after RDS recovery
Early signs: lethargy and gastric residuals
Bloody stool, temperature instability, apnoea and bradycardia

Question 33

What are some other complications of NEC?

Answer 33

Retinopathy of prematurity- usually 6-8wks after delivery
Metabolic-
Early: hypoglycaemia, hyponatraemia
Late: osteopenia of prematurity

Question 34

What are some overall complications of prematurity?

Answer 34

Higher mortality
Morbidity:
Neurodevelopmental outcome: impaired cognitive/motor/sensory skills, behavioural/psychological problem
Chronic health issues
Growth issues
Effect on adult health

Question 35

What effects on adult health can prematurity have?

Answer 35

Insulin resistance
Hypertension and vascular changes
Associated with decrease reproduction in adulthood
Preterm women but not men were at increased risk of having preterm offspring