Preterm Infant Flashcards
What is the average numbers of preterm births in Scotland?
6-7%
Who are most at risk of stillbirths and neonatal deaths?
Black or Black British Asian or Asian British
Teenage mothers & mothers over 40yo
Mothers living in poverty
What are the causes of preterm birth?
Spontaneous Multiple pregnancy Preterm prelabour rupture of membranes Pregnancy associated HT Cervical incompetence/uterine malformation APH IUGR
What are the RFs for preterm birth?
>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
What do most very preterm babies need help with?
Assistance with transition to air breathing, not resuscitation
Describe cord clamping in preterm birth
If baby is OK and can be kept warm, pause for at least 1min to allow placental transfusion
How can preterm babies best be kept warm?
Whilst still wet place them in a suitable plastic bag and later under a radiant heater
What can overinflation of the lungs of a preterm infant cause?
Damage leading to inflammation and long-term morbidity
Can cause cascade which will predispose to bronchopulmonary dysplasia
What are common concerns in the preterm infant?
Temp control Feeding/nutrition Sepsis System immaturity/dysfunction- RDS, PDA, intraventricular haemorrhage (IVH), NEC Others- metabolic, ROP
What is low admission temperature an independent risk factor for?
Neonatal death- increases severity of all preterm morbidities
What is gestational correction?
Adjusts the plot of a measurement to account for the number of weeks a baby was born early (40wks-gestational age)
How long should gestational correction be carried out?
1y for infants born 32-36wks
2y for infants born before 32 weeks
What is early onset sepsis (EOS) mainly due to?
Bacteria acquired before and during delivery
What is LOS due to?
Acquired after delivery (nosocomial or community sources)
What organisms can cause neonatal sepsis?
GBS
Gram -ve organisms: Klebsiella, E. coli, Pseudomonas and Salmonella
Gram +ve organisms: S. aureus, CONS, Strep, pneumonia, Strep. pyogenes
What do incubators increase the risk of?
Infection
What is the primary pathology of Hyaline Membrane Disease?
Surfactant deficiency
Structural immaturity
What is the secondary pathology of Hyaline Membrane Disease?
Alveolar damage
Formation of exudate from leaky capillaries
Inflammation
Repair
What are the clinical features of RDS?
Tachypnoea Grunting Intercostal recessions Nasal flaring Cyanosis Worsen over minutes to hours Natural history (nadir at 2-4 days then improvement)
How should RDS be managed?
Maternal steroid
Surfactant
Ventilation- invasive/non-invasive
What are some CV concerns in preterm infants?
PDA
Systemic hypotension
What can PDA cause?
Symptoms of CHF
High oxygen requirements
Exacerbates RDS
What is Intraventricular Haemorrhage?
A form of intracranial haemorrhage that occurs in preterm infants, which begins with bleeding into the germinal matrix
What do 80% of cases of Germinal Matrix Haemorrhage (GMH) lead to?
An intraventricular bleed
What is the clinical presentation of IVH?
Inverse relationship between incidence and gestational age at birth
Most occurs in first day, 90% by 72hrs
What are the 2 major RFs for IVH?
Prematurity
RDS
What are some preventive measures for IVH?
Antenatal steroids
Prompt and appropriate resuscitation
Avoid haemodynamic instability, hypoxia, hypercarbia, hyperoxia, hypocarbia
How is IVH classified?
Grades 1-4
What is the outcome for Grade 1 and 2 IVH?
Neurodevelopmental delay in up to 20%
Mortality 10%
What is the outcome for Grade 3 and 4 IVH?
Neurodevelopmental delay in up to 80%
Mortality 50%
What is necrotising enterocolitis?
Widespread necrosis in the small and large intenstine
What is the clinical picture of NEC?
Usually after RDS recovery
Early signs: lethargy and gastric residuals
Bloody stool, temperature instability, apnoea and bradycardia
What are some other complications of NEC?
Retinopathy of prematurity- usually 6-8wks after delivery
Metabolic-
Early: hypoglycaemia, hyponatraemia
Late: osteopenia of prematurity
What are some overall complications of prematurity?
Higher mortality Morbidity: Neurodevelopmental outcome: impaired cognitive/motor/sensory skills, behavioural/psychological problem Chronic health issues Growth issues Effect on adult health
What effects on adult health can prematurity have?
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
