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Year 3 Clinical > Preterm Infant > Flashcards

Preterm Infant Flashcards

1
Q

Define preterm?

A

Birth that occurs before 37 completed weeks of gestation

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2
Q

Define term?

A

Birth between 37 weeks and 42 weeks of gestation

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3
Q

Define post-term?

A

Birth that occurs after 42 completed weeks of gestation

ADD IMAGE

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4
Q

When do the majority of childhood deaths occur?

A

Over 1/2 of deaths in childhood occur during the 1st year of a child’s life and are strongly influenced by preterm delivery and low birth weight (LBW)

NOTE - many babies that died were born at term

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5
Q

Risk factors for childhood death?

A

Maternal age

Smoking

Disadvantages circumstances

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6
Q

Causes of preterm birth?

A

Spontaneous preterm labour (major cause)

Multiple pregnancy

Preterm pre-labour rupture of membranes

Pregnancy-assoc. hypertension

Intrauterine growth restriction

Antepartum haemorrhage

Cervical incompetence / uterine malformation

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7
Q

Late consequences of preterm deliveries?

A

Increased risk of another premature baby

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8
Q

Risk factors for preterm birth?

A

Interval of <6 months between pregnancies

Conceiving via IVF

Smoking, drinking alcohol, using illicit drugs

Poor nutrition

Chronic conditions like hypertension and diabetes

Multiple miscarriages or abortions

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9
Q

Differences between preterm and term infants?

A

Become cold even faster

More fragile lungs

Do not breathe effectively

Have fewer reserves

NOTE - pulse oximetry is more useful for these babies

Cord clamping is delayed, if possible (if the baby is in good condition and can be kept warm) for 1 minute, to allow placental transfusion and to avoid anaemia; Fe deficiency increase the risk of infections and is linked to a lower IQ

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10
Q

Use of assistance vs resuscitation for preterm babies?

A

Most very preterm babies require help with transitioning to air breathing, i.e: most do not require resuscitation

NOTE - asphyxiated babies generally require more intensive care

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11
Q

How can preterm babies be kept warm?

A

Very preterm babies should be kept warm by placing them into a plastic bag immediately; later, they can be placed under a radiant heater

NOTE - if the baby is being placed into a plastic bag, they should not be dried

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12
Q

Risks assoc. with lung inflation?

A

Lungs of preterm babies are more fragile than those of term babies

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

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13
Q

Common concerns in preterm infants?

A

Temperature control

Feeding / nutrition

Sepsis

System immaturity / dysfunction:
• RDS
• PDA
• Intraventricular haemorrhage
• NEC

Others:
• Metabolic
• Retinopathy of Prematurity (ROP)

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14
Q

What is hypothermia?

A

Low admission temp is an independent risk factor for neonatal death; it increases the severity of all preterm morbidities

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15
Q

Why is thermal regulation ineffective in preterm babies?

A

Low BMR (body mass ratio)

Minimal muscular activity

S/c fat insulation is negligible

High ratio of surface area to body mass

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16
Q

4 methods by which heat is lost?

A
  1. Radiation
  2. Convection
  3. Conduction
  4. Evaporation
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17
Q

Methods of achieving temp control in preterm babies?

A

Wrap or bags

Transwarmer mattress

Skin-to-skin care

Pre-warmed incubator

18
Q

Why are preterm babies at increased risk of potential nutritional compromise?

A

Limited nutritional reserves

Immature metabolic pathways

Increased nutrient demands

19
Q

How many calories do preterm babies require?

A

Preterm babies have higher nutrition requirements

The very smallest babies require ~120-130 calories per day, which is very difficult to reach with breast milk alone; specific formulas are often used as well

NOTE - usually, mothers are encouraged to express milk / use a breast pump

20
Q

Gestational correction for plotting of preterm infants?

A

Adjusts the plot of a measurement to account for the no, of weeks a baby was born early

No. of weeks early = 40 weeks - gestational age

It should continue to be used for:
• 1 year, for infants born 32-36 weeks
• 2 years, for infants born 32 weeks

NOTE - this should not be used for term infants

21
Q

Types of neonatal sepsis, with regards to time of onset of the disease?

A

Early onset (EOS) - mainly due to bacteria acquired before and during delivery

Late onset (LOS) - acquired after delivery (nosocomial or community services)

22
Q

Organisms that cause neonatal sepsis?

A

Group B Strep.

Gram -ve organisms:
• Klebsiella
• E. coli
• Pseudomonas
• Salmonella
Gram +ve organisms:
• Staph. aureus
• Coagulase -ve Staph.
• Strep. pneumoniae
• Strep. pyogenes

NOTE - INCUBATORS INCREASE INFECTION

23
Q

Mx of neonatal sepsis?

A

Prevention - hand washing, vigilant infection screening

Judicial use of antibiotics

Optimum supportive measures

24
Q

Respiratory complications of prematurity?

A

Respiratory Distress Syndrome (RDS)

Apnoea of prematurity

Bronchopulmonary dysplasia

25
Q

Causes of RDS?

A

AKA hyaline membrane disease

Primary causes:
• Surfactant deficiency
• Structural immaturity

Secondary causes (to interventions):
• Alveolar damage 
• Formation of exudate from leaky capillaries
• Inflammation 
• Repair
26
Q

Occurrence of RDS?

A

Common, mainly occurring in infants born <29 weeks

It can occur in term infants but it less common (more likely to be TTN)

27
Q

Symptoms and signs of RDS?

A 
Signs of respiratory distress:
• Tachypnoea
• Cyanosis 
• Grunting
• Nasal flaring
• Intercostal recessions

It worsens over minutes to hours, with nadir at 2-4 days and then gradual improvement; this natural history can be modified with

28
Q

Mx of RDS?

A

Maternal steroids

Surfactant replacement

Ventilation (invasive vs non-invasive)

29
Q

CV concerns in preterm infants?

A

Patent Ductus Arteriosus (PDA)

Systemic hypertension

30
Q

Issues assoc. with PDA?

A

Leads to symptoms of CHF

O2 requirements are high

It exacerbates RDS

31
Q

What is intraventricular haemorrhage (IVH)?

A

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

32
Q

Incidence of IVH?

A

Inverse relationship between the incidence and gestational age

33
Q

2 major risk factors for IVH?

A
  1. Prematurity - germinal matrix is still present and cerebral auto-regulation is immature
  2. Respiratory Distress Syndrome (RDS) - hypoxia, acidosis and hypotension increase likelihood of having an unstable cerebral circulation
34
Q

PC of IVH?

A

Most occur on the 1st day in of life (almost all neonates who develop GMH-IVH present within 72 hours):
• Clinically silent
• Intermittent deterioration
• Catastrophic deterioration

35
Q

Preventative measure of IVH?

A

Antenatal steroids

Prompt and appropriate sterilisation

Avoid:
• Haemodynamic instability
• Hypoxia
• Hypercarbia
• Hyperoxia
• Hypocarbia
36
Q

Classification of IVH?

A

Grade 1 & 2:
• Neurodevelopmental delay in up to 20%
• Mortality 10%

Grade 3 & 4:
• Neurodevelopmental delay in up to 80%
• Mortality 50%

37
Q

What is necrotising enterocolitis (NEC)?

A

Widespread necrosis in the small and large intestine

38
Q

Occurrence of NEC?

A

Most common neonatal surgical emergency

High incidence in the most premature infants

Usually occurs after recovery from RDS

39
Q

Symptoms and signs of NEC?

A

Early signs:
• Lethargy
• Gastric residuals

Bloody stool

Temp instability

Apnoea

Bradycardia

40
Q

Other complications of prematurity?

A

Retinopathy of prematurity (usually 6-8 weeks after delivery)

Metabolic complications:
• Early - hypoglycaemia and hyponatraemia
• Late - osteopaenia of prematurity

41
Q

Long-term complications of prematurity?

A

Neurodevelopmental outcomes:
• Motor deficits - mild fine or gross motor delay and CP
• Sensory deficits - vision and hearing loss
• Behavioural and psychological issues

Chronic health issues (higher rates compared to children who were born full term)

Growth issues (more likely to exhibit poor growth compared to those born full-term)

Effects on adult health:
• Insulin resistance
• Hypertension and vascular changes
• Decreased reproduction in adulthood 
• Preterm women, but not preterm men, have increased risk of preterm offspring
42
Q

Relationship between gestational age at delivery and special educational need?

A

Increased if preterm and also if post-term

The lowest risk is at 41 weeks

Year 3 Clinical (100 decks)

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