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Reproduction and Sexual Health > Preterm Infant > Flashcards

Preterm Infant Flashcards

1
Q

Preterm?

A

A birth that occurs before 37 completed weeks of gestation

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2
Q

Term?

A

A birth between 37 weeks and 42 weeks of gestation

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3
Q

Post-term?

A

A birth that occurs after 42 completed weeks of gestation

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4
Q

What % of all pregnancies are preterm?

A

6-7%

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5
Q

Over a half of deaths in childhood occur during the first year of life and are influenced strongly by …

A
  • Preterm delivery

* LBW

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6
Q

The number of preterm births globally rises every year due to …

A
  • Increasing maternal age
  • Increasing rate in pregnancy related complications
  • Greater use of infertility treatments
  • More c-sections
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7
Q

What is the biggest cause of preterm birth?

A

Spontaneous

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8
Q

Women with a ________ pregnancy are much more likely to give birth early

A

Multiple

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9
Q

> 2 previous preterm deliveries increases the risk of another preterm delivery by __%

A

70

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10
Q

An abnormally shaped _______ can increase the chances of giving birth early

A

Uterus

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11
Q

An interval of less < 6 months between pregnancies increases the risk of giving birth early

A

TRUE

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12
Q

Conceiving through IVF makes you less likely to give birth early

A

FALSE - more likely to have a preterm brith

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13
Q

Smoking, drinking alcohol and using illicit drugs make you more likely to have a ________ birth

A

Preterm

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14
Q

Multiple miscarriages/ abortions make you more likely to have a ________ birth

A

Preterm

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15
Q

** Delay cord clamping if possible in a preterm baby– they have very little amounts of blood !! **

A

TRUE

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16
Q

You must keep preterm babies warm, they get cold very easily

A

:((((

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17
Q

Low admission ___________ is an independent risk factor for neonatal death

A

Temperature

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18
Q

Thermal regulation of the preterm is ineffective due to …

A
  • Low BMR
  • Minimal muscular activity
  • No SC fat for insulation
  • Surface area : body mass ratio is very high
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19
Q

By what 4 methods do babies lose heat?

A

Convection – box prevents this
Radiation – heat inside the box
Evaporation – plastic bag + humidity
Conduction – box with insulated mattress

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20
Q

List 4 methods of keeping a baby warm.

A
  • Skin to skin
  • Wrap or bags
  • Prewarmed incubator
  • Transwarmer mattress
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21
Q

Why is the an increased risk of nutritional compromise (calorie deficit) in preterm infants?

A
  • Limited nutrient reserves
  • Gut immaturity
  • Immature metabolic pathways
  • Increased nutrient demands
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22
Q

What is early onset neonatal sepsis usually due to?

A

Bacteria acquired before or during labour

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23
Q

What is late onset neonatal sepsis usually due to?

A

Bacteria acquired after delivery

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24
Q

What babies are more at risk of infection?

A

Preterm babies

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25
Q

Name the 2 most common early onset neonatal sepsis organisms.

A
  • Group B Streptococcus

* Gram negatives

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26
Q

Name the 4 most common late onset neonatal sepsis organisms.

A
  • Coagulase negative staphylococci
  • Gram negatives
  • Staph aureus
  • Group B Streptococcus
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27
Q

Why are premature babies more likely to get sepsis?

A
  • Immature immune system.
  • Intensive care environment.
  • Indwelling tubes and lines.
28
Q

What commonly used machine in the wards increases a babies risk of infection?

A

INTUBATORS!!

29
Q

** When a baby gets sick, if they are premature then their bone marrow cannot make WBC’s

In sick premature babies, what happens to WBC count?

A

FALLS

30
Q

What is different about the retina of a preterm baby?

A

It is not vascularised

31
Q

List the 3 most common resp complications of newborns.

A
  • Respiratory distress syndrome (RDS) – surfactant deficiency
  • Apnoea of prematurity
  • Bronchopulmonary dysplasia
32
Q

RDS is common in ________ babies

A

Preterm

33
Q

What is RDS a problem of?

A

Hyaline membranes

34
Q

Describe the primary pathology of RDS.

A
  • Surfactant deficiency

* Structural immaturity

35
Q

Describe the secondary pathology of RDS.

A
  • Alveolar damage
  • Formation of exudate from leaky capillaries
  • Inflammation
  • Repair
36
Q

What is the classical x-ray sign in RDS?

A

Ground glass

37
Q

List the signs of RDS.

A
  • Tachypnoea
  • Grunting
  • Intercostal recessions
  • Nasal flaring
  • Cyanosis
  • Worsening over minutes to hours !!
38
Q

Describe the series of events in RDS.

A

Gradual worsening to a nadir at 2-4 days then gradual improvement

39
Q

Outline the management of RDS.

A
  1. Maternal steroid
  2. Surfactant
  3. Ventilation – invasive/non-invasive
40
Q

On an x-ray of a baby with severe RDS, what will be practically impossible to see?

A

Heart border

41
Q

Necrotising enterocolitis is a neonatal ________ __________

A

Surgical emergency

42
Q

What is necrotising entercolitis?

A

Necrosis in the small and large intestine !! – multifactorial bowel infection

43
Q

What does a baby always have before getting necrotising entercolitis?

A

Milk

44
Q

Free gas in the bowel wall gives tramlining appearance

What condition is this seen in?

A

Necrotising enterocolitis

45
Q

Babies who get necrotising enterocolitis are usually recovering from what condition?

A

RDS

46
Q

What are the early signs of necrotising enterocolitis?

A

Lethargy and gastric residuals

47
Q

What is seen in the bowel wall of a baby with NE?

A

Necrotic areas + abscesses

48
Q

List the 4 main signs of NE.

A

Blood stool, temperature instability, apnoea and bradycardia

49
Q

Who is at risk of PDA (patent ductus arteriosus)?

A

Preterm babies

50
Q

What are the 3 consequences of failure of the ductus arteriosus to close after birth?

A
  • Leads to symptoms of congestive heart failure
  • Oxygen requirements are high
  • Exacerbates RDS
51
Q

Explain the 6 stages of closure of the ductus arteriosus.

A
  1. Baby is born and takes first breath
  2. Lungs starts working
  3. Pulmonary resistance decreases
  4. Pumonary vascular resistance drops and blood flows into the lungs
  5. Foramen ovale closes at same time  systemic vascular resistance increases
  6. Less blood flows through ductus arteriosus and it closes (+ there is prostaglandin decrease)
52
Q

MACHINE LIKE MURMUR

A

Patent Ductus Arteriosus

53
Q

What is the most common clinical sign in PDA?

A

Machine like murmur !!!

54
Q

Outline 3 signs seen in PDA.

A
  • Cardiomegaly
  • Poor feeding
  • Increased systolic pressure
55
Q

Describe intraventricular haemorrhage.

A
  • Cardiomegaly
  • Poor feeding
  • Increased systolic pressure
56
Q

In 80% of cases, ____ leads to an intraventricular bleed

A

GMH

57
Q

1st line Ix for intraventricular haemorrhage?

A

USS

58
Q

How can the risk of bleeding in intraventricular haemorrhage be greatly reduced?

A

Surfactant

59
Q

How can the risk of bleeding in intraventricular haemorrhage be greatly reduced?

A

Surfactant

60
Q

Grade 1/2 intraventricular haemorrhage ….

A
  • Neurodevelopmental delay up to 20%

* Mortality 10%

61
Q

Grade 3/4 intraventricular haemorrhage ….

A
  • Neurodevelopmental delay up to 80%

* Mortality 50%

62
Q

How can IVH be prevented?

A
  • Antenatal steroids.
  • Prompt and appropriate resuscitation.
  • Avoid haemodynamic instability.
63
Q

What 4 H’s should you avoid when trying to prevent IVH?

A

hypoxia
hypercarbia
hyperoxia
hypocarbia

64
Q

What is there an inverse relationship between in IVH?

A

Gestational age at birth

65
Q

What are the 2 major risk factors for IVH?

A
  • Prematurity.

* Respiratory distress syndrome.

66
Q

When do most IVH’s occur?

A

In the first day of life.

In up to 90% of neonates who will get GMH-IVH, the insult is present by 72 hours.

67
Q

Why does RDS increase the risk of IVH?

A

Hypoxia, acidosis and hypotension increase the likelihood of the cerebral circulation being unstable.

Reproduction and Sexual Health (51 decks)

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