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REPRODUCTION & GYNAECOLOGY > Preterm Infant > Flashcards

Preterm Infant Flashcards

1
Q

What is the definition of a preterm birth?

A

A birth occurring before 37 weeks

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2
Q

What is the difference between post-date and post-term pregnancy?

A
  • Post-term = pregnancies lasting longer than 42 weeks. - Post-date = last longer than the established or estimated due date (therefore can be between 40 and 42 wks)
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3
Q

Foetal loss is thought to occur if a baby is born at what gestation?

A

<22 weeks

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4
Q

What law brought in during 2006 reduced premature births by 10%?

A

Smoking Ban

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5
Q

Over 1/2 of childhood deaths occur during the first year of a child’s life. What factors increase this risk?

A
  • pre-term delivery
  • low birth weight
  • maternal age
  • smoking
  • disadvantaged circumstances (low socioeconomic background)
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6
Q

How many babies die before or during labour (stillbirth) or within the neonatal period according to the embrace report?

A 
781,932 live births
BUT:
3286 - Stillbirths
1436 - Neonatal Deaths
=> around 15 babies die every day
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7
Q

What factors can increase the risk of stillbirth or neonatal death in a preterm baby?

A
  • Ethnicity (black, Asian)
  • Maternal age (extremes of reproductive age most at risk => young teens and women >40)
  • multiple pregnancy
  • previous preterm delivery
  • <6 months between pregnancies (back-to-back)
  • abnormally shaped uterus
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8
Q

Why is the number of babies being born each year increasing?

A
  • increased maternal age
  • greater use of infertility treatments
  • more caesarean deliveries before term => babies are living rather than dying during labour
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9
Q

What are the main causes of preterm birth?

A
  • spontaneous preterm labour
  • multiple pregnancy
  • preterm prelabour rupture of membranes
  • pregnancy associated hypertension
  • IUGR
  • Antepartum haemorrhage
  • Cervical Incompetence/ uterine malformation
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10
Q

How can we keep a preterm baby warm?

A
  • plastic bag under a radiant heater
  • skin to skin contact
  • transwarmer mattress
  • Pre-warmed incubator
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11
Q

What are the common problems of prematurity?

A
  • Temperature control
  • Feeding/nutrition
  • Sepsis
  • System immaturity / dysfunction (e.g. respiratory distress syndrome, PDA, intraventricular haemorrhage, nectrotising enterocolitis)
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12
Q

WHy is thermal regulation ineffective in premature babies?

A
  • Low Basal Metabolic Rate
  • Minimal muscular activity
  • Subcutaneous fat insulation is negligible (not laid down in 3rd trimester in utero)
  • High ratio of surface area to body mass
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13
Q

Why do premature babies have an increased risk of nutritional compromise and problems with growth?

A
  • Limited nutrient reserves
  • Gut immaturity
  • Immature metabolic pathways (=> cant deal with the amount of calories/nutrition provided immediately after birth)
  • Increased nutrient demands
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14
Q

How can nutrition be provided to premature babies?

A
  • suckling, swallowing and breathing not coordinated yet
    => often premature infants cannot breastfeed straight away
  • Mum is encouraged to produce milk and store till baby is ready
  • Donor milk may be used
  • Total Parenteral Nutrition may be used
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15
Q

Explain how the donor milk system is used in Scotland?

A
  • Mothers need prescription for donor milk

- all donor mothers are tested for infection to prevent spread through milk

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16
Q

Why are formula fed babies in lower socioeconomic classes or areas at increased risk of complications ?

A
  • If no breastfeeding attempted, then no IgA passed to baby
  • Unsanitary water used for milk
  • Uncleaned bottle used
  • Families dilute milk more to reduce amount of powder used as babies get hungrier (too expensive)
    => Baby can develop Protein Energy Malnutrition
17
Q

How is neonatal sepsis differentiated?

A
  • EARLY onset = mainly due to bacteria acquired before and during delivery
  • LATE onset = acquired after delivery
18
Q

What bacteria usually cause early onset neonatal sepsis?

A
  • Group B Strep.

- Gram Negative (lower GI bugs e.g. EColi)

19
Q

What bacteria is usually found to cause late onset neonatal sepsis?

A
  • coagulase negative staph.
  • Gram Negative
  • Staph Aureus
20
Q

What measures have been taken in order to reduce rates of neonatal sepsis?

A
  • Aim for prevention
  • Handwashing
  • sterile cord clamping
  • Vigilant infection screening
  • Antibiotics and Supportive measures
21
Q

What respiratory complications can occur as a result of prematurity?

A
  • Respiratory distress syndrome
  • Apnoea of prematurity
  • Bronchopulmonary dysplasia
22
Q

How can respiratory complications in a premature baby be considered Primary or Secondary?

A

Primary = Surfactant deficiency OR Structural immaturity

Secondary = consequence of both prematurity and hospital intervention (intubation and ventilation)

23
Q

What symptoms or signs may occur as a result of respiratory distress syndrome in the newborn?

A
  • Tachypnoea
  • Grunting
  • Intercostal recessions
  • Nasal flaring
  • Cyanosis
  • Worsen over minutes to hours
24
Q

How is respiratory distress prevented and treated?

A
  • Maternal steroid
  • Surfactant
  • Ventilation (Invasive ET tube / non invasive ventilation CPAP)
25
Q

HOw can an intraventricular haemorrhage be visualised in a preterm infant?

A

Anterior fontanelle used as a window for visualising hameorrhage with US

26
Q

How are intraventricular haemorrhages graded?

A

Graded 1-4

- higher grades (major bleeds) may cause increased neurodevelopmental delay and mortality in the infant)

27
Q

Why does necrotising enterocolitis usually occur in preterm babies?

A
  • In utero, babies dont normally pass meconium until term when born
  • immature gut cant handle milk/ nutrition once out of womb => bacteria translocates into bloodstream
    => causes severe SEPSIS and DIC
  • Sometimes gut can rupture and require surgery
28
Q

What is the best time for a baby to be born in order to minimise additional needs at school?

A

40-41 weeks (Term)

REPRODUCTION & GYNAECOLOGY (58 decks)

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