Preterm Infant Flashcards
What is the definition of a preterm birth?
A birth occurring before 37 weeks
What is the difference between post-date and post-term pregnancy?
- 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)
Foetal loss is thought to occur if a baby is born at what gestation?
<22 weeks
What law brought in during 2006 reduced premature births by 10%?
Smoking Ban
Over 1/2 of childhood deaths occur during the first year of a child’s life. What factors increase this risk?
- pre-term delivery
- low birth weight
- maternal age
- smoking
- disadvantaged circumstances (low socioeconomic background)
How many babies die before or during labour (stillbirth) or within the neonatal period according to the embrace report?
781,932 live births BUT: 3286 - Stillbirths 1436 - Neonatal Deaths => around 15 babies die every day
What factors can increase the risk of stillbirth or neonatal death in a preterm baby?
- 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
Why is the number of babies being born each year increasing?
- increased maternal age
- greater use of infertility treatments
- more caesarean deliveries before term => babies are living rather than dying during labour
What are the main causes of preterm birth?
- spontaneous preterm labour
- multiple pregnancy
- preterm prelabour rupture of membranes
- pregnancy associated hypertension
- IUGR
- Antepartum haemorrhage
- Cervical Incompetence/ uterine malformation
How can we keep a preterm baby warm?
- plastic bag under a radiant heater
- skin to skin contact
- transwarmer mattress
- Pre-warmed incubator
What are the common problems of prematurity?
- Temperature control
- Feeding/nutrition
- Sepsis
- System immaturity / dysfunction (e.g. respiratory distress syndrome, PDA, intraventricular haemorrhage, nectrotising enterocolitis)
WHy is thermal regulation ineffective in premature babies?
- 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
Why do premature babies have an increased risk of nutritional compromise and problems with growth?
- Limited nutrient reserves
- Gut immaturity
- Immature metabolic pathways (=> cant deal with the amount of calories/nutrition provided immediately after birth)
- Increased nutrient demands
How can nutrition be provided to premature babies?
- 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
Explain how the donor milk system is used in Scotland?
- Mothers need prescription for donor milk
- all donor mothers are tested for infection to prevent spread through milk
Why are formula fed babies in lower socioeconomic classes or areas at increased risk of complications ?
- 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
How is neonatal sepsis differentiated?
- EARLY onset = mainly due to bacteria acquired before and during delivery
- LATE onset = acquired after delivery
What bacteria usually cause early onset neonatal sepsis?
- Group B Strep.
- Gram Negative (lower GI bugs e.g. EColi)
What bacteria is usually found to cause late onset neonatal sepsis?
- coagulase negative staph.
- Gram Negative
- Staph Aureus
What measures have been taken in order to reduce rates of neonatal sepsis?
- Aim for prevention
- Handwashing
- sterile cord clamping
- Vigilant infection screening
- Antibiotics and Supportive measures
What respiratory complications can occur as a result of prematurity?
- Respiratory distress syndrome
- Apnoea of prematurity
- Bronchopulmonary dysplasia
How can respiratory complications in a premature baby be considered Primary or Secondary?
Primary = Surfactant deficiency OR Structural immaturity
Secondary = consequence of both prematurity and hospital intervention (intubation and ventilation)
What symptoms or signs may occur as a result of respiratory distress syndrome in the newborn?
- Tachypnoea
- Grunting
- Intercostal recessions
- Nasal flaring
- Cyanosis
- Worsen over minutes to hours
How is respiratory distress prevented and treated?
- Maternal steroid
- Surfactant
- Ventilation (Invasive ET tube / non invasive ventilation CPAP)
HOw can an intraventricular haemorrhage be visualised in a preterm infant?
Anterior fontanelle used as a window for visualising hameorrhage with US
How are intraventricular haemorrhages graded?
Graded 1-4
- higher grades (major bleeds) may cause increased neurodevelopmental delay and mortality in the infant)
Why does necrotising enterocolitis usually occur in preterm babies?
- 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
What is the best time for a baby to be born in order to minimise additional needs at school?
40-41 weeks (Term)
