Preterm Infant Flashcards
what is defined as a preterm infant?
a birth that occurs before 37 completed weeks of gestation
- term = 37-42
- post term = >42
what is defined as a preterm infant?
a birth that occurs before 37 completed weeks of gestation
- term = 37-42
- post term = >42
premature births fell 10% after which ban?
the smoking ban
over a quarter of deaths in childhood occur during first year of childs life and are strongly influenced by pre-term delivery and low birth weight - true or false?
false - over a half
which babies are more at risk of stillbirths and neonatal deaths?
black or asian families
teenage mothers and mothers >40
mothers in poverty (highest risk)
what is thought to be the reason behind the rise in number of preterm babies?
increased maternal age
increasing rate in pregnancy related complications
greater use of infertility treatments
more caesarean deliveries before term
what are some of the many causes of preterm birth?
spontaneous preterm labour multiple pregnancy preterm prelabour rupture of membranes pregnancy associated hypertension IUGR antepartum haemorrhage cervical incompetence / uterine malformation
what are the risk factors for a preterm birth?
interval of <6 months between pregnancies
conceiving through IVF
smoking, drinking alcohol and using ilicit drugs
poor nutrition
some chronic conditions (high BP, diabetes)
multiple miscarriages or abortions
what is the difference between managing a preterm infant and one born at term?
need more help to stay warm have more fragile lungs don't breathe effectively have fewer reserves delay cord clamping if possible
how is a preterm baby kept warm?
using a plastic bag under a radiant heater
what are the common problems as a result of prematurity?
temperature control feeding / nutrition sepsis system immaturity / dysfunction other - metabolic, ROP
what conditions are often caused by system immaturity / dysfunction?
respiratory distress syndrome
patent ductus arteriosus
intraventricular haemorrhage
necrotising enterocolitis
why is thermal regulation ineffective in premature babies?
low BMR
minimal muscular activity
subcutaneous fat insulation is negligible
high ratio of surface area to body mass
why is there an increased risk of nutritional compromise in premature babies?
limited nutrient reserves
gut immaturity
immature metabolic pathways
increased nutrient demands
what is the difference between early onset (EOS) and late onset sepsis (LOS)?
early = mainly due to bacteria acquired before and during delivery
late = acquired after delivery (nosocomial or community sources)
what organisms cause early onset neonatal sepsis?
gp B streptococcus
gram negatives
what organisms cause late onset neonatal sepsis?
coagulase negative staph
gram negatives
staph aureus
how is neonatal sepsis managed?
prevention hand washing super vigilant and infection screening judicious use of antibiotics supportive measures
what are the respiratory complications of prematurity?
RDS
apnoea of prematurity
bronchopulmonary dysplasia
what is respiratory distress syndrome in newborn commonly known as?
hyaline membrane disease
what causes RDS in newborn?
primary pathology - surfactant deficiency, structural immaturity
secondary pathology
alveolar damage - formation of exudate from leaky capillaries, inflammation
how common is RDS in newborn?
75% of infants born before 29 weeks
10% in infants born after 32 weeks
what is the clinical features of RDS in newborn?
respiratory distress
tachypnoea
premature births fell 10% after which ban?
the smoking ban
over a quarter of deaths in childhood occur during first year of childs life and are strongly influenced by pre-term delivery and low birth weight - true or false?
false - over a half
which babies are more at risk of stillbirths and neonatal deaths?
black or asian families
teenage mothers and mothers >40
mothers in poverty (highest risk)
what is thought to be the reason behind the rise in number of preterm babies?
increased maternal age
increasing rate in pregnancy related complications
greater use of infertility treatments
more caesarean deliveries before term
what are some of the many causes of preterm birth?
spontaneous preterm labour multiple pregnancy preterm prelabour rupture of membranes pregnancy associated hypertension IUGR antepartum haemorrhage cervical incompetence / uterine malformation
what are the risk factors for a preterm birth?
interval of <6 months between pregnancies
conceiving through IVF
smoking, drinking alcohol and using ilicit drugs
poor nutrition
some chronic conditions (high BP, diabetes)
multiple miscarriages or abortions
what is the difference between managing a preterm infant and one born at term?
need more help to stay warm have more fragile lungs don't breathe effectively have fewer reserves delay cord clamping if possible
how is a preterm baby kept warm?
using a plastic bag under a radiant heater
what are the common problems as a result of prematurity?
temperature control feeding / nutrition sepsis system immaturity / dysfunction other - metabolic, ROP
what conditions are often caused by system immaturity / dysfunction?
respiratory distress syndrome
patent ductus arteriosus
intraventricular haemorrhage
necrotising enterocolitis
why is thermal regulation ineffective in premature babies?
low BMR
minimal muscular activity
subcutaneous fat insulation is negligible
high ratio of surface area to body mass
why is there an increased risk of nutritional compromise in premature babies?
limited nutrient reserves
gut immaturity
immature metabolic pathways
increased nutrient demands
what is the difference between early onset (EOS) and late onset sepsis (LOS)?
early = mainly due to bacteria acquired before and during delivery
late = acquired after delivery (nosocomial or community sources)
what organisms cause early onset neonatal sepsis?
gp B streptococcus
gram negatives
what organisms cause late onset neonatal sepsis?
coagulase negative staph
gram negatives
staph aureus
how is neonatal sepsis managed?
prevention hand washing super vigilant and infection screening judicious use of antibiotics supportive measures
what are the respiratory complications of prematurity?
RDS
apnoea of prematurity
bronchopulmonary dysplasia
what is respiratory distress syndrome in newborn commonly known as?
hyaline membrane disease
what causes RDS in newborn?
primary pathology - surfactant deficiency, structural immaturity
secondary pathology
alveolar damage - formation of exudate from leaky capillaries, inflammation
how common is RDS in newborn?
75% of infants born before 29 weeks
10% in infants born after 32 weeks
what is the clinical features of RDS?
respiratory distress
tachypnoea - grunting, intercostal recessions, nasal flaring, cyanosis
worsening over minutes to hours
natural history (gradual worsening to a nadir at 2-4 days then gradual improvement)
what is the management of RDS?
maternal steroid
surfactant
ventilation (invasive / non invasive ventilation)
how are intraventricular haemorrhages graded?
1-4
grade 1 and 2 = neurodevelopmental delay up to 20%, mortality 10%
grade 3 and 4 = neurodevelopmental delay up to 80%, mortality 50%
what are the main symptoms of NEC?
poor feeding, bloating, blood in stool, vomiting of bile
when does retinopathy of prematurity usually occur?
6-8 weeks after delivery
what are the early and late metabolic complications?
early - hypoglycaemia and hyponatraemia
late - osteopenia of prematurity
