Preterm Infant Flashcards
What is a preterm birth?
Before 37 weeks gestation
What is a post term birth?
After 42 completed weeks of gestation
What is an extremely preterm birth?
<28 weeks
What is a very preterm birth?
<32 weeks
What is a preterm birth?
<37 weeks
What impact did the smoking ban have on premature birth?
Fell by 10%
When do over half the childhood deaths occur?
1st year of life; strongly influenced by preterm delivery and low birth weight (RF; maternal age, smoking, disadvantaged circumstances)
If you are born before 32 weeks; what times more likely are you to die?
10x
Which babies are most at risk for preterm birth?
Black or asian mothers
Teenage and geriatric mothers (>40)
Poverty
How many births are preterm?
1 in 10
What are the causes of preterm birth?
Spontaneous Multiple pregnancy Preterm prelabour rupture of membranes Pregnancy assoc hypertension IUGR Antepartum haemorrhage Cervical incompetence/ uterine malformation
What are risk factors for preterm birth?
> 2 preterm deliveries previously Abnormally shaped uterus Multiple pregnancy <6 month interval between pregnancies Conceiving through IVF Smoking, drinking alcohol, illicit drug use Poor nutrition, high BP, diabetes Multiple miscarriages or abortions
What extra support will all preterm babies require?
More help to stay warm More fragile lungs Don't breathe effectively Fewer reserves Delay cord clamping if possible
How can preterm babies be kept warm?
Plastic bag under a radiant heater
Skin to skin care
Transwarmer mattress
Prewarmed incubator
What are common problems of prematurity?
Temp control Feeding/ nutrition Sepsis System immaturity/ dysfunction Metabolic
What system immaturity/ dysfunction affects premature babies?
Resp distress syndrome
Patent ductus arteriosus
Intraventricular haemorrhage
NEC
What is an independent risk factor for neonatal death?
Hypothermia
Increases severity of all preterm morbidities
Why is thermal regulation ineffective in neonates?
Low BMR
Minimal muscular activity
Subcut fat insulation is negligible
High ratio of surface area to body mass
What is the triangle in terms of temp control in babies?
Hypothermia
Hypoglycemia
Hypoxia
Why will hypoglycemia lead to hypoxia?
Decreased surfactant production
Pulmonary vasoconstriction
Increased work of breathing
Resp distress
Why can hypothermia lead to hypoxia?
Increased metabolism Decreased o2 consumption Increased RR O2 demand greater than supply Anaerobic metabolism Acidosis Hypoxia
Why can hypothermia lead to hypoglycemia?
Increased metabolism Increased glucose uptake Increased use of glycogen stores Depleted glycogen stores Hypoglycaemia
Why is there an increased risk of nutritional compromise in neonates?
Limited nutrient reserves
Gut immaturity
Immature metabolic pathways
Increased nutrient demands
What is the best form of nutrition for preemies?
Breast milk; can use donor milk bank
What will early onset neonatal sepsis suggest?
Bacteria acquired before and during delivery
What will late onset neonatal sepsis suggest?
Acquired after delivery
Nosocomial or community
Which bugs can cause early onset neonatal sepsis?
GBS
Gram negs; e.coli
Which bugs can cause late onset neonatal sepsis?
Coagulase neg staph
Gram negs
Staph aureus
What are the risks of infection assoc with prematurity?
Immature immune system
Intensive care environment
Indwelling tubes and liens
How can infections in neonates be managed?
Prevention Hand washing Super vigilant and infection screening Judicious use of antibiotics Supportive measures
What are the respiratory complications of prematurity?
Resp distress syndrome
Apnoea of prematurity
Bronchopulmonary dysplasia
What can cause resp distress syndrome?
Primarily; surfactant deficiency, structural immaturity
Secondary pathology
Alveolar damage; formation of exudate from leaky capillaries
What are the clinical features of RDS?
Resp distress
Tachypnoea; grunting, intercostal recessions, nasal flaring, cyanosis
Worsens over min- hours
What is the management of RDS?
Maternal steroids when in utero
Surfactant
Ventilation; invasive/ non invasive
What is the imaging of choice to monitor interventricular haemorrhages in neonates?
Anterior fontanelle via USS
What are the classification/ grades of intraventricular haemorrhages?
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 consequences of NEC?
Gut is necrotic
Can perforate
Sepsis
DIC
When will the retina of babies fully develop?
6-8 weeks after delivery
What are the early metabolic complications seen in preterms?
Hypoglycaemia
Hyponatraemia
What is the late metabolic complication seen in preterms?
Osteopenia of prematurity
Describe the survival in extreme preterms?
Survival without disability of admissions for neonatal care: 22 weeks; 5% 23 weeks; 14% 24 weeks; 28% 25 weeks; 47% 26 weeks; 61%
What are the short term complications of preterm birth?
Respi
GIT
CV complications
What are the long term sequelae of preterm birth?
Neurodevelopmental disabilities such as CP
