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Repro and Sexual Health > Preterm Infant > Flashcards

Preterm Infant Flashcards

1
Q

What is a preterm birth?

A

Before 37 weeks gestation

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2
Q

What is a post term birth?

A

After 42 completed weeks of gestation

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3
Q

What is an extremely preterm birth?

A

<28 weeks

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4
Q

What is a very preterm birth?

A

<32 weeks

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5
Q

What is a preterm birth?

A

<37 weeks

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6
Q

What impact did the smoking ban have on premature birth?

A

Fell by 10%

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7
Q

When do over half the childhood deaths occur?

A

1st year of life; strongly influenced by preterm delivery and low birth weight (RF; maternal age, smoking, disadvantaged circumstances)

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8
Q

If you are born before 32 weeks; what times more likely are you to die?

A

10x

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9
Q

Which babies are most at risk for preterm birth?

A

Black or asian mothers
Teenage and geriatric mothers (>40)
Poverty

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10
Q

How many births are preterm?

A

1 in 10

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11
Q

What are the causes of preterm birth?

A 
Spontaneous
Multiple pregnancy
Preterm prelabour rupture of membranes
Pregnancy assoc hypertension 
IUGR
Antepartum haemorrhage 
Cervical incompetence/ uterine malformation
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12
Q

What are risk factors for preterm birth?

A 
> 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
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13
Q

What extra support will all preterm babies require?

A 
More help to stay warm 
More fragile lungs
Don't breathe effectively 
Fewer reserves
Delay cord clamping if possible
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14
Q

How can preterm babies be kept warm?

A

Plastic bag under a radiant heater
Skin to skin care
Transwarmer mattress
Prewarmed incubator

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15
Q

What are common problems of prematurity?

A 
Temp control
Feeding/ nutrition 
Sepsis 
System immaturity/ dysfunction 
Metabolic
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16
Q

What system immaturity/ dysfunction affects premature babies?

A

Resp distress syndrome
Patent ductus arteriosus
Intraventricular haemorrhage
NEC

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17
Q

What is an independent risk factor for neonatal death?

A

Hypothermia

Increases severity of all preterm morbidities

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18
Q

Why is thermal regulation ineffective in neonates?

A

Low BMR
Minimal muscular activity
Subcut fat insulation is negligible
High ratio of surface area to body mass

19
Q

What is the triangle in terms of temp control in babies?

A

Hypothermia
Hypoglycemia
Hypoxia

20
Q

Why will hypoglycemia lead to hypoxia?

A

Decreased surfactant production
Pulmonary vasoconstriction
Increased work of breathing
Resp distress

21
Q

Why can hypothermia lead to hypoxia?

A 
Increased metabolism
Decreased o2 consumption 
Increased RR
O2 demand greater than supply
Anaerobic metabolism 
Acidosis 
Hypoxia
22
Q

Why can hypothermia lead to hypoglycemia?

A 
Increased metabolism
Increased glucose uptake
Increased use of glycogen stores
Depleted glycogen stores
Hypoglycaemia
23
Q

Why is there an increased risk of nutritional compromise in neonates?

A

Limited nutrient reserves
Gut immaturity
Immature metabolic pathways
Increased nutrient demands

24
Q

What is the best form of nutrition for preemies?

A

Breast milk; can use donor milk bank

25
Q

What will early onset neonatal sepsis suggest?

A

Bacteria acquired before and during delivery

26
Q

What will late onset neonatal sepsis suggest?

A

Acquired after delivery

Nosocomial or community

27
Q

Which bugs can cause early onset neonatal sepsis?

A

GBS

Gram negs; e.coli

28
Q

Which bugs can cause late onset neonatal sepsis?

A

Coagulase neg staph
Gram negs
Staph aureus

29
Q

What are the risks of infection assoc with prematurity?

A

Immature immune system
Intensive care environment
Indwelling tubes and liens

30
Q

How can infections in neonates be managed?

A 
Prevention 
Hand washing
Super vigilant and infection screening
Judicious use of antibiotics
Supportive measures
31
Q

What are the respiratory complications of prematurity?

A

Resp distress syndrome
Apnoea of prematurity
Bronchopulmonary dysplasia

32
Q

What can cause resp distress syndrome?

A

Primarily; surfactant deficiency, structural immaturity
Secondary pathology
Alveolar damage; formation of exudate from leaky capillaries

33
Q

What are the clinical features of RDS?

A

Resp distress
Tachypnoea; grunting, intercostal recessions, nasal flaring, cyanosis
Worsens over min- hours

34
Q

What is the management of RDS?

A

Maternal steroids when in utero
Surfactant
Ventilation; invasive/ non invasive

35
Q

What is the imaging of choice to monitor interventricular haemorrhages in neonates?

A

Anterior fontanelle via USS

36
Q

What are the classification/ grades of intraventricular haemorrhages?

A

Grade 1 and 2; neurodevelopmental delay up to 20%, mortality 10%
Grade 3 and 4; neurodevelopmental delay up to 80%, mortality 50%

37
Q

What are the consequences of NEC?

A

Gut is necrotic
Can perforate
Sepsis
DIC

38
Q

When will the retina of babies fully develop?

A

6-8 weeks after delivery

39
Q

What are the early metabolic complications seen in preterms?

A

Hypoglycaemia

Hyponatraemia

40
Q

What is the late metabolic complication seen in preterms?

A

Osteopenia of prematurity

41
Q

Describe the survival in extreme preterms?

A 
Survival without disability of admissions for neonatal care: 
22 weeks; 5% 
23 weeks; 14%
24 weeks; 28%
25 weeks; 47%
26 weeks; 61%
42
Q

What are the short term complications of preterm birth?

A

Respi
GIT
CV complications

43
Q

What are the long term sequelae of preterm birth?

A

Neurodevelopmental disabilities such as CP

Repro and Sexual Health (77 decks)

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