Preterm Infant Flashcards
what is a pre term baby
born before 37 weeks completed gestation
what is a post term baby
a baby born after 42 completed weeks
what public health effort reduced pre term labours by 10%
the smoking ban
when do half of childhood deaths occur
within the first year (strongly influenced by pre term delivery and low birth weight)
what are the risk factor for fetal death
ethnicity (black and british black, asian or asian black)
poverty
maternal age (teenage and mothers over 40)
pre term
mulitple pregnancies
labour complications
why are preterm births rising in incidence (>1:10)
increased maternal age
increased pregnancy complications
fertility treatments
more C sections done before term
what are the most common causes of pre term birth
spontaneous preterm labour multiple pregnancy PROM pregnancy associated hypertension IUD antepartum haemorrhage cervical incompetence/ uterine malformation
what are the risk factors for pre term deliveries
previous pre term baby abnormally shaped uterus multiple pregnancies interval <6 months between pregnancies conceiving through in vitro fertilisation smoking, alcohol, drug use poor nutrition chronic conditions (high BP, diabetes) multiple miscarriages/ abortions
what extra management is needed for pre term babies
need more help to stay warm (put baby in plastic bag under a radiant heater immediately- while still wet)
more fragile lungs and dont breath effectively, may need resp support
have fewer reserves- need to feed well
delay cord clamping if possible
what are common problems of prematurity
temperature control (important for enzyme activity) feeding/nutrition sepsis system immaturity/ dysfunction: -respiratory distress syndrome -patent ductus arteriosus -intraventricular haemorrhage -necrotising enterocolitis metobolic dysfunction retinopathy if prematurity
why is hypothermia in prematurity so bad
increases severity of all preterm morbidities
leads to hypoglycaemia and hypoxia as increases metabolism = hypoglycaemia which causes decreases surfactant production and pulmonary constriction, and increased RR= resp distress= hypoxia
why is thermal regulation ineffective in premature babies
low BMR
minimal muscular activity
subcutaneous fat insulation is negligible
high SA to body mass
what are the four ways babies loose heat
convection, conduction, radiation, evaporation
how is heat maintained in premature babies
wrap or bags
skin to skin
transwarmer mattress
PREWARMED incubator
why are pre term babies at more risk of nutritional compromise
limited nutrient reserves
gut immaturity
immature metabolic pathways
increased nutrient demands
what nutrition options for premature babies
breast milk is best- ask mothers to express and store milk until baby is able to feed normally
can have total parental nutrition if required
can have donor breast milk
rarely formula feeding
what are the types of neonatal sepsis
early onset sepsis:
-mainly bacterial acquired before and during pregnancy
late onset sepsis:
-acquired after delivery from hospital/community
what organisms commonly cause early onset sepsis
group B strep
gram -ves
what organisms commonly cause late onset sepsis
coagulase negative staph (epi)
gram -ves
staph aureus
why are the infections risks associated with prematurity
immature immune system
intensive care environment
indwelling tubes and lines
what management is in place to prevent neonatal infections
hand washing v vigilant screen for infections be early to prescribe antibiotics supportive measure in place if infections starts
what are the resp complications of prematurity
respiratory distress syndrome
apnoea of prematurity
bronchopulmonary dysplasia
what is respiratory distress syndrome
(aka hyaline membrane disease)
when primary pathology (surfactant deficiency and structural immaturity) or secondary pathology result in
alveolar damage:
-formation of exudate from leaky capillaries
-inflammation
-repair
how common in resp distress syndrome
75% of infants born before 29 week, 10% in infants born after 32 weeks
what are the clinical features of respiratory distress syndrome
resp distress tachypnoea grunting intercostal recession nasal flaring cyanosis
worsens over minutes to hours
worst at 2-4 days then gradual improvement
what is the management of resp distress syndrome
maternal steroid before birth
surfactant replacement
ventilation (invasive or non invasive- CPAP)
how do infantile intraventricular haemorrhages present
most present by third day of life dimished/ absent moro reflex poor muscle tone sleepiness lethargy apnoea
The fontanelle may be tense and bulging with severe IVH.
Neurological depression may progress to coma.
In mild forms there may be no clinical signs, or there may be alternating symptomatic and asymptomatic periods.
what are the grade of intraventricular haemorrhage
grades 1-4, how contained the blood is within the ventricular system and how dilated they are
Grade 1 and 2 : Neurodevelopmental delay up to 20% Mortality 10%
Grade 3 and 4: Neurodevelopmental delay up to 80%
Mortality 50%
how can intraventricular haemorrhage be prevented
antenatal steroids
what causes necrotising enterocolitis
when very premature gut not meant to have milk yet, only liquor, so if feed then gut becomes inflamed and can start to necrose
bacteria can translocate from gut into bloodstream causing sepsis and severe dehydration
who is most likely to get retinopathy of prematurity
those born <32 weeks
usually happens 6-8 weeks after delivery
(screened until retina properly vascularised)
what are the early metabolic complications of prematurity
hypoglycaemia
hyponatraemia
what are the late metabolic complications of prematurity
osteopenia of prematurity
how does term relate to educational needs
early or later more likely to need more help
how common in prematurity
~6%
