Preterm Infants Flashcards
When is a baby classed as preterm?
Born before 37 weeks gestation
When is a baby classed as post-term?
Born after 42 weeks gestation
How many births in the UK are classed as preterm?
1 in 10
List causes of preterm brith
Spontaneous preterm labour Multiple pregnancy Preterm ROM Pregnancy associated hypertension Cervical incompetence/ uterine malformation Antepartum haemorrhage Intra-uterine growth retardation
List some risk factors for preterm birth
Previous preterm delivery Abnormally shaped uterus Smoking, alcohol, drugs Poor socioeconomic status/poverty Complications, maternal disease Twin pregnancy Teenage mother IVF conception
What are the physiological differences between a preterm and term infant?
Get colder quicker
Fragile lungs
Less effective breathing
Little reserve
The cord should be clamped immediately in a preterm baby. True/False?
False
Can wait a minute to allow placental transfusion if baby is OK and can be kept warm
What are the two main factors for risk of complications at birth?
Reduced gestational age
Reduced birth weight
How can a neonate be kept warm?
Wrap clothes
Plastic bag under a radiant heater
Skin-skin care
Prewarmed incubator
List the main medical concerns in a preterm infant
Hypothermia Sepsis Undernutrition Respiratory distress Patent ductus arteriosus Interventricular haemorrhage Necrotising enterocolitis Retinopathy of prematurity Metabolic complications
Why are preterm babies more predisposed to hypothermia?
Low BMR
Minimal muscular activity
Subcutaneous fat negligible
High ratio surface area: body mass
How does hypothermia lead to hypoxia?
Increased metabolism decreases O2 supply
How does hypothermia lead to hypoglycaemia?
Increased metabolism increases glucose uptake and usage of glycogen stores
How does hypothermia lead to respiratory distress?
Brown fat metabolism causes release of fatty acids which decreases surfactant production, requiring more work for breathing
Why are preterm babies more predisposed to nutrient deficiencies?
Limited nutrient reserves
Gut immaturity
Immature metabolic pathways
Increased nutrient demands
For preterm infants, gestational correction is done for plotting growth charts. How is gestation corrected?
Number of weeks early = 40 weeks minus gestational age
How is early onset neonatal sepsis acquired?
Bacteria before and after delivery
How is late onset neonatal sepsis acquired?
After delivery via community sources
List organisms that cause EOS in neonates
Group B strep
Gram negatives
List organisms that cause LOS in neonates
Coagulase negative staph
Gram negatives
Staph aureus
Why are preterm babies more predisposed to sepsis?
Immature immune system
Intensive care environment
Indwelling tubes and lines
What is the pathophysiology behind respiratory distress syndrome?
Surfactant deficiency causes alveolar collapse and decreased residual capacity, requiring more effort to breathe
List clinical features of respiratory distress syndrome in neonates
Tachypnoea Grunting Intercostal recession Nasal flaring Cyanosis
How is neonatal respiratory distress managed?
Maternal steroid
Surfactant
Ventilation (invasive/non-invasive)
What is the clinical consequence of patent ductus arteriosus?
Opening between aorta and pulmonary artery causing extra blood to be pumped to the lungs
When does intraventricular haemorrhage occur typically in neonates?
First day of life
Insult is present by 72 hours
What classifications of IVH most commonly cause long-term neurodevelopmental delay?
Grade 3
Grade 4
What is the most common neonatal surgical emergency?
Necrotising enterocolitis
Tissues in the intestine become inflamed and start to die, leading to a perforation developing, which allows the contents of the intestine to leak into the abdomen
List clinical features of necrotising enterocolitis
Lethargy, poor feeding Bloating Gastric residue Bloody stool Sepsis
List early and late metabolic complications, common in prematurity
Hypoglycaemia, hyponatraemia
Osteopaenia of prematurity
List long-term complications of premature birth
Neurodevelopmental dysfunction, cerebral palsy
Growth issues
Chronic medical conditions
Define newborn jaundice
Jaundice that occurs in the first two weeks of life, and typically develops in the first 2-3 days after birth
More common in preterm babies
List symptoms of neonatal jaundice
Yellow skin Yellow sclera Sleepiness Poor feeding Dark pee Pale poo
Why are babies at risk of jaundice following birth?
Babies have a high number of RBCs, which are broken down and replaced frequently.
Liver isn’t fully developed, so it’s less effective at removing the bilirubin from the blood
When is neonatal jaundice thought to be pathological?
If it develops within first 24 hours of life
What are the main treatments for neonatal jaundice?
Usually self-limiting within 14 days
Phototherapy
Exhange transfusion
If a baby with very high levels of bilirubin isn’t treated, what are they at risk of developing?
Kernicterus
Permanent brain damage that occurs when jaundice is untreated due to very high levels of billirubin in the blood
