Preterm Infants

Question 1

When is a baby classed as preterm?

Answer 1

Born before 37 weeks gestation

Question 2

When is a baby classed as post-term?

Answer 2

Born after 42 weeks gestation

Question 3

How many births in the UK are classed as preterm?

Answer 3

1 in 10

Question 4

List causes of preterm brith

Answer 4

Spontaneous preterm labour
Multiple pregnancy
Preterm ROM
Pregnancy associated hypertension
Cervical incompetence/ uterine malformation
Antepartum haemorrhage 
Intra-uterine growth retardation

Question 5

List some risk factors for preterm birth

Answer 5

Previous preterm delivery
Abnormally shaped uterus
Smoking, alcohol, drugs
Poor socioeconomic status/poverty
Complications, maternal disease
Twin pregnancy
Teenage mother
IVF conception

Question 6

What are the physiological differences between a preterm and term infant?

Answer 6

Get colder quicker
Fragile lungs
Less effective breathing
Little reserve

Question 7

The cord should be clamped immediately in a preterm baby. True/False?

Answer 7

False

Can wait a minute to allow placental transfusion if baby is OK and can be kept warm

Question 8

What are the two main factors for risk of complications at birth?

Answer 8

Reduced gestational age

Reduced birth weight

Question 9

How can a neonate be kept warm?

Answer 9

Wrap clothes
Plastic bag under a radiant heater
Skin-skin care
Prewarmed incubator

Question 10

List the main medical concerns in a preterm infant

Answer 10

Hypothermia
Sepsis
Undernutrition
Respiratory distress
Patent ductus arteriosus
Interventricular haemorrhage
Necrotising enterocolitis
Retinopathy of prematurity
Metabolic complications

Question 11

Why are preterm babies more predisposed to hypothermia?

Answer 11

Low BMR
Minimal muscular activity
Subcutaneous fat negligible
High ratio surface area: body mass

Question 12

How does hypothermia lead to hypoxia?

Answer 12

Increased metabolism decreases O2 supply

Question 13

How does hypothermia lead to hypoglycaemia?

Answer 13

Increased metabolism increases glucose uptake and usage of glycogen stores

Question 14

How does hypothermia lead to respiratory distress?

Answer 14

Brown fat metabolism causes release of fatty acids which decreases surfactant production, requiring more work for breathing

Question 15

Why are preterm babies more predisposed to nutrient deficiencies?

Answer 15

Limited nutrient reserves
Gut immaturity
Immature metabolic pathways
Increased nutrient demands

Question 16

For preterm infants, gestational correction is done for plotting growth charts. How is gestation corrected?

Answer 16

Number of weeks early = 40 weeks minus gestational age

Question 17

How is early onset neonatal sepsis acquired?

Answer 17

Bacteria before and after delivery

Question 18

How is late onset neonatal sepsis acquired?

Answer 18

After delivery via community sources

Question 19

List organisms that cause EOS in neonates

Answer 19

Group B strep

Gram negatives

Question 20

List organisms that cause LOS in neonates

Answer 20

Coagulase negative staph
Gram negatives
Staph aureus

Question 21

Why are preterm babies more predisposed to sepsis?

Answer 21

Immature immune system
Intensive care environment
Indwelling tubes and lines

Question 22

What is the pathophysiology behind respiratory distress syndrome?

Answer 22

Surfactant deficiency causes alveolar collapse and decreased residual capacity, requiring more effort to breathe

Question 23

List clinical features of respiratory distress syndrome in neonates

Answer 23

Tachypnoea
Grunting
Intercostal recession
Nasal flaring
Cyanosis

Question 24

How is neonatal respiratory distress managed?

Answer 24

Maternal steroid
Surfactant
Ventilation (invasive/non-invasive)

Question 25

What is the clinical consequence of patent ductus arteriosus?

Answer 25

Opening between aorta and pulmonary artery causing extra blood to be pumped to the lungs

Question 26

When does intraventricular haemorrhage occur typically in neonates?

Answer 26

First day of life | Insult is present by 72 hours

Question 27

What classifications of IVH most commonly cause long-term neurodevelopmental delay?

Answer 27

Grade 3 | Grade 4

Question 28

What is the most common neonatal surgical emergency?

Answer 28

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

Question 29

List clinical features of necrotising enterocolitis

Answer 29

``` Lethargy, poor feeding Bloating Gastric residue Bloody stool Sepsis ```

Question 30

List early and late metabolic complications, common in prematurity

Answer 30

Hypoglycaemia, hyponatraemia | Osteopaenia of prematurity

Question 31

List long-term complications of premature birth

Answer 31

Neurodevelopmental dysfunction, cerebral palsy Growth issues Chronic medical conditions

Question 32

Define newborn jaundice

Answer 32

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

Question 33

List symptoms of neonatal jaundice

Answer 33

``` Yellow skin Yellow sclera Sleepiness Poor feeding Dark pee Pale poo ```

Question 34

Why are babies at risk of jaundice following birth?

Answer 34

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

Question 35

When is neonatal jaundice thought to be pathological?

Answer 35

If it develops within first 24 hours of life

Question 36

What are the main treatments for neonatal jaundice?

Answer 36

Usually self-limiting within 14 days Phototherapy Exhange transfusion

Question 37

If a baby with very high levels of bilirubin isn't treated, what are they at risk of developing?

Answer 37

Kernicterus | Permanent brain damage that occurs when jaundice is untreated due to very high levels of billirubin in the blood