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Child Health > Preterm Infants > Flashcards

Preterm Infants Flashcards

1
Q

What is the definition of preterm?

A

A birth that occurs before 37 weeks of completed gestation

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2
Q

What is the definition of term?

A

A birth between 37-42 weeks of gestation

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3
Q

What is the definition of post-term?

A

A birth that occurs after 42 completed weeks of gestation

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4
Q

What does post-date mean?

A

A birth that occurs after the expected date of delivery

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5
Q

What time period does foetal loss encompass?

A

Less than 22 weeks gestation

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6
Q

What are the different classes of preterm births?

A

Extremely preterm = 23-27 weeks gestation

Very preterm = 23-31 weeks gestation

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7
Q

What public health intervention caused a fall in the preterm birth rates?

A

The smoking ban = caused decline of 10%

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8
Q

How many women in Scotland smoke during their pregnancy?

A

1 in 12 = of these women, 10% start smoking in the later stages of pregnancy

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9
Q

When do over half of childhood deaths occur?

A

In the first year of life = strong association with preterm birth and low birth weight

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10
Q

What is the association between preterm births and death?

A

10 times higher risk of death when born before 32 weeks

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11
Q

Why is prematurity rising globally?

A

Increased maternal age, increased pregnancy-related complications, greater use of infertility treatments, more C-section births before term

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12
Q

What are the most common reasons for preterm births?

A

Multiple pregnancies = 9 times higher risk of prematurity
Spontaneous preterm labour
Preterm prelabour rupture of membranes

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13
Q

Does having more than one preterm delivery increase the risk of future preterm births?

A

Yes = >2 preterm deliveries increases risk of another premature baby by 70%

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14
Q

What impact does an abnormally shaped uterus have on preterm birth?

A

Increases risk by 19%

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15
Q

What are some risk factors for preterm birth?

A

Interval of less than 6 months between pregnancies
Conceived through IVF
Smoking, alcohol and illicit drugs
Poor nutrition, high BP, diabetes, multiple miscarriages or abortions

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16
Q

What are the main differences between term and preterm babies that need to be considered when managing a preterm baby?

A

Need more help to stay warm, more fragile lungs, don’t breathe effectively, have fewer reserves, delay cord clamping if possible

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17
Q

How are preterm babies kept warm?

A

Using a plastic bag under a radiant heater = baby goes in bag feet first

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18
Q

What are common problems in preterm babies?

A

Temperature control, feeding/nutrition, sepsis, metabolic, ROP, system immaturity/dysfunction

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19
Q

What are some problems caused by system immaturity/dysfunction in preterm babies?

A

Respiratory distress syndrome (RDS)
Patent ductus arteriosus (PDA)
Intraventricular haemorrhage (IVH)
Necrotising enterocolitis (NEC)

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20
Q

What is low admission temperature a risk factor for?

A

Neonatal death = hypothermia increases severity of all preterm morbidities

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21
Q

What is mostly responsible for hypothermia in newborns?

A

More due to lack of knowledge than lack of equipment

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22
Q

Why is thermal regulation ineffective in preterm babies?

A

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

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23
Q

What does maintaining the temperature of a baby prevent?

A

Hypoglycaemia and hypoxia

24
Q

What is the treatment for hypothermia?

A

Wrap/bags, skin to skin contact, transwarmer mattress, prewarmed incubator

25
Q

Why do preterm babies have an increased risk of nutritional compromise?

A

Limited nutrient reserves, gut immaturity, immature metabolic pathways, increased nutrient demands

26
Q

How much must the weight of a preterm baby be increased by?

A

Must increase by 7 times in 14-16 weeks

27
Q

How may babies be supported nutritionally?

A

Breastmilk is best
Total parenteral nutrition may be used
Formula feeding rarely used and isn’t advocated

28
Q

What must any breastmilk donor undergo?

A

Viral screening

29
Q

How does protein energy malnutrition arise in babies being fed using formula?

A

Demand of baby increases as it grows but parents often don’t increase the amount of formula they are buying

30
Q

What are the two types of neonatal sepsis?

A 
Early onset (EOS) = mainly due to bacteria before and during delivery
Late onset (LOS) = acquired after delivery (nosocomial or community sources)
31
Q

What organisms are implicated in neonatal sepsis?

A

Early onset = Group B strep, gram negatives (lower GI)

Late onset = gram negatives, coagulase negative staph, staph aureus

32
Q

Why are preterm babies at risk of neonatal sepsis?

A

Immature immune system, intensive care environment, indwelling tubes and lines

33
Q

How is neonatal sepsis managed?

A

Prevention, hand washing, infection screening, antibiotics, supportive measures

34
Q

What are some respiratory complications associated with preterm birth?

A

Respiratory distress syndrome, apnoea of prematurity, bronchopulmonary dysplasia

35
Q

What causes respiratory distress syndrome?

A

Primary pathology = surfactant deficiency, structural immaturity
Secondary pathology = may be due to intubation

36
Q

What is respiratory distress syndrome?

A

Hyaline membrane disease due to lack of surfactant

37
Q

How does alveolar damage occur in respiratory distress syndrome?

A

Formation of exudate from leaky capillaries, inflammation, repair

38
Q

Is respiratory distress syndrome common in preterm babies?

A

Yes = occurs in 75% of babies born before 29 weeks

39
Q

What are the clinical features of respiratory distress syndrome?

A

Tachypnoea, grunting, intercostal recessions, nasal flaring, cyanosis, respiratory distress, worsens over minutes to hours

40
Q

What is the natural history of respiratory distress syndrome?

A

Gradual worsening over 2-4 days then gradual improvement

41
Q

How is respiratory distress syndrome treated?

A

Maternal steroid, surfactant replacement, ventilation

42
Q

Why is blood shunted away from the lungs by the ductus arteriosus in normal foetal circulation?

A

Blood mostly bypasses the lungs in order to supply the other developing organs (e.g the brain)

43
Q

What does a patent ductus arteriosus cause?

A

It increases the workload of the heart

44
Q

How are intraventricular haemorrhages graded?

A

From 1 to 4

45
Q

What occurs is grade 1 and 2 intraventricular haemorrhages?

A

Neurodevelopmental delay up to 20%, mortality is 10%

46
Q

What occurs in grade 3 and 4 intraventricular haemorrhages?

A

Neurodevelopmental delay up to 80%, mortality is 50%

47
Q

Why does necrotising enterocolitis occur?

A

Gut of baby is not ready to process and digest milk = gut bacteria translocates across broken barrier into bloodstream causing sepsis

48
Q

What babies are more commonly affected by necrotising enterocolitis?

A

Usually extremely preterm babies

49
Q

What are some features of retinopathy of prematurity?

A

Usually presents 6-8 weeks after delivery, common in babies born before 32 weeks, screened for every 4 weeks after birth

50
Q

What are some metabolic complications associated with preterm births?

A 
Early = hypoglycaemia, hyponatraemia
Late = osteopenia of prematurity (due to increased demand for minerals for growth)
51
Q

How much difference does each day make in the survival of extremely preterm babies?

A

Very important = survival increases by 2% each day

52
Q

What has the trend been in the survival of preterm babies?

A

Trend has been increasing since 1998

53
Q

What two treatments have made the most difference n improving the survival of preterm babies?

A

Antenatal steroids and surfactant replacements

54
Q

How common are preterm births?

A

About 6% of births are preterm

55
Q

Are the survival rates of preterm babies different depending on gender?

A

Yes = girls have higher survival rates than boys when born preterm

Child Health (27 decks)

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