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HD2 > Problems of low birth weight > Flashcards

Problems of low birth weight Flashcards

1
Q

What does ‘at term’ mean?

A

40 weeks

38-42

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2
Q

What is considered low birthweight?

A

<2500g

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3
Q

What is considered very low BW?

A

<1500g

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4
Q

What is considered extremely low birthweight?

A

<1000g

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5
Q

What is prematurity?

A

Birth before 37 completed weeks of gestation

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6
Q

What is small for gestation age?

A
  • birth weight below 10th/3rd centile for gestation
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7
Q

What is fetal growth restriction?

A

Failure to achieve normal rate of fetal growth
Different from small for gestation as adverse effects causing this
May be full-term so grown to normal gestation but may be growth restricted making you small

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8
Q

Why may a baby be LBW?

A
  • premature (early)
  • small for gestation age (size)
  • premature + SGA (too soon and too small)
  • IUGR - something adversely affecting normal rate of growth
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9
Q

Why is LBW relevant?

A

Indicator of survival

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10
Q

What is the relevance of small gestation age?

A
  • complications for fetal growth restriction

- very long term health problems

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11
Q

What is the relevance of premature birth?

A
  • neurodevelopmental sequelae
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12
Q

What is the cause of SGA?

A

Genetic or acquired

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13
Q

What are the genetic causes of SGA?

A
  • chromosomal disorders (Edwards, trisomy 18)
  • inherited disorders
  • normal small baby as parents are small
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14
Q

What are the acquired causes of SGA?

A
  • utero-placental insufficiency
  • congenital infection
  • maternal smoking
  • maternal chronic illness
  • multiple pregnancy
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15
Q

What is utero-placental insufficiency?

A
  • antenatally detected (poor growth)
  • synctiotrophoblast invasion failure as highly resistant spiral arteries
  • poor placental development with raised resistance in vascular bed
  • Doppler ultrasound of uterine arteries/fetal circulation picks up (early diastolic notching)
  • high resistance of uterine artery blood flow and reversal of flow
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16
Q

How does a hypoxic fetus present?

A
  • prioritises blood flow to brain and cardiac muscle
  • expense of gut, kidneys, aorta, adrenals, liver, skin
  • Doppler ultrasound detects reduced uterine artery diastolic flow, reversed flow
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17
Q

What vessels are in the umbilical cord?

A
  • 2 arteries

- 1 vein

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18
Q

What does CMV cause?

A
  • hydrocephalus and calcification of the brain

- growth restriction

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19
Q

What maternal chronic illnesses can cause SGA?

A
  • diabetes
  • hypertension
  • CHD
  • stroke
  • chronic bronchitis

(affect fetus cellular growth, gene expression, hormonal axis)

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20
Q

What neonatal problems can cause SGA?

A
  • temperature control
  • polycythaemia
  • Hypoglycaemia
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21
Q

How can temperature control be impaired?

A
  • increased SA;V ratio
  • reduced adipose tissue insulation as inadequate nutrition
  • reduced capacity for thermogenesis
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22
Q

How does polycythaemia occur?

A

Increased RBCs

  • hypoxic in utero
  • hyper viscosity = dangerous
23
Q

How does hypoglycaemia occur?

A
  • reduced glycogen reserves if preterm/inadequate trans placental nutrition
  • urgent treatmentment = feeds, bolus of dextrose and IV infusion
  • lethargy, fits -> neurodevelopmental risk
24
Q

What are the 2 ways prematurity can occur?

A
  • spontaneous preterm labour

- obstetrician delivers

25
Q

What are the causes of spontaneous preterm labour?

A
  • infection/ruptured membranes
  • cervical incompetence
  • polyhydraminios
26
Q

Why may the obstetrician have to deliver the baby prematurely?

A
  • save mother (hypertension/haemorrhage)
  • save fetus (placental insufficiency)

but try to keep the fetus in utero as long as possible as uterus better than intensive care

27
Q

What are the main problems of prematurity?

A
  • temperature control
  • respiratory - structurally and functionally immature/infection susceptibility
  • cardiovascular
  • nutritional
  • infection
  • neurological
28
Q

Why is a premature baby at high risk of heat loss?

A
  • large SA: body mass
  • thin skin and less adipose tissue
  • wet at birth and cannot shiver
  • poor metabolic reserve
29
Q

How is hypothermia avoided?

A
  • modern incubators provide humidified warmth
  • temp set to help baby maintain own temp at min. metabolic cost
  • neutral thermal environment
  • <26 weeks = deliver baby into polythene bag
  • lower temperature = higher oxygen consumption
30
Q

How may the respiratory system be structurally immature?

A
  • primitive alveolar dev.

- susceptible to oxygen toxicity

31
Q

How may the respiratory system be functionally immature?

A
  • surfactant deficiency
  • lack of respiratory drive
  • intercostals and diaphragm weak
32
Q

How may premature babies be susceptible to respiratory infections?

A
  • immature immune system

- instrumentation of airway

33
Q

What short term respiratory clinical problems are there?

A
  • RDS
  • pneumonia
  • apnoea of prematurity (temp. cessation of breathing)
34
Q

What is RDS?

A
  • respiratory distress syndrome
  • surfactant deficiency
  • tachypnoea, expiratory grunting, recession
  • within 4 hours of birth
35
Q

How is RDS prevented?

A
  • ante-natal steroids
  • avoid intrauterine hypoxia
  • prophylactic surfactant treatment
  • keep warm, avoid acidosis
36
Q

How is RDS treated?

A
  • surfactant/respiratory support
37
Q

What is chronic lung disease of infancy?

A
  • bronchopulmonary dysplasia
  • oxygen dependency in preterm baby
  • lung injury by inflammation, fibrosis, emphysema
  • low gestation prevalent
38
Q

What is surfactant?

A
  • monolayer of phospholipid molecules
  • hydrophobic tails, hydrophilic heads
  • reduces surface tension around alveoli keeping them open
  • contains DPPC and PG
  • stabilised by surfactant protein B
39
Q

What is PG?

A

Phosphatidylglyercol

40
Q

What are the cardiovascular problems of prematurity?

A
  • PPHN (persistant pulmonary hypertension of the newborn, lung vessels don’t relax so are constricted and blood flow Is suboptimal)
  • failure to maintain bp
  • patent ductus arteriosus
41
Q

How much energy do you need to grow?

A
  • need 110-135 kcals to grow
  • mature human milk is 68 cals/100ml
  • if gut is immature gut will not absorb it so need to feed and:
  • need to fortify milk
42
Q

What are the nutritional problems of prematurity?

A
  • immature suckling: enteral feeding required
  • baby not fed = gut mucosa atrophies = poor gut motility
  • excess feeding = precipitate necrotising enterocolitis
43
Q

What is necrotising enterocolitis?

A
  • acute bacterial invasion/inflammation/necrosis of bowel with bowel gas formation in bowel wall (pneumotosis)
44
Q

What are the RF of necrotising enterocolitis?

A
  • prematurity
  • hypoxia
  • infection
  • enteral feeding
45
Q

How is necrotising enterocolitis presented clinically?

A
  • abdominal distension, tenderness, discolouration
  • blood in stools
  • generalised collapse
46
Q

How is necrotising enterocolitis treated?

A
  • stop feeds

- give antibiotics

47
Q

How hospital acquired infections may the mother get?

A
  • coagulase negative staphylococci

- gram negative organisms (colonise intestine)

48
Q

What problems in pregnancy may cause infections?

A

term babies:

  • transplacental IgG in 3rd trimester
  • IgA and immunologically active cells in colostrum
  • skin barrier
  • acquisition of normal flora from mother and family

Preterm baby:

  • denied this protection
  • nursed in bacteriologically hostile environment
  • given broad spectrum antibiotics
  • invasive procedures breach host defences
49
Q

What neurological problems can happen in prematurity?

A
  • susceptibility to periventricular haemorrhage (poor control of brain perfusion, if sudden increased flow)
  • risk of periventricular leukomalacia (ischaemia of periventricular white matter)
50
Q

What are the risk factors of periventricular haemorrhage?

A
  • prematurity
  • RDS
  • pneumothorax
  • acidosis
  • hypercapnia
  • hypotension
  • instability and handling
  • severe bruising at birth
51
Q

Is a symmetrical or asymmetrical baby worse?

A

Symmetrical as means brain and body are being spared of circulation so both small whereas asymmetrical means only abdominal organs spared and brain needs it more so function not impaired

52
Q

How many LBW babies be associated with adult disease?

A

Barker hypothesis

  • diabetes
  • hypertension
  • CHD
  • stroke
  • chronic bronchitis

Fetal environment can affect cellular growth/gene expression and hormonal axes

53
Q

How can we protect preterm baby from infection episodes?

A
  • disinfect hands and objects
  • limit antibiotic usage
  • trials of immunoglobulins, probiotics etc.
54
Q

What are the complications of intracerebral bleeding?

A
  • collapse and death
  • loss of brain parenchymal tissue with cyst development
  • CSF circulation blockage = hydrocephalus

HD2 (22 decks)

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