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HD CC > Problems of Low Birth Weight + Prematurity > Flashcards

Problems of Low Birth Weight + Prematurity Flashcards

1
Q

Median UK birth weight at term (40 weeks)

A

3.48kg

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2
Q

Low birthweight

A

<2500g

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3
Q

Very low birthweight

A

<1500g

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4
Q

Extremely low birthweight

A

<1000g

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5
Q

Prematurity

A

Birth before 37 weeks completed gestation
Problems
Neurodevelopmental sequelae

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6
Q

Small for Gestational Age

A

Birth weight below 10th/3rd centile for gestation
Complications of foetal growth restriction
Very long term health problems

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7
Q

Fetal Growth Restriction (FGR/IUGR)

A

Failure to achieve normal rate of foetal growth e.g. from uteroplacental insufficiency or foetal infection

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8
Q

SGA Genetic

A

Normal small baby
Chromosomal disorders
Inherited disorders

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9
Q

SGA Acquired

A 
Utero-placental insufficiency
Congenital infection
Smoking
Maternal chronic illness (renal, sickle cell disease)
Multiple pregnancy
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10
Q

Edwards syndrome

A

Trisomy 18

Small with congenital abnormalities

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11
Q

Utero-placental insufficiency and Intrauterine growth restriction- DETECTION

A

May be detected antenatally because of poor growth

Doppler ultrasound of uterine arteries + foetal circulation

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12
Q

Utero-placental insufficiency and Intrauterine growth restriction- Causes

A

Failure of syncytiotrophoblast invasion of high resistance spinal arteries
Poor placental development with raised resistance in placental vascular bed

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13
Q

SGA baby problems

A

Temp control- Increased SA/V ratio, reduced adipose tissue insulation, reduced capacity for thermogenesis
Polycythemia- response to foetal hypoxia
Poor nutritional status –> hypoglycaemia
Low blood sugar treated with feeds or IV dextrose
Symptomatic hypoglycaemia –> risk of adverse neuro-developmental outcome
Increased risk necrotising enterocolitis

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14
Q

Hypoglycaemia

A

Low birth weight baby likely to have reduced glycogen reserves (preterm or inadequate transplacental nutrition)
Risk of hypoglycaemia <2.6mmol/l
Treated with feeds or bolus of dextrose + IV infusion
Symptomatic (lethargy, fits) hypoglycaemia is a RF for adverse neuro-developmental outcome

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15
Q

Barker hypothesis

A 
Low birth weight associated with:
Diabetes
Hypertension
CHD
Stroke
Chronic Bronchitis
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16
Q

Causes of prematurity

A

Spontaneous preterm labour

Delivered by an obstetrician

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17
Q

Spontaneous preterm labour

A

Infection or ruptured membranes
Cervical incompetence
Polyhydramnios

18
Q

Premature delivery by obstetrician

A

To save mother (hypertension, haemorrhage)

To save foetus (placental insufficiency)

19
Q

Preterm baby problems

A

High risk of heat loss

–> large SA/V ratio, think skin, less adipose tissue, wet at birth, can’t shiver, poor metabolic reserve

20
Q

Resp Problems of prematurity

A 
Primitive alveolar development
Susceptibility to O2 toxicity + barotrauma
Surfactant deficiency
Lack of respiratory drive
Immature immune system
Instrumentation of airway
21
Q

Resp. clinical problems

A

Resp. distress syndrome
Pneumonia
Apnoea of prematurity
Chronic lung disease of infancy

22
Q

Surfactant structure

A

Monolayer of phospholipid molecules at air-liquid interface in alveoli
Mainly consists of DPPC + PG
Stabilised by Surfactant Protein B
Reduces surface tension at the air-fluid interface

23
Q

Resp. Distress syndrome

A

Lack of surfactant in premature baby
Diagnosis- clinical, radiological + post-mortem
Tachypnoea, expiratory grunting, recession
Onset within 4h of birth

24
Q

Prevention of RDS

A 
Ante-natal steroids
Avoidance intrauterine hypoxia
Prophylactic surfactant treatment
Keep warm
Avoid acidosis
25
Q

RDS treatment

A

Surfactant

Resp. support

26
Q

Chronic lung disease of infancy

A

O2 dependency in preterm baby at 36 weeks post menstrual age
Lung injury in preterm infant
Inflammation, fibrosis, emphysema

27
Q

CV problems prematurity

A

Persistent pulmonary hypertension of newborn PPHN
Failure to maintain BP
Patent ductus arteriosus

28
Q

Preterm nutritional needs

A

110-135 kcals/kg/d to grow
160-200ml/kg/day of milk
Can fortify milk to increase protein, calorie + minerals
Can give IV parenteral nutrition if baby can’t tolerate milk

29
Q

Nutritional challenges in vitro

A

Foetus swallows amniotic fluid

30
Q

Nutritional challenges preterm baby

A

Immature sucking
Digestive enzymes present
poor gut motility
doesn’t tolerate enteral feeds

31
Q

Nutritional challenges

A

If baby not fed gut mucosa atrophies

Feeding may precipitate necrotising enterocolitis

32
Q

Necrotising enterocolitis

A

Acute bacterial invasion/inflammation/necrosis of bowel with gas formation in bowel wall

33
Q

Necrotising enterocolitis RFs

A

Prematurity
Hypoxia
Infection
Enteral feeding

34
Q

Necrotising enterocolitis clinical presentation

A

Abdominal distension, tenderness, discolouration
Blood in stools
Generalised collapse

35
Q

Necrotising enterocolitis treatment

A

Stop feeds
Antibiotics
Surgery

36
Q

Necrotising enterocolitis complications

A

death
short gut secondary to resection
strictures + late obstruction

37
Q

Bacteria causing infection

A

Early (<48hrs)- Group B strep, E Coli

Late- after 48hrs- hospital acquired, coagulase negative staphylococci, gram negative organisms that colonise intestine

38
Q

Term baby benefits from

A

Transplacental IgG in 3rd trimester
IgA + immunologically active cells in colostrum
Skin barrier
Acquisition of normal flora from mother + family

39
Q

Preterm CNS

A

Susceptibility to Periventricular Haemorrhage (PVS)- germinal matrix on floor of lateral ventricles is v. vascular due to active glial and neuronal proliferation
Risk of Periventricular white matter- ischaemia

40
Q

Periventricular Haemorrhage RFs

A 
Prematurity
RDS
Pneumothorax
Hypercapnia
Acidosis
Hypotension
Instability + handling
Severe bruising at birth
41
Q

Complications of intracerebral bleeding

A

Collapse
Death
Loss of brain parenchymal tissue + cyst development
Blockage of CSF circulation –> hydrocephalus

42
Q

Prematurity Long term

A

Cerebral palsy
Sensory impairment
Chronic lung disease of prematurity
Retinopathy of prematurity

HD CC (22 decks)

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