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HD 2 > Problems of Low Birthweight Infant > Flashcards

Problems of Low Birthweight Infant Flashcards

1
Q

What is the median UK birthweight at term?

A

3.480kg

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2
Q

Below what weight is low birth weight

A

<2500g

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3
Q

Below what weight is very low birth weight

A

<1500g

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4
Q

Define prematurity

A

Birth before 37 weeks gestation

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5
Q

Define small for gestational age

A

Birth weight below 10th centile

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6
Q

What is fetal growth restriction

A

Failure of achieve normal rate of foetal growth

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7
Q

What are the consequences of a small for gestational age baby

A

Complications of foetal growth restriction

Very long term health problems

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8
Q

What are the consequences of a premature baby

A

Neurodevelopmental disorder

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9
Q

Name 5 acquired causes of SGA baby

A
  • Utero-placental insufficiency
  • Congenital infection
  • Smoking
  • Maternal chronic illness
  • Multiple pregnancy
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10
Q

What are the consequences of congenital CMV on the brain

A

Hydrocephalus and calcification

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11
Q

What is genetic basis of Edwards syndrome

A

Trisomy 18

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12
Q

What does Edwards syndrome baby look like

A

Small with congenital abnormalities (clenched fist)

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13
Q

In which 2 ways can utero-placental insufficiency lead to untrauterine growth restriction

A
  • Failure of syncytiotrophoblast invasion of high resistance spiral arteries
  • Poor placental development with raised resistance in placental vascular bed
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14
Q

How can hypoxic placenta be detected

A

Doppler ultrasound in uterine arteries and foetal circulation

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15
Q

What is meant by brain sparing circulatory redistribution

A

When there is limited oxygen, baby’s circulation prioritises blood floow to deliver oxygen to brain and heart at expense of other parts of body

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16
Q

Where does SGA baby have problems with temperature control

A

Increased SA:V ratio
Reduced adipose tissue insulation
Reduced capacity for thermogenesis

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17
Q

How is hypoglycaemia treated in SGA baby

A

IV dextrose

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18
Q

What does symptomatic hypooglycaemia look like, and what does it suggest

A

Lethargy and fits

Risk of adverse neuro-developmental outcome

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19
Q

What is necrotising enterocolitis

A

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

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20
Q

Why is SGA baby at risk of hypoglycaemia

A

Low glycogen reserves

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21
Q

What adult diseases is low birth weight associated with

A 
Diabetes
HT
Coronary heart disease
Stroke
Chronic bronchitis
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22
Q

What can cause spontaneous preterm labour

A

Infection/ ruptured membranes
Cervical incompetence
Polyhydramnios

23
Q

Name 6 systems that may be affected by prematurity

A 
Temp control
Resp
Cardiovascular
Nutritional
Infection
Neurological
24
Q

Why is preterm baby at high risk of heat loss?

A 
Large SA: body mass ratio
Thin skin
Less adipose tissue
Wet at birth
Can't shiver
Poor metabolic reserve
25
Q

Why is temperature set as it is in modern incubators

A

Set to help baby maintain temperature but at minimal metabolic cost- neutral thermal environment

26
Q

What respiratory structural immaturity can be seen in premature infants

A

Primitive alveolar development

Susceptibility to oxygen toxicity and barotrauma

27
Q

What respiratory functional immaturities can be seen in premature infants

A

Surfactant deficiency

Lack of resp drive

28
Q

Why are premature babies more susceptible to infection

A

Immature immune system

Instrumentation of airway

29
Q

3 short term respiratory clinical problems of premature babies

A

Respiratory distress syndrome
Pneumonia
Apnoea of prematurity

30
Q

Long term respiratory clinical problem of premature baby

A

Chronic lung disease of infancy

31
Q

What is found at the air-liquid interface in alveoli and what does it consist of

A

Surfactant- monolayer of phospholipid molecules

Consists of DPPC and phosphatidylglycerol

32
Q

What stabilises surfactant

A

Surfactant protein B

33
Q

What is the function of surfactant

A

Reduces surface tension at air-fluid interface

34
Q

What is RDS

A

Respiratory distress syndrome
Lack of surfactant in premature baby
Tachypnoea, expiratory grunting, recession

35
Q

4 ways to prevent RDS

A

Ante-natal steroids
Avoidance of intrauterine hypoxia
Prophylactic surfactant treatment
Keep warm, avoid acidosis

36
Q

What causes chronic lung disease of infancy

A

Lung injury in preterm infant

Inflammation, fibrosis, emphysema

37
Q

What is PPHN

A

Persistent pulmonary hypertension of the newborn

38
Q

How many caloiries does preterm baby need to grow a day

A

110-135

39
Q

How does the baby receive nutrition in utero

A

Foetus swallows amniotic fluid

Nutrition is provided continuously across placenta

40
Q

What are the challenges in feeding a preterm baby

A

Immature suckling
Poor gut motility
May not tolerate enteral feeds

41
Q

What happens if baby is not fed

A

Gut mucosa atrophies

42
Q

What is pneumotosis

A

Gas formation in bowel wall

43
Q

Risk factors for necrotising enterocolitis

A

Prematurity, hypoxia, infection, enteral feeding

44
Q

Clinical presentation of nectorising enterocolitis

A

Abdo distention
Tenderness
Discolouration
Blood in stools

45
Q

Treatment of necrotising enterocolitis

A

Stop feeds
Give antibiotics
Sometimes surgery

46
Q

What bacterias most commonly cause infections within 48 hours of birth

A

Group B beta haemolytic strep

E coli

47
Q

What bacterias most commonly cause infections >48 hours after birth (hospital acquried)

A

Coagulase negative straphylococci

Gram negative organisms that colonise intestine

48
Q

What immune protection is present in full term baby but not preterm

A

Transplacental IgG in 3rd trimester
IgA and immunlogically active cell in colostrum
Skin barrier
Acquisition of normal flora from mother

49
Q

Why is preterm baby immunocompromised?

A

No usual full term benefits
Nursed in bacterially hostile environment
Given broad spectrum antibiotics
Invasive procedures breach host defeces

50
Q

Why are preterm babies susceptible to Periventricular haemorrhage

A

Germinal matrix in floor of lateral ventricles is vascular due to active glial and neuronal proliferation
Poor control of brain perfusion

51
Q

What is periventricular leucomalacia

A

Ischaemia of periventricular white matter

52
Q

What are the risk factors for periventricular haemorrhage

A 
Prematurity 
RDS
Pneumothorax
Hypercapnia
Acidosis
Hypotension
53
Q

What % of babies <1500g develop cerebral palsy

A

10

54
Q

What long term problems in the brain result from prematurity

A

Cognitive and behavioural problems
Sensory impairment
Minor hearing and vidual impairment

HD 2 (26 decks)

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