PROBS RELATED TO PRE- AND POST- MATURITY Flashcards
every year, an estimated ___ babies are born preterm
15 million
preterm birth complicatiosn are the leasing cause of death among children under ___ years of age
5
___ of these deaths could be prevented with current, cost-effective interventions
three-quarters
across 184 countires, the rate of preterm birth ranges from ___% of babies born
5-18%
- live infant born before the end of week 37 of gestation
- weight of less than 2500g at birth
preterm infant
causes of preterm birth
- low socioeconomic level, early termination of pregnancy
- inadequate nutrition
- iatrogenic causes - elective cesarean, inducing labor
pregnancy behaviors that may contribute to preterm birth
cigarette smoking
working 12 hour shifts
preterm baby is small and ___
underdeveloped
preterm baby’s head is ___
disproportionately large (cm greater then chest)
preterm baby’s skin is usually ruddy because of little ___
subcutaneous fat
preterm baby’s ___ are easily noticeable, and high degree of ___ may be present
veins
acrocyanosis
___ is absent in preterm because it is not formed this early in pregnancy (< 25 weeks ges)
vernix
___ is usually extensive, covering the back, forearms, forhead, and side of the face
lanugo
preterm baby’s anterior and posterior ___ are small
fontanelles
there are no ___ on the soles of the feet
creases
preterms has varying degrees of ___ because of lack of eye globe depth
myopia / nearsightedness
the ___ of the ear is immature and allows the ___ to fall forward
cartilage
pinna
the ___ appear large in relation to the head
ears
if the preterm infant cries, the cry is weak and ___
high-picthed
___ and ____ reflexes are absent if below 33 weeks
sucking and swallowing
____ reflex markedly diminished
achilles tendon
an infant who has difficulty accomplishing effective breathing may expreince residual ___ ___ as a result of cerebral hypoxia
neurologic morbidities
process of resuscitation of preterm
establish an airway
the lung
initiate and maintain effective ventilation
start chest compressions is ___ becomes so severe
respiratory depression (<60 bpm)
___ should occur if there is an obstruction such as mucus plug
suctioning
an infant with no effort at spontaneous respirations after initial steps may require insertion of?
endotracheal tube
what medication given to the mother may cause respiratory depression in an infant after birth
morphine, meperidine
- a drug to reverse the action of narcotics
- may cause seizure in newborn
naloxone (narcan)
resiscitation efforts should focus on ___ and ___ for the persistenty apneic newborn
effective ventilation
airway support
___ may be administered IV to stimulate heart action
epinephrine 1:10,000
preterms may recieve ___ to replace the natural ___ that has not yet formed in their lungs
surfactant
all high-risk infants have difficulty maintaining ___
temp
if preterm environment becomes too hot, they are forced to decrease ___ to cool their body
metabolism
why is increased metabolism destructive for preterms?
increased metabolism = increased oxygen need = respiratory difficulty = hypoxia
- a pause in breathing for 15-20 secs or more
- may happen together with a slow HR
apnea of prematurity
- a lung disease that can develop in prematue babies as well as babies who have treatment with a breathing machine
- have a higher risk of lung infections than other babies
bronchopulmonary dysplasia
a lack of lung surfactant makes them vulnerable to this
respiratory distress syndrome
- can acquire more esily because their immune systems arent fully developed
infections / nenonatal sepsis
- develop a normochromic, normocytic anemia
- reticulocyte count is low bc the bone marrow does not increase its production until approximately 32 weeks
anemia of prematurity
anemia - infant appears ___ and may be ___ and ____
pale
lethargic and anorectic
anemia - may need ___, and supplementation of ___ and ___ provided by preterm formula
blood transfusion
vitamin E and iron
occurs bc preterms have both fragile capillaries and immature cerebral vascular development
periventricular/intraventricular hemorrhage
an infant experiences ___ distal to the rupture
brain anoxia
___ is done after the first few days of life to detetct if a hemorrhage has occured
cranial ultrasound
- destruction of brain cells by invasion of indirect bilirubin
- occurs from the high concentration of indirect bilirubin in the blood from excessive breakdown of RBC
kernicterus
kernicterus - have less ___ available to bind indirect bilirubin and therefore inactivate its effect
serum albumin
if jaundice occurs, what are the interventions?
blood transfusion and phototherapy
- acute injury to the small/large intestines that causes nflammation and injury to the bowel lining
- occurs within 2 weeks of birth
- feeding difficulties, abd swelling, hypotension, sepsis
necrotizing enterocolitis
when NEC is suspected, infants are treated with ___ and ___
antibiotics
bowel rest
- preterms lack surfactant, their lungs are noncompliant, so it is more dificult for them to move blood from the pulmonary artery in the lungs
- lead to pulmonary artery HTN, which may interfere with the closure of the DA
persistent patent ductus arteriosus
medications for persistent patent ductus arteriosus
indomethacin and ibuprofen
side effect of indomethacin
oliguria
- most common eye abnormality
- neovascular retinal disorder, incidence increases with decreasing age and weight
- immaturity with an avascular retina
retionapthy of prematurity
an infant must be kept ___ during resuscitation procedures
warm
give ___ oxygen during resuscitation
100%
preterm experience a high ___ and cannot concentrate urine well because of immature kidney function
insensible water loss
normal neuromaturation can be promoted by?
positioning the infant that mimic’s its position in the womb
extreme flexion
hip adduction
avoid neck and trunk extension
comfortable breathing, better oxygenation, and more sleep have been noted in infants in the ___ position
prone
elements of neurodevelopmental support
- NICU design and lighting
- nursing routines & care plans
- feeding methods
- management of pain
- attention to sensory input, activity, and signs of stress
- involvement of parents
preterms fed ___ have lower risk of infections and NEC, have higher cognitive scores, and have lower risk of chronic gastrointestinal diseases and allergies
breast milk
most infants have a ___ before a first feeding
chest xray
a preterm needs ___ calories per kg of body weight per day
115-140
feedings may be as small as ___ ml every ___ hours
1-2 ml
2-3 hours
a gag reflex is not intact until ___ weeks gestation
32
___ may be given intermittently every few hours or continuously via tubes
gavage feedings
infants may be fed by ___ at about 1ml/hr
continuous drip feeding
the caloric concentration of formula used for preterms is usually ___
24 cal/oz
- born after the 41st week of a pregnancy
- special risk because a placenta appears to function effectively for only 40 weeks
post term infant
posterms may be ___ because of poor placental function
lightweight
posterms is likelt to have difficulty establishing ___, expecially if meconium aspirations occurd
respirations
posterms is unusually ___ and wide eyed with a ___ look
alert
worried look
posterm may be thin with ___ and little ___
loose skin
subcutaneous fat
posterms cord is thin with little ___
wharton’s jelly
posterms have little to no lanugo and vernic but have abundant ___ and long ___
hair and nails
posterms skin is ___, ___, and ___
wrinkled, cracked, and peeling
posterms should be assessed for ___ bc of rapid use of glycogen stores
hypoglycemia
if loss of subcutaneous fat has occured, the infant is at risk for ___
low temp
posterm is diagnosed based on
gestational age
postmaturity is diagnosed based on
gestational age and physical exam
placental insuffiency and cord compression secondary to olugohydramnio
perinatal asphyxia
may be severe bc amniotic fluid is decreased and meconium is less dilute
meconium aspiration syndrome
occurs after meconium aspiration
persistent pulmonary hypertension
management for meconium aspiration
- suctioning
- chest physiotherapy
- supplemental oxygen and respiration support
provide ___ to prevent hypoglycemia if not contraindicated by respi status
early feeding
avoid the use of ___ in postterm
powders, creams, and lotions
tape
- birth weight is below the 10th percentile
- microsomia
- may be born preterm, term or posterm
- IUGR in utero
small of gestational age
causes of small for gestational age
- teen pregnancy
- smoking
- inadequate nutrition
common cause of IUGR is
placental anomalies
other causes for SGA (intrauterine infections)
rubella, toxoplasmosis, chromosomal abnormality
how to detect size of baby in utero
sonogram
CS birth is the birth method of choice if ___ occurs
hypoxia
SGA - overall ___ appearance
wasted
SGA’s have small ___, which may cause difficulty regulating glucose, protein, and bilirubin
liver
SGA - poor ___ and disproportionate head
skin turgor
SGA - hair is ___ and ____
dull and lusterless
SGA - abd may be ___
sunken
SGA - the cord often appear dry and stained ___
yellow
SGA lab findings
- polycythemia
- high hematocrit
- high RBC
- low blood glucose (<40 mg/dl)
SGA - later in life there is increased risk of ___, which are thought o be caused by abnormal vascular development
ischemic heart disease
hypertension
stroke
- macrosomia
- birth weight above the 90th percentile
large of gestational age
LGA is common in mothers who are ___ and have ___
obese
DM
other causes of LGA
- transposition of great vessles
- beckwith syndrome
- congenital anomalies (ex: emphalocele)
___ is performed to assess the placenta’s ability to sustain the large fetus during labor
non stress test
LGA - lung maturity can be assessed by ___
amniocentesis
LGA - CS birth may be necessary due to
CPD or shoulder dystocia
LGA - mature ___ and ___ scores on gestational age exams (apgar)
reflexes
low scores
LGA may have extensive ___ or birth injury such as:
bruising
broken clavicle; erb duchenne paralysis
complications of LGA
birth trauma
hypoglycemia
hyperviscosity
hyperbilirubinemia
some LGA have difficulty establishing ___ at birth bc of birth trauma
respirations
a ___ may occur due to cervical nerve trauma
diaphragmatic paralysis
LGA needs to be breastfed immediately to avoid ___
hypoglycemia
do not over stimulate infant’s ability to ___ effectively after birth
suck
LGA observe closely for signs of
hyperbilirubineamia
polycythemia
hypoglycemia
___ is the major cause of LGA
maternal DM
large size itself increases risk of ___
birth injury
perinatal asphyxia
infants of diabetic mothers are also at risk of ___
respiratory distress syndrome and congenital anomalies
