Sick Preterm Baby Flashcards
What is very preterm defined as?
<32 weeks
How were premature births affected by the smoking ban?
fell 10%
What is the risk of preterm birth with mulitple pregnnacy?
x9 risk
What is the average gestation at birth for twins?
37 weeks
What is the average gestation at birth for triplets?
34 weeks
What can hypothermia result in?
increased oxygen and energy consumption–hypoxia; metabolic acidosis and hypoglycaemia; apnea; noenatal cold injury; reduced blood coagulability; failure to gain weight; increased mortality
What is neonatal cold injury?
redness of the skin from dissociation of haemoglobin
Why are newborn babies liable to hypothermia?
large SA realtive to mass; skin is thin; little subcut fat; limitied capacity to generate heat; unable to curl up to reduce skin exposure
How are babies under 28 weeks kept warm?
placed in a plastic bag immediately whilst still wet under a radiant heater
What happens if you over-inflate a preterm babies lungs?
causes damage leading to inflammation and long-term morbidity; predisposes to bronchopulmonary dysplasia
What are the options for keeping a baby warm?
wrap or bags; skin-skin care; transwarmer mattressl prewarmed incubator
Why are extremely preterm infants unable to breastfeed immediately?
unable to suck and swallow until 34-35 weeks; initially unable to tolerate milk in enough quantity
Why are preterm babies are risk of nutritional compromise?
limited nutrient reserves; immature metabolic pathways; increased nutrient demands
What effect does oxygen have on pulmonary vasculature?
potent vasodilator
What is gestational corrrection?
adjusts the plot of a measurement to accoutn for the number of weeks a baby was born early
How long should gestational correction be continued for infants born between 32 and 36 weeks?
1 year
How long should gestational correction be continued for infants born before 32 weeks?
2 years
What is the cause of early onset noenatal sepsis?
due to bacteria acquired before and during delivery
What is the cause of late onset neonatal sepsis?
acquired after delivery
What is the primary problem in respiratory distress syndrome?
surfactant deficiency and structural immaturity
What causes the secondary pathology in respiratory distress sundrome?
from treating- ventilation
How many calories per kg does a preemie need?
> 100kcal/kg
What are the secondary problems in respiratory distress syndrome?
alveolar damage and formation of exudate from leaky capillaires due to damaged fragile lungs
How common is RDS in babies born before 29 weeks?
75%
What is the natural history of RDS?
worsens over minutes to hours; nadir at 2-4 days then gradual improvement
What is the management for RDS?
maternal steroids; surfactant; ventilation
What are the CVS concerns in preterm infants?
PDA; systemic hypotension
What does PDA lead to?
symptoms of congestive heart failure; babies need lots of oxygen and will exacerbate RDS
What is an intraventricular haemorrhage?
form of intracranial haemorrhage that begins with bleeding into the germinal matrix
What are the 2 major risk factors for IVH?
prematurity and respiratory distress syndrome
When does IVH usually occur?
first day of life
Why is prematurity a RF for IVH?
germinal matrix is present but cerebral autoregulation is immature
Why does RDS inrease risk of IVH?
hypoxia; acidosis and hypotension make the cerebral circulation more unstable
What is the most common neonatal surgical emergency?
necrotizing enterocolitis
What happens in NEC?
widespread necrosis in the small and large intestine
What is the clinical picture of NEC?
usually after recovering from RDS; lethargy and gastric residuals; bloody stool; temperature instability; apnoea and bradycardia
What are the early metabolic comlplications in preterm babies?
hypoglycaemia and hyponatraemia
When does retinopathy of prematurity tend to develop?
6-8 weeks after delivery
What is a late metabolic complication of prematurity?
osteopenia of prematurity
Why do preemies get retinopathy?
the retina isnt well developed or vascularised- get a diabetic retinopathy type picture
What effects does being premature have on their adult health?
insulin resistance; hypertension and vascular changes; decreased reproduction- and F more likely to have preemie
How common is prematurity?
around 6 %
