Small and preterm baby

Question 1

Definition of low birthweight, very low and extremely low birthweight?

Answer 1

Low - under 2.5 kg
Very low - under 1.5
Extremely low - under 1

Question 2

Definition of preterm, very preterm and extremely preterm baby?

Answer 2

Preterm - under 37 weeks
Very preterm - under 32 weeks
Extremely preterm - under 28 weeks

Question 3

Definition of small for gestational age (SGA)?

Answer 3

Birthweight under 10th centile of gestational age

Question 4

4 main categories for causes of SGA baby?

Answer 4

Normal
Maternal
Placental
Foetal

Question 5

Name 3 maternal causes of a SGA baby

Answer 5

Environmental - malnutrition, smoking

Comorbid disease - PE, HT, renal disorders, medications

Question 6

Name 3 foetal causes of a SGA baby

Answer 6

Infection
Chromosomal abnormality
Malformation

Question 7

Name 3 placental causes of a SGA baby

Answer 7

Multiple pregnancy
Poor implantation
Malformation
Placental insufficiency

Question 8

Name 5 causes of a preterm birth

Answer 8

Idiopathic/unexplained (preterm labour +/- PROM)
Cervical incompetence
Multiple pregnancy
APH
Uterine abnormalities
Indicated preterm delivery (due to maternal or foetal compromise)

Question 9

Name 8 consequences of being born SGA or premature. Which is worse, SGA or prematurity, in terms of severity of consequences)

Answer 9

Death
Respiratory distress, apnoea
Hypothermia
Hypoglycaemia
Poor feeding
Neonatal jaundice
Dehydration
Low Ca/Mg
Anaemia
Necrotising enterocolitis

Prematurity worse than SGA

Question 10

What are the 3 key elements to managing a preterm newborn?

Answer 10

Keep it pink, warm and sweet

Question 11

Name 3 causes of respiratory distress in a preterm newborn

Answer 11

Hilar-membrane disease (insufficient surfactant)
Pneumonia
Wet lung

Question 12

Name 4 ways of delivering O2 to a newborn in respiratory distress. What is one complication of giving too much oxygen? What SaO2 is aimed for?

Answer 12

Nasal prongs/mask
Incubator
Nasal CPAP
Endotracheal tube

Complication of too much O2 - retinopathy of prematurity. Aim for SaO2 88 - 92%

Question 13

What temperature do you aim to keep a newborn at?

Answer 13

36.8 +/- 0.3 C

Question 14

What blood sugar do you aim for in a premature neonate?

Answer 14

> 2.5mmol/L

Question 15

What are the main causes of mortality to extremely premature vs very premature neonates?

Answer 15

Extremely prem - Hilmar-Membrane disease, sepsis, NEC, malformations
Very prem - Sepsis and malformations

Question 16

Name 3 main contributors to morbidity in very premature neonates

Answer 16

Cerebral palsy
Deafness
Developmental delay
Blindness