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LR Child Health > Term & Preterm Infants > Flashcards

Term & Preterm Infants Flashcards

1
Q 
At what weeks is a baby considered...
-Term
-Preterm
-Post-term
?
A

Term: 37-42 weeks
Preterm: before 37 weeks
Post-term: after 42 weeks

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2
Q

As preterm is the widest spectrum, it is split into 3 groups again. What are these?

A

Extremely preterm (22-<28 weeks)

Very preterm (28-<32 weeks)

Moderate/late preterm (32-<37 weeks)

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3
Q 
What newborn weight is considered...
-Normal
-Small for gestational age (SGA)
-Large for gestational age (LGA)
?
A

Normal: 2.5 - 4.0kg
SGA: <2.5kg
LGA: >4.0kg

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4
Q

The most rapid increase in fat mass occurs in the 1st trimester. T/F?

A

False

Build-up of fat occurs most rapidly in the 3rd trimester - esp. the last 4 weeks of pregnancy

This is a problem in preterm babies

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5
Q

List some physical differences you may notice in a preterm baby as opposed to a term baby (3)

A
  • Thinner due to less fat, may see bones
  • Arms lying flat at sides, not flexed up, due to less muscle
  • Pinker in colour as less SC fat means capillary beds are more visible through the skin
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6
Q

Why may a baby become acidotic during prolonged labour?

A
  • Womb contractions reduce O2 delivery down the placenta

- Foetal Hb releases O2, but prolonged labour can deplete foetal reserves and lead to acidosis

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7
Q

What 2 hormones can enhance foetal adaptation to the hypoxic environment of labour?

A

Cortisol
+
Adrenaline

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8
Q

Describe perinatal adaptation

A
  • Baby takes first breath/cries
  • Lungs expand and open alveoli
  • Foetal circulation changes to newborn circulation
  • Pulmonary arterial blood pressure decreases
  • PaO2 (partial pressure of O2 in arterial blood) increases)
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9
Q

The ? score is an objective measure of perinatal adaption

A

Apgar score

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10
Q

What are the 5 considerations in the Apgar score?

A 
Colour (Appearance)
Heart rate (Pulse)
Responsiveness (Grimace)
Tone (Activity)
Resp rate (Resp rate)

*spells out Apgar

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11
Q

Describe how the Apgar score is calculated

A
  • Each component (HR, RR, responsiveness, tone, colour) is given a score from 0-2
  • 0 = not present, 1 = abnormal, 2 = abnormal
  • Normal score is >=8 /10
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12
Q

Why is skin-to-skin contact with the parents so important immediately after birth? (3)

A
  • Babies get cold easily so it helps keep them warm (alongside blanket, hat etc)
  • Establishes breastfeeding
  • Helps form hormonal and emotional attachment between parents and baby
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13
Q

Why are all babies given vitamin K after birth?

A

To prevent haemorrhagic disease of the newborn

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14
Q

Which maternal infections carry risk of infecting the baby? (6)

A
  • Hep B
  • Hep C
  • HIV
  • Syphilis
  • TB
  • Group B Strep
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15
Q

At birth, which infections may the baby be vaccinated against if the mother has them? (2)

A

Hep B (immunoglobulin treatment may also be required but vaccine usually enough)

TB (BCG vaccine)

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16
Q

Name 2 vaccines which a pregnant woman can receive

A

Influenza vaccine (as pregnancy can cause worse illness)

Pertussis vaccine (to provide antibodies against Pertussis for the growing baby)

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17
Q

What screening tests are carried our for newborns and when?

A
  • Newborn physical examination (within first 3 days)
  • Blood spot test (~ 5 days)
  • Universal hearing screening (birth to 4 weeks)
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18
Q

What conditions does the blood spot test currently check for? (4)

A
  • CF
  • Congenital hypothyroidism
  • Sickle cell disorder
  • Inherited metabolic disease
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19
Q

What are some abnormalities of the head that may be seen in newborns? (7)

A
  • Orofacial cleft
  • Overlapping sutures
  • Fontanelles (soft spots where sutures have not come together)
  • Ventouse/forcep marks (from assisted delivery)
  • Moulding (altered head shape from prolonged delivery)
  • Cephalhaematoma (pool of blood under the scalp due to pressure during birth)
  • Caput succcedaneum (swelling in the scalp due to pressure during birth)
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20
Q

What are some abnormalities that may be seen in the mouth of a newborn?

A
  • Tongue tie
  • Cleft lip or cleft palate (often seen together, cleft palate alone may be missed)
  • Neonatal teeth (choking hazard so remove)
  • Ebsteins pearls (keratin bumps in mouth, go away by themselves)
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21
Q

Facial palsy is often caused by…

A

Nerve compression during forceps delivery

22
Q

What is meconium?

A

Baby’s first poo

23
Q

How common is premature birth…

  • In the UK
  • Globally
A

UK: ~6% of births
Globally: >10%

24
Q

Why is prematurity becoming more common worldwide? (4)

A
  • Increasing maternal age
  • Increasing rate in pregnancy complications
  • Greater use of infertility treatments
  • More C sections delivered before term
25
Q

What are the most common causes of preterm birth? (4)

A
  • Spontaneous preterm labour
  • Multiple pregnancy
  • Rupture of membranes
  • Pregnancy associated hypertension
26
Q

List risk factors for premature birth (7)

A
  • > 2 previous preterm deliveries
  • Abnormally shaped uterus
  • Multiple pregnancy
  • <6 months between 2 pregnancies
  • IVF
  • Smoking, alcohol, drugs
  • Poor nutrition, hypertension, diabetes, multiple miscarriages
27
Q

List 4 ways in which the preterm infant may be managed differently from a term baby

A
  • Delayed cord clamping
  • Bigger demand to keep warm
  • Gentle lung inflation
  • Monitor O2 sats closely
28
Q

What extra measures may be used to keep a preterm infant warm? (4)

A
  • Place immediately in a plastic bag to prevent heat loss
  • Place under a radiant heater later
  • Heat in prewarmed incubator
  • Transwarmer mattress
29
Q

Why must lung inflation have positive end expiratory pressure (PEEP)?

A

To keep the alveoli from collapsing

30
Q

Complications risk increases in preterm birth with decreasing… (2)

A
  • Gestational age

- Birth weight

31
Q

List 7 common problems of prematurity

A

Hypothermia

Poor feeding/malnutrition

Infection/sepsis

Respiratory distress syndrome (RDS)

Patent ductus arteriosus (PDA)

Intraventricular haemorrhage (IVH)

Necrotising enterocolitis (NEC)

32
Q

Why is hypothermia more common in preterm babies? (4)

A
  • Low BMR
  • Minimal muscle activity
  • Negligible SC fat insulation
  • High SA to body mass ratio
33
Q

Why is nutritional compromise more common in premature babies?

A
  • Limited nutrient reserves
  • Gut immaturity
  • Immature metabolic pathways
  • Increased nutrient demands
34
Q

Why can preterm babies not be fed immediately after birth?

A

Due to immature gut and metabolic pathways

35
Q

How may a preterm baby be fed? (3)

A
  • IV total parenteral nutrition
  • Tube feeding (via NG or OG tube)
  • Donor milk can be used until mother is able to provide her own breast milk
36
Q

Why is formula not recommended before 34 weeks?

A

Due to immature metabolic pathways

But specially prescribed formula can be used if necessary

37
Q

Why are babies born prematurely more at risk of infection? (3)

A
  • Immature immune system
  • Intensive care environment e.g., increased temp in incubator
  • Indwelling tubes and catheters
38
Q

What is the difference between early onset sepsis (EOS) and late onset sepsis (LOS)?

A

EOS: acquired before or during delivery

LOS: acquired after delivery

39
Q

Which bacteria most commonly cause:
- early onset sepsis (EOS)
- late onset sepsis (LOS)
?

A

EOS:

  • Group B Strep
  • Gram -ves

LOS:

  • Coagulase -ve staph
  • Gram -ves
  • Staph aureus
40
Q

List 3 respiratory complications of prematurity

A
  • Respiratory distress syndrome (RDS)
  • Apnoea of prematurity
  • Bronchopulmonary dysplasia
41
Q

What is respiratory distress syndrome (RDS)?

A

Babies born at <34 weeks may not have produced enough surfactant to prevent the alveoli of the lungs from collapsing

Collapse leads to impaired gas exchange

42
Q

What are the features of RDS?

A 
Increased work of breathing
Tachypnoea
Grunting
Intercostal recessions
Nasal flaring
Cyanosis

Worsens over minutes to hours, improves after 2-4 days

43
Q

How is RDS managed?

A

Maternal steroid (beta- or dexa-methasone) to prevent RDS in anticipated preterm birth

Surfactant

Invasive/non-invasive ventilation

44
Q

What is apnoea of prematurity and how is it managed?

A

Babies born at <34 weeks haven’t developed the part of the CNS which controls subconscious breathing, leading to periods of breathing cessation

This can be managed with a once-daily dose of caffeine to stimulate breathing mechanisms until these CNS centres develop in the next few weeks

45
Q

What medication can be used to close a patent ductus arteriosus?

A

Indometacin

Ibuprofen

46
Q

What is intraventricular haemorrhage?

A

Bleeding inside or around the ventricles of the brain (where the CSF is held)

Usually occurs within the first 72 hours of life

47
Q

What is necrotizing enterocolitis?

A

Inflammation and death of the walls of the intestine, which can lead to perforation and infection

48
Q

To monitor for retinopathy, premature babies should have their eyes checked how regularly?

A

Every 2 weeks for 6-8 weeks

49
Q

The majority of childhood deaths occur when?

A

In the first year of life (majority within 28 days of birth)

50
Q

Risk factors for infant death include…

A
  • Increasing maternal age
  • Smoking during pregnancy
  • Poverty
  • Prematurity
  • Multiple birth

LR Child Health (12 decks)

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