The Preterm Infant

Question 1

What is the definition of a preterm infant?

Answer 1

A birth that occurs before 37 completed weeks of gestation

Question 2

What is the spectrum of preterm birth?

Answer 2

Extremely preterm - <28 weeks
Very preterm - 28-<32 weeks
Moderate or late preterm - 32-<37 weeks

Question 3

How many babies are born preterm?

Answer 3

More than 1 in 10

Question 4

What are causes of preterm birth?

Answer 4

Spontaneous preterm labour
Multiple pregnancy
Preterm pre-labour rupture of membranes
Pregnancy associated hypertension
Antepartum haemorrhage
Cervical incompetence/uterine malformation
Intrauterine growth restriction

Question 5

What are risk factors for preterm labour?

Answer 5

>2 preterm deliveries
Abnormally shaped uterus
Multiple pregnancy
Interval of <6 months between pregnancies
Concieving trough invitro fertilisation
Smoking/drinking alcohol/drug abuse
Poor nutrition
Chronic conditions - diabetes;high blood pressure
Multiple miscarrigaes or abortions

Question 6

What are the differences between a preterm compared to a term baby?

Answer 6

Get cold faster
Have fewer reserves
Dont breathe effectively
Titration of oxygen

Question 7

What alterations should we make when birthing a preterm baby?

Answer 7

Delayed cord clamping - for smooth transition to O2
Keep baby warm
Gentle lung inflation
Initial O2 concentration lower
Use a saturation monitor

Question 8

What should we use gentle lung inflation?

Answer 8

We want to maintain semi-distended lungs otherwise they are likely to collapse

Question 9

How do we keep baby warm?

Answer 9

Plastic Bag
Hat
Heater

Question 10

What are common problems in preterm infants?

Answer 10

Temperature control
Feeding/nutrition
Sepsis
System immaturity
Metabolic disorders

Question 11

What are diseases that can result from system immaturtiy in the preterm baby?

Answer 11

Respiratory distress syndrome
Patent ductus arteriosus
Intraventricular haemorrhage
Necrotising enterocolitis

Question 12

Why is thermal regulation ineffective in the newborn?

Answer 12

They have a lower BMR
Minimal muscular activity
Less subcutaneous fat therefore less insulation
High surface area to volume ration

Question 13

If we prevent hypothermia in the newborn baby, what other conditions can that also help to prevent?

Answer 13

Hypoglycaemia
Hypoxia
These form a triad and all go hand in hand

Question 14

Why is there increased risk of nutritional compromise in the preterm baby?

Answer 14

Limited nutrient reserves
Gut immaturity
Immature metabolic pathways - to breakdown; absorb and convert food to energy
Increased nutrient demands

Question 15

Below what gestational age is it recommended that we don’t use formula feeds?

Answer 15

<34 weeks

Question 16

What are the likely causative pathogens in early onset neonatal sepsis?

Answer 16

Group B Strep

Gram negatives

Question 17

What are the likely causative pathogens in late onset neonatal sepsis?

Answer 17

Coagulase negative staph
Gram negatives
Staph aureus

Question 18

What is tha=e cause of RDS?

Answer 18

Surfactant deficiency and structural immaturity - this forms exudate from leaky capillaries; causes inflammation

Question 19

What are the clinical signs of RDS?

Answer 19

Tachypnoea
Grunting
Intercostal recession
Nasal flaring
Cyanosis

Question 20

How do we manage RDS?

Answer 20

Maternal steroids - BETHAMETASONE/DEXAMETHASONE
Surfactant replacement
Ventilation

Question 21

What are the clinical signs of necrotising enterocolitis?

Answer 21

Distended abdomen

Jaundice