Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Paediatrics 4MB > The Preterm Infant > Flashcards

The Preterm Infant Flashcards

1
Q

What are the medical problems encountered by preterm infants?

A
  1. Respiratory:
    - RDS
    - Apnoea
    - Pneumothorax
  2. CVS:
    - Hypotension
    - PDA
  3. Metabolic:
    - Electrolyte imbalance
  4. Neurological:
    - IVH
  5. GI:
    - Necrotising Enterocolitis
    - Hernias
    - Reflux
  6. Infection
  7. Jaundice
  8. Retinopathy of Prematurity
  9. Temperature control
  10. Nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the cause of RDS in a preterm infant?

A

Deficiency in surfactant leading to increased alveolar surface tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which infants are more at risk of RDS?

A

Those born at less than 28wks gestation and male infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What term infants are at risk of RDS?

A
  1. Infants of diabetic mothers

2. Infants with genetic mutations in surfactant genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How can we prevent RDS in preterm infants?

A

Antenatal corticosteroids (glucocorticoids) can be given to stimulate surfactant production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the clinical signs of RDS in a neonate?

A
  1. Tachypnoea >60bpm
  2. Chest wall recession and nasal flaring
  3. Expiratory grunting
  4. Cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management of RDS in a preterm infant?

A

Surfactant therapy, via tracheal tube or catheter, and respiratory support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What types of respiratory support can be offered to a neonate?

A
  1. Non-invasive:
    - CPAP
    - High flow nasal cannula
  2. Invasive:
    - Mechanical ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is the mechanical ventilation adjusted?

A

It is adjusted according to oxygenation, chest wall movements and bloods gas analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is pulmonary interstitial emphysema?

A

When air from overdistended alveoli escapes into the interstitium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a pneumothorax?

A

A pneumothorax is when air leaks into the pleural cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the clinical signs of a pneumothorax in a neonate?

A
  1. Increased oxygen requirement
  2. Decreased breath sounds on affected side
  3. Decreased chest movements on affected side
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do we diagnose a pneumothorax in a neonate?

A

It can be diagnosed with transillumination or CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define a tension pneumothorax

A

A tension pneumothorax is the progressive build up of air within the pleural space, usually due to a large lung laceration, which allows air to enter the pleural space but not to leave it (one way valve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the management of a tension pneumothorax?

A

URGENT decompression with a chest drain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can we prevent a pneumothorax in a neonate?

A

Ventilate with the lowest pressures possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What infants are at risk of apnoea?

A

Very low birthweight infants until they reach about 32wks of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the mechanism behind the apnoea?

A

Bradycardia occurs and either:

a) Infant stops breathing for over 20-30secs or
b) Breathing continues against a closed glottis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What underlying causes of apnoea should be excluded?

A
  1. Hypoxia
  2. Infection
  3. Anaemia
  4. Electrolyte disturbance
  5. Hypoglycaemia
  6. Seizures
  7. Heart failure
  8. Aspiration due to reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the usual cause of apnoea in preterm infants?

A

Immaturity of respiratory control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the treatment of apnoea in preterm infants?

A
  1. Gentle physical stimulation
  2. Caffeine (central respiratory stimulant)
  3. CPAP or mechanical ventilation if frequent episodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why are preterm infants at greater risk of hypothermia?

A
  1. Large surface area relative to mass so greater heat loss than heat generation
  2. Higher transepidermal water loss than term infants
  3. Little subcutaneous fat
  4. Cannot conserve heat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the consequences of hypothermia in a neonate?

A
  1. Increased energy consumption
  2. Hypoxia and hypoglycaemia
  3. Failure to gain weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can we maintain temperature in a neonate?

A

Incubators - increase ambient humidity so decrease transepidermal water loss
Overhead radiant heaters used initially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the consequences of a PDA?
1. Shunting of blood from left to right 2. Apnoea and bradycardia 3. Increased oxygen requirement 4. Difficulty weaning from artificial ventilation
26
What are the clinical signs of PDA?
1. Bounding pulses 2. Prominent precordial impulse 3. Systolic murmur
27
What investigations are performed for PDA?
Echocardiogram
28
What is the pharmacological management of PDA?
1. Prostaglandin synthetase inhibitor 2. Indomethacin 3. Ibuprofen
29
What are the surgical options for treatment of PDA?
Surgical ligation - only done if pharmacological methods fail and patient is symptomatic
30
What are the fluid requirements of a preterm infant?
Requirements vary with chronological and gestational age 1st day of life - 60-90ml/kg Increase by 20-30ml/kg per day to 150-180ml/kg on day 5
31
How are fluid requirements adjusted?
Adjusted according to: 1. Clinical condition 2. Plasma electrolytes 3. Urine output 4. Weight change
32
Why are the nutritional requirements of a preterm infant higher?
Their requirements are higher due to rapid growth
33
What mode do we use to feed preterm infants?
Mode of nutrition depends on gestational age 35-36wks = mature enough to suck and swallow milk Less mature = orogastric or nasogastric tube
34
How can we meet the nutritional requirements of a very preterm infant?
Introduce enteral feeds ASAP Supplement breast milk with phosphate Can also supplement with protein, calories and calcium
35
What are the advantages and disadvantages of special infant formulas?
They can meet the increased nutritional requirements of preterm infants but they provide no protection against infection, unlike breast milk
36
How do we meet the nutritional requirements of the extremely preterm or sick neonate?
Parenteral nutrition via a PIC line or an umbilical venous catheter
37
Why are preterm infants more predisposed to iron deficiency and how do we prevent it?
As most of the iron transfer from the mother is in the third trimester. Combat this by starting supplements at several weeks of age.
38
Why are preterm infants at greater risk of infection?
1. IgG mainly transferred in 3rd trimester 2. No IgA or IgM transfer 3. Infection of mother's cervix can be a cause of preterm labour
39
When do most infections occur?
Most occur at several days of age
40
What increases risk of infection for these infants?
1. Indwelling catheters | 2. Mechanical ventilation
41
Define Necrotising Enterocolitis (NEC)
NEC is damage to vulnerable bowel via ischaemic injury or bacterial invasion which occurs in the first few weeks of life
42
What are the clinical signs of NEC?
1. Feed intolerance 2. Bile stained vomit 3. Distended abdomen 4. Fresh blood in stool
43
What are the features of NEC on x-ray?
1. Distended loops of bowel 2. Thickening of the bowel wall 3. Intramural gas 4. May have gas in portal venous tract
44
What is the management of NEC?
1. Stop oral feed 2. Broad spectrum antibiotics (cover aerobes and anaerobes) 3. TPN 4. Mechanical ventilation 5. Circulatory support 6. Surgery if perforation
45
What are the complications of NEC?
1. Bowel perforation 2. Strictures 3. Malabsorption 4. Increased risk of poor neurodevelopmental outcome
46
What are the risk factors for IVH?
1. Very low birth weight infant 2. Perinatal asphyxia 3. Severe RDS 4. Pneumothorax
47
What are the complications of a large IVH?
Impaired drainage leading to hydrocephalus - treated with a ventriculo-peritoneal shunt
48
What are the complications of sever IVH?
Hemiplegia
49
Define Retinopathy of Prematurity
Retinopathy of Prematurity is abnormal replacement of sensory retina by fibrous tissue and blood vessels
50
What are the complications of retinopathy of prematurity?
1. Retinal detachment 2. Fibrosis 3. Blindness
51
What are the risk factors for developing retinopathy of prematurity?
1. Very low birth weight infants | 2. Uncontrolled use of high concentrations of oxygen
52
How is retinopathy of prematurity managed?
1. Laser therapy can decrease visual impairment | 2. Intravitreal anti-VEGF is being investigated but is not routine
53
Define Hyponatraemia
Na+ <130mmol/L
54
What are the causes of hyponatraemia in a neonate?
1. Water overload 2. Maternal fluid overload 3. Iatrogenic 4. Sick infant 5. Excess renal loss 6. GI loss 7. Drainage of ascites/CSF 8. Hypoadrenalism
55
What are the symptoms of hyponatraemia in a neonate?
1. Irritability 2. Apnoeas 3. Seizures
56
How is hyponatraemia managed?
Management depends on the underlying cause | Too rapid correction can cause neurological damage
57
Define Hypernatraemia
Na+ >150mmol/L
58
What are the causes of hypernatraemia in a neonate?
1. Water depletion | 2. Excess Na+ administration
59
What infants are at increased risk of hypernatraemia?
1. Extremely preterm infants in first days of life | 2. Breastfed infants with poor intake
60
How do we manage hypernatraemia in a neonate?
Increase fluid intake | Be cautious with rapid correction
61
Define Hypokalemia
K+ <2.5mmol/L
62
What are the causes of hypokalemia in a neonate?
1. Excess losses | 2. Inadequate intake
63
How do we manage hypokalemia in a neonate?
Correct with supplementation (either IV or enteral) | Be aware with IV infusion as risk of arrhythmias
64
Define Hyperkalemia
K+ >7.5mmol/L OR >6.5mmol/L + ECG changes
65
What are the causes of hyperkalemia in a neonate?
Failure of K+ excretion (renal failure)
66
How do we manage hyperkalemia in a neonate?
1. Administer calcium gluconate for myocardial stabilisation 2. Eliminate the excess K+ with calcium resonium and dialysis 3. Redistribute the K+ using Salbutamol and Insulin (SE of these is hypokalemia)

Paediatrics 4MB (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions