Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Child Health > The Preterm Infant + Neonatal Problems > Flashcards

The Preterm Infant + Neonatal Problems Flashcards

1
Q

How is preterm birth defined?

A

Delivery before 37 weeks gestation

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

What are the definitions of extremely preterm, very preterm and moderate/late preterm?

A

Extremely preterm = < 28 weeks
Very preterm = 28 - 32 weeks
Moderate to late preterm = 32 - 37 weeks

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

What are some of the causes of preterm birth?

A 
Spontaneous preterm labour
Multiple pregnancy
Preterm prelabour rupture of membranes
Pregnancy associated hypertension
Cervical incompetence/uterine malformation
Antepartum haemorrhage
Intrauterine growth restriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the risk factors for preterm delivery?

A 
Previous preterm deliveries
Abnormally shaped uterus
Multiple pregnancies
Interval of < 6 months between pregnancies
IVF
Smoking, alcohol + illicit drugs
Poor nutrition
High BP
Diabetes
Multiple miscarriages or abortions
Infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some of the common problems in a premature infant?

A 
Temperature control
Feeding/nutrition
Sepsis
System immaturity/dysfunction:
- respiratory distress syndrome
- patent ductus arteriosus
- intraventricular haemorrhage
- necrotising enterocolitis
Others e.g. metabolic, retinopathy of prematurity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is it so important to regulate temperature in preterm infants?

A

Hypothermis is independent risk factor for neonatal death
Increases severity of all preterm morbidities
More susceptible than term infants due to:
- low BMR
- minimal muscular activity
- minimal subcutaneous fat
- high ratio of surface area to body mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is hypothermia treated/prevented?

A

Wrap or bags
Skin to skin
Transwarmer mattress
Prewarmed incubator

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

Which organisms are likely to be causative in early onset neonatal sepsis?

A

Bacteria acquired before + during delivery:

  • group B strep
  • gram negatives
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which organisms are likely to be causative in late onset neonatal sepsis?

A

Acquired after delivery:

  • coagulase negative staph
  • gram negatives
  • staph aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why are premature babies particularly at risk of infection?

A

Immature immune system
Intensive care environment
Indwelling tubes and lines

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

What are the respiratory complications of prematurity?

A

Respiratory distress syndrome (RDS)
Apnoea of prematurity
Bronchopulmonary dysplasia

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

What causes RDS?

A

Surfactant deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the clinical features of RDS?

A 
Within minutes-hours from birth
Respiratory distress, RR >60
Grunting
Intercostal recessions
Nasal flaring
Cyanosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How can RDS be prevented?

A

Maternal IM corticosteroids for deliveries < 36 weeks –> increases fetal surfactant production

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

What does RDS look like on CXR?

A

Widespread atelectasis with ground glass appearance

Air bronchogram = air filled trachea + bronchi stand out black against ground glass appearance

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

How is RDS managed?

A

Nasal CPAP

–> if remains distressed, intubate and give surfactant via ET tube

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

Apart from RDS, what are the other causes of neonatal respiratory distress?

A 
Transient tachypnoea of the newborn
Meconium aspiration syndrome (MAS)
Bronchopulmonary dysplasia
Milk aspiration
Apnoea of prematurity
PPHN
Pneumonia (GBS)
Pneumothorax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is bronchopulmonary dysplasia?

A

Chronic lung disease resulting from disruption of normal lung development in preterm infants with respiratory problems

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

How is bronchopulmonary dysplasia clinically defined?

A

Need for supplementary oxygen beyond 28 days postnatal or 36 weeks postmenstrual age in absence of other diagnosis requiring oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How can bronchopulmonary dysplasia be prevented?

A

Prevent and treat RDS
Minimise ventilation
Caffeine IV if born < 30 weeks
Consider dexamethasone if premature and still ventilated at 8 days (although risk of neurodevelopmental problems)

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

What causes transient tachypnoea of the newborn (TTN)?

A

Delay in resorption of lung liquid

–> C-section and maternal DM are risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the clinical features of TTN and how is it managed?

A

Respiratory distress at birth
Usually resolves in 24-48 hours
Give oxygen if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is meconium aspiration syndrome (MAS)?

A

Occurs when meconium is passed in utero (meconium in liquor) or during birth and is inhaled
- can happen due to fetal maturation (post term baby) or in response to acute hypoxia
Can lead to pneumonitis and obstruction –> collapse or pneumothorax

24
Q

What might be seen on CXR in MAS?

A

Patchy atelectasis or consolidation

25
Q

What is the management and complication of MAS?

A

Intubate for suction

Can be complex and lead to pulmonary hypertension

26
Q

How is apnoea of prematurity treated?

A

IV caffeine

27
Q

What are the risk factors for intraventricular haemorrhage?

A

Premature or low birth weight

Associated trauma or asphyxia e.g. RDS

28
Q

What are the signs of intraventricular haemorrhage?

A 
Lethargy
Seizures
Apnoea
Bulging fontanelle
(signs may be minimal)
29
Q

Which investigation should be done to look for intraventricular haemorrhage?

A

Premature + very low birth weight infants:

–> cranial USS monitoring in week 1 and week 6

30
Q

What is necrotising enterocolitis (NEC)?

A

Bowel necrosis from unknown cause, typically in premature or low birth weight infants

31
Q

What are the clinical features of NEC?

A 
Abdominal distension or mass
Bloody mucous stool
Bilious vomit
Reduced bowel sounds
Shock
DIC
32
Q

What might be seen on x-ray of a baby with NEC?

A

Pneumatosis intestinalis (gas in bowel wall)
Gas filled bowel loops
“Football sign”
Or pneumoperitoneum

33
Q

How is NEC managed?

A

Stop feeds
Insert NG tube for decompression
Give IV antibiotics

34
Q

What is retinopathy of prematurity (ROP)?

A

Abnormal vascular growth in retina due to arrest of normal vascular growth
–> can lead to retinal detachment and blindness

35
Q

What are the causes or ROP?

A 
Premature birth (<32 weeks)
Oxygen therapy
36
Q

How is ROP treated?

A

Laser therapy

37
Q

Which metabolic complications might be seen in prematurity?

A 
Early:
- Hypoglycaemia
- Hypocalcaemia
- Hyponatraemia
Late:
- osteopenia of prematurity
38
Q

How is neonatal hypoglycaemia defined?

A

Normal to have slightly low glucose due to drop off of maternal glucose
< 2.6 is pathological

39
Q

What are the causes of neonatal hypoglycaemia?

A 
Maternal diabetes
Premature or SGA
Infection --> increased glucose use
Hypothyroidism
Congenital hyperinsuliniam: maternal diabetes, pancreatic islet cell hyperplasia
40
Q

Why does maternal diabetes cause neonatal hypoglycaemia?

A

Raised glucose during pregnancy –> compensatory fetal raised insulin
Raised insulin remains postpartum while maternal glucose stops

41
Q

What are the clinical features of neonatal hypoglycaemia?

A 
Lethargy and altered consciousness
Seizures
Vomiting
Respiratory distress
Cyanosis
42
Q

How is neonatal hypoglycaemia managed?

A

Prevent through adequate feeding soon after birth and then 3 hourly
If asymptomatic: ensure adequate feeding, consider NG tube if problems
If symptomatic or severe (<1): IV glucose (bolus then infusion)

43
Q

When is jaundice considered pathological?

A

< 24 hours

> 2 weeks

44
Q

At what level is jaundice visible?

A

> 85 bilirubin

45
Q

What are the causes of early (<24 hours) neonatal jaundice?

A

Haemolytic disease

Congenital infection

46
Q

What causes of haemolytic disease might be the cause of neonatal jaundice?

A

Rh incompatibility
ABO incompatibility
G6PD deficiency
Spherocytosis

47
Q

Which congenital infections might cause neonatal jaundice?

A 
Group B strep
TORCH:
TOxoplasmosis
Rubella
CMV
HSV
48
Q

What are the possible causes of high or prolonged (>2 weeks) jaundice?

A

Breast feeding (failure) jaundice
Breast milk jaundice
Sepsis (most commonly from UTI)
Cephalohaematoma (haemolysis of blood pool)
Biliary atresia
Specific diseases e.g. hypothyroidism, CF, galactosaemia

49
Q

What is breast feeding failure jaundice and when does it present?

A

Poor feeding –> reduced gut motility, allowing more conjugated bilirubin to revert to unconjugated and re-enter the blood as part of the enterohepatic circulation
Presents in the first few days

50
Q

What is breast milk jaundice and when does it present?

A

An enzyme in breast milk unconjugates the bilirubin, thus increasing enterohepatic circulation
Presents as prolonged jaundice

51
Q

How does biliary atresia present and what are the complications?

A

Elevated CONJUGATED bilirubin
Presents with pale stool and dark urine
–> liver failure and death if not treated surgically (phototherapy no use)

52
Q

What are the signs of neonatal jaundice?

A

Starts at head and spread down

- Spread below the umbilicus suggests non-physiological jaundice

53
Q

Which investigations should be done for neonatal jaundice?

A 
Serum bilirubin + conjugated fraction
FBC
Blood film (haemolysis)
Reticulocyte count (haemolysis)
Blood group
Direct antiglobulin (Coombs') test --> +ve in Rh or ABO haemolytic anaemia

LFTs (increased in infection)
Urine culture
TFTs

54
Q

When should phototherapy be given?

A

Onset < 24 hours or lasts > 2 weeks

OR bilirubin above treatment line

55
Q

What is the goal of phototherapy?

A

To prevent kernicterus

56
Q

How long should phototherapy continue?

A

Until bilirubin >50 below the treatment line (because of rebound after stopping treatment)

57
Q

What is kernicterus?

A

Unconjugated bilirubin > 360 which deposits in the brain
- sleepiness
- reduced feeding
- irritability
- seizure
- coma
Long term complications: cerebral palsy + deafness

Child Health (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions