The sick preterm infant Flashcards
Define:
- Preterm
- Term
- Post term
-birth occurring before 37 wks gestation
-birth between 37 wks and 42 wks gestation
-birth after 42 wks gestation
(can’t survive before 23 wks)
risk factors for prematurity? (4)
- More than 2 preterm deliveries
- abnormally shaped uterus
- maternal age
- smoking, drinking, illicit drugs
- poor nutrition, some chronic conditions e.g. high BP/diabetes
- multiple miscarriages/abortions
- multiple pregnancy
- interval less than 6 months between pregnancies
- IVF
Causes of preterm birth? (7)
- spontaneous preterm labour
- multiple pregnancy
- preterm pre labour rupture of membranes
- pregnancy assoc hypertension
- IUGR
- Antepartum haemorrhage
- cervical incompetence/uterine malformation
What predisposes prem babies to illness?
- get cold more quickly
- more fragile lungs
- don’t breath effectively
- have fewer reserves
- pulse oximetry often indicated
Explain assistance vs resuscitation?
few preterm babies will be asphyxiated need to keep them in good condition while helping to establish air breathing
Should cord clamping occur immediately?
-when?
If they baby is in good condition then can wait and allow placental transfusion to take place but need to keep the baby warm!
-when the physiological pulsing of the cord stops
How do we keep prem babies warm?
place them immediately (while still wet) into a plastic bag and under a radiant heater
Risk of over inflating prem lungs?
If you overinflated them you are likely to damage the tissue setting in motion an inflammatory cascade which will predispose to bronchopulmonary dysplasia
List the common concerns in a preterm infant
- temp control
- feeding/nutrition
- sepsis
- system immaturity/dysfunction (RDS, PDA, IVH, NEC)
- other: metabolic, ROP
why is thermoregulation ineffective in the newborn?
- name the 4 methods of heat loss
- name methods to prevent heat loss
- risk of incubator?
- Low BMR
- Minimal muscular activity
- subcut fat insulation negligible
- high ratio of SA to body mass
- conduction, radiation, convection, evaporation
- bags, skin to skin care, transwarmer mattress, prewarmed incubator
- increased risk of infection was warm wet environment for bacteria
growth and nutrition
- why is nutritional compromise more likely? (3)
- what is gestational correction?
- limited nutrient reserves, immature metabolic pathways and increased nutrient demands
- adjusts the plot of a measurement to account for the number weeks a baby was born early, continue this until: 1 yr for 32-36 wks, 2 yrs for <32 weeks
Neonatal sepsis
- onset?
- organisms causing neonatal sepsis
- Management
-can be: early onset mainly due to bacteria acquired before and during delivery Late onset acquired after delivery
-Group B strep
Gram negative organisms (Klebsialla, Escherichia coli, Pseuomonas and salmonella)
Gram positive organisms
(Staph aureus, Coagulase neg staph, strep pneumonia, strep pyogenes)
-Prevention/hand washing/vigilance/optimum supportive measures/ antibiotics
respiratory complications of prematurity:
-name the 3 main problems
-respiratory distress syndrome
Apnoea of prematurity
Bonchopulmonary dysplasia
Respiratory distress syndrome
- definition
- pathology
- clinical features
- management
- complication
-Hyaline membrane disease
-Primary pathology:
surfactant deficiency, structural immature
secondary pathology, Alveolar damage, formation of exudate from leaky capillaries, inflammation, repair
-tachypnoea, grunting, intercostal recession, nasal flaring, cyanosis
these worsen over minutes to hours
ground glass appearance on X-ray
-maternal steroid, surfactant, ventilation, invasive/ non invasive ventilation
tend to use umbilical veins to put lines in
-tension pneumothorax
Cardiovascular concerns
-name the 2 major concerns
-patent ductus arteriosus, systemic hypotension
