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Perinatal Medicine > The Small Baby > Flashcards

The Small Baby Flashcards

1
Q

How do you determine gestational age before and after delivery?

A

Before- LMP, early USS, SFH/ late USS (much less accurate)After- scoring systems using neuromuscular and physical signs, such as Ballard, Dubrowitz or Finnstrom

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2
Q

What classifies a preterm infant?

A
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3
Q

What is normal birth weight?

A

2500-4000g

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4
Q

What classifies LBW, VLBW and ELBW?

A

LBW 1500-2499g
VLBW 1000-1499g
ELBW

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5
Q

Using weight for GA, what three results can you find?

A

Preterm
Low birth weight
Appropriate for gestational age

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6
Q

What is symmetrical growth restriction?

A

The fetus has developed slowly throughout the duration of the pregnancy and was affected from a very early stage
The HC is in proportion to the rest of the body

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7
Q

What is asymmetrical growth restriction?

A

Fetus has grown normally for the first two trimesters but encounters difficulties in the third
A lack of subcutaneous fat leads to a thin and small body which is out of proportion with the head

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8
Q

SGA babies can be divided into which 2 groups?

A

Constitutionally small babies

Growth-restricted babies

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9
Q

What are maternal causes of preterm delivery?

A 
Age- 35
Malnutrition
Poor SES
GPH
Infections
UTI
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10
Q

What are placental causes of preterm delivery?

A

Placenta praevia

Abruptio placenta

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11
Q

What are fetal causes of preterm delivery?

A

Multiple pregnancy
Congenital abnormalities
Congenital infections

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12
Q

List the problems associated with preterm infants

A

Apnoea. Low Apgar scores. Hypothermia. Respiratory distress. PDA. Anaemia. Poor feeding. Hypoglycaemia. Infections. Intraventricular bleeds. Neonatal jaundice. Necrotising enterocolitis. ROP.

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13
Q

What is the evidence for delayed cord clamping?

A

Cord pulsation usually continues for several minutes
Neonatal blood volume increases by up to 35%
In preterm infants, with DCC, they require less blood t/f, less inotropes and have less IVH
In term infants, it improves their iron status

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14
Q

What is the current recommendation regarding cord clamping?

A

Delay clamping for at least 1 min for newborn infants not requiring resus

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15
Q

What is the standard for supplementary oxygen in term infants?

A

Commence with air

If no improvement in heart rate or oxygenation, increase inspired oxygen

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16
Q

What is the standard for supplementary oxygen in preterm infants?

A 
Titration oxygen (commence with 30-90%, dependent on response)
If blended oxygen not available, start with air and only move to 100% oxygen if inadequate response
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17
Q

What are normal oxygen saturations in a newborn at 1,2,3,4,5 and 10 minutes?

A

1: 60-65%
2: 65-70%
3: 70-75%
4: 75-80%
5: 80-85%
10: 85-95%

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18
Q

What is the normal body temperature for a neonate (axillary temp)?

A

36.5 - 37

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19
Q

What 4 ways is heat lost?

A

Convection
Conduction
Radiation
Evaporation

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20
Q

Why is hypothermia a particular problem in preterm infants?

A

Thin skin. Fast breathing. Large surface area. Less subcutaneous and brown fat. Unable to shiver. Often not feeding well.

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21
Q

List the signs and symptoms of hypothermia

A

Cold to touch. Peripherally cyanosed. Poor perfusion with delayed capillary refill. Tachypnoea. Hypoglycaemia. Metabolic acidosis. Can be clinically assymptomatic!

22
Q

How do you treat hypothermia?

A

Anticipate heat loss and ensure preventative measures immediately after delivery
Dry baby. Head cap. KMC. Incubator +/- heat shield. Treat infections. Manage hypoglycaemia. Administer oxygen. Give energy by feeds or IV fluids.

23
Q

What occurs with each 1*C decrease in NICU admission temp?

A

Decrease chance of survival by 10%
Increase risk of late-onset sepsis by 11%
Increase odds of death by 28%

24
Q

What are the consequences of hypothermia?

A

Depletion of surfactant. Hypoxia. Hypoglycaemia. Metabolic disorders. Increased caloric usage. Acidosis. Increased neonatal morbidity.

25
Q

When and how can a LBW feed?

A

LBW can feed enter ally shortly after birth

26
Q

How must a VLBW or EBLW be fed?

A

May require IV fluids for nutrition

Initiate trophic feeds on day 1. Slow progression of enteral feeds until all intake is oral (+/- 5-7 days)

27
Q

What is normal blood glucose in the neonate?

A

2.5 - 7.0 mmol/l

28
Q

Why is hypoglycaemia a common problem in preterms?

A

Reduced stores- glycogen, fat, protein not built up prior to delivery; feeding usually delayed if ill/distressed; feeding problems common. Increased needs- resp distress increases energy needs; hypothermia competes for energy sources

29
Q

What are the signs and symptoms of hypoglycaemia in a preterm?

A

Can be assymptomatic

Irritable. Jittery. Seizures. Lethargic.

30
Q

What is the long-term, severe complication of hypoglycaemia?

A

Brain damage

31
Q

How is hypoglycaemia treated?

A

Provide energy by feeds or IV fluids

Treat sepsis, resp distress, hypothermia etc

32
Q

How do you prevent infection in the preterm infant?

A

Scrupulous hand washing. Alcohol rubs. Limit procedures and indwelling catheters. Give probiotics.

33
Q

What are common causative organisms in preterm infection?

A

Nocosomial infections!:Gram - organisms
Group B strep
Fungal infections

34
Q

With what signs should you suspect a PDA?

A

Murmur. Collapsing or bounding pulse. Tachycardia. Respiratory distress. Cardiac failure.

35
Q

How do you treat a PDA?

A

Restrict fluid (total 120ml/kg/day). Oxygenate. Treat anaemia. Antifailure treatment when indicated (diuretics). Indomethicin/Brufen but controversial. Surgical ligation.

36
Q

Do all patients with PDA need treatment?

A

No

37
Q

What is apnea?

A

Cessation of breathing long enough to cause bradycardia, cyanosis and/or pallor (lasts about 20 seconds)

38
Q

What are the three groups of causes of apnea?

A

Obstructive
Central
Mixed

39
Q

What causes obstructive apnoea?

A

Loss of airway patency, caused by mucus secretions, choanal stenosis or choanal atresia

40
Q

What causes central apnoea?

A

Immaturity. Maternal sedation. Peri-/intra-ventricular bleeds. Hypoxia. Hypoglycaemia. Hypo- and hyper-thermia. Anaemia. Convulsions.

41
Q

A mixed cause of apnoea refers to what?

A

Infection

42
Q

What is the difference between apnoea and periodic breathing?

A

Apnoea is cessation of breathing long enough (+/-20secs) to cause bradycardia, cyanosis and/or pallor.
Periodic breathing is a normal pattern of irregular breathing seen in most preterm infants that does not have a negative effect on the infant.

43
Q

Why are preterm infants at risk for IVH?

A

Immature cerebral vasculature
Hypoxia
Fluctuations in cerebral perfusion

44
Q

What are the grades of IVH?

A

Grade 1- bleeding only in the germinal matrix
Grade 2- bleeding in germinal matrix + ventricles
Grade 3- ventricles enlarged by blood
Grade 4- bleeding into brain tissue around the ventricles

45
Q

What is the normal HC in a term neonate?

A

33-37cm (35 average)

46
Q

What is the normal Hb at birth?

A

15-22g/dL

47
Q

How does the Hb change by 6-8/52?

A

+ / - 7 g/dL

48
Q

What is the normal blood volume in an infant?

A

80ml/kg

49
Q

What causes anaemia in neonates?

A

Anaemia of prematurity (preterm kidneys don’t produce enough EPO). Blood sampling. Infections. Haemolysis. Iron deficiency (in older preterms around 3/12). Bleeding (from cord post delivery or to mother antenatally).

50
Q

How is anaemia managed?

A

Very restrictive blood transfusion policies therefore rarely used
Recombinant EPO only in exceptional cases, never in preterms (can lead to ROP)
Iron supplementation of preterms for 6/12
Blood drawing procedures limited

51
Q

What developmental problems can be seen in LBW at follow up?

A

Developmental delay
Learning difficulties
Blindness
Auditory problems

Perinatal Medicine (14 decks)

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