The small infant

Question 1

Define the terms: Prematurity, small for gestational age, and fetal growth restriction

Answer 1

Prematurity: A baby born before 37 weeks gestation (mod to late preterm 32-36+6, very preterm 28-31+6. extremely preterm <28 weeks)
SGA: The infant’s weight is below the 10th centile for its gestation, but this is not pathological
FGR: Infant’s weight below 10th centile or has not reached its growth potential with dopplers indicating placental dysfunction

Question 2

What are the 5 H’s referring to in terms of complications of prematurity

Answer 2

Hypoxia - low O2 - consider warm sweet pink

Hypothermia - low temp, trying to avoid cold stress- consider warm sweet pink

Hypoglycaemia - want to avoid low BGL nto maintain metabolism - consider warm sweet pink

Hypercarbia - high CO2 due to hypoxia, hypotension etc. contributes to resp distress and 5 cardinal signs, as well as pulmonary hypertension

Hypotension - causes pulmonary vascular resistance to be higher than systemic which prevents change to extrauterine life

Question 3

Differentiate between symmetrical and asymmetrical FGR

Answer 3

Symmetrical: Both HC and AC and FL are proportionally small
- insult occured within firsty 20 weeks of pregnancy
- typically due to chromosomal abnormalitites, TORCH infections, substance use etc.
- more severe and poorer prognosis but less common

Asymmetrical: HC is normal relatively, Fl and AC are small
- occurs after 20 weeks
- head sparing
- more common but less severe - head sparing is protective
- often caused by placental insufficiency due to smoking, HTN, diabetes, poor or shallow placental implantation

Question 4

Explain the risk factors for prematurity and SGA infants, including associated feeding challenges

Answer 4

Risks of being premature/SGA
- mat previous prem
- substance
- placental abruption
- multiple pregnancy

Risks when prom infant is born
- feeding challenges
- BGL
- hypoxia/resp distress
- hypothermia
- poor weight gain

What causes feeding challenges
- immature neurological - such swallow
- limited reserves - hypoglycaemia
- any conditin which limits BF, requires them be in incubator, makes them lethargic, or makes them nil by mouth

• higher morbidity and mortality -

Question 5

Explain the potential impact of prematurity and SGA on short and long term infant health outcomes

Answer 5

Short term:
- increased medical procedures
- conditions
- feeding difficulties

Long term:
- decreased successful rates of BF
- growth and developmental delays
- long term respiratory issues- BPD
- delayed developmental milestones

Question 6

Describe the midwives role in caring for the premature or SGA infant as part of the MDT, using family centred approach

Answer 6

-

Question 7

Summarise the causes of prematurity and SGA

Question 8

List some potential problems of prematurity

Question 9

Discuss the role of the midwife in caring for a premature infant

Question 10

Discuss the importance of nutrition including introduction of enteral feeding, safety and management of NGT feeding and observing the developmment of complications and feed intolerance

Question 11

Discuss cue based feeding principles

Question 12

Review breastfeeding physiology

Answer 12

oxytocin –> milk production
letdown
Prolactin and oxytocin

Question 13

Discuss developmental care principles in promoting optimal neurodevelopmental outcomes

Question 14

Enteral vs parenteral nutrition

Question 15

When should neonates be transitioned to oral feeds?