VLBW

Question 1

VLBW how many kg?

Answer 1

<1500g

Question 2

Primary causes of VLBW

Answer 2

IUGR

Prematurity

Question 3

Prematurity is at what range of weeks?

Answer 3

22-37

borderline 23-24w

Question 4

Risk factors VLBW

Answer 4

Afro-american
Age <16 and >35
Twins,…
Maternal health: socioeconomic status, health before pregnancy, health during pregnancy

Question 5

Consequences of VLBW for baby?

Answer 5

Hypothermia: large body surface:weight, skin barrier immature, metabolism 1/3 of needed

CV: PDA and hypotension

Hypoglycemia: low glycogen/fat stores

Perinatal asphyxia: suffered from hypoxia in utero (mother health, placental health) can cause or be consequence of!

Respiratory distress (surfactant deficiency), apnea

Electrolyte and fluid disorders: water loss, renal insufficiency, dehydration/overload, hypo/pernatremia,….

Hyperbilirubinemia: unconjugated- due to hepatic immaturity, delayed enteral feeding, infection, polycythemia,…

                               conjugated: complication of parenteral nutrition

Neuro: IV hemorrhage, periventricular leukomalacia, incr. risk cerebral palsy, learning difficulties

ROP
Hearing deficit: due to LBW itself or ototoxicity drugs given,…

Anemia
Impaired nutrition
Infection

Question 6

Management of VLBW

Answer 6

CV- give dopamine 5mcg/kg/min
Resp- 02 takes 10 mins to reach extrauterine levels- maintain this at 90-95%, CPAP, IT, surfactant
Fluids- 1st day low @ 60-80ml/kg/d +Ca
RBC- transfusion or EPO
Nutrition: usually needs early aggressive TPN <12h of life with aa +lipids and within 5 days of life initiate trophic feedings with breast milk or formula, then start enteric
Glycemia: >45mg/dL
AB: if risk factors like strep B no prophylaxis, chorioamnionitis, PROP,…
Hyperbili: phototherapy prophylaxis
Retinopathy: screen @4w of life
US: PVL and IV hemorrhage