W1 - Complications of Prematurity Flashcards
what is the definition of premature
– Less than 37 weeks completed gestation
what is extremely premature
<28 weeks
what is very preterm
28-32 weeks
what is the neonatal period
1st 28 days of life
what are the weight categories
- Low birth weight <2.5 kg
- Very low birth weight <1.5kg
- Extremely low birth weight <1.0kg
what are some of the risk factors of having a premature birth
- Previous premature birth
- Pregnancy with twins, triplets or other multiples
- IVF
- Problems with the uterus, cervix or placenta
- Smoking cigarettes, drinking alcohol or using illicit drugs
- Poor nutrition
- Some infections - group B step
- Some chronic conditions, such as high blood pressure and diabetes
- Being underweight or overweight before pregnancy
- Multiple miscarriages or abortions
- No or late antenatal care
- Those who are under 17 and over 35
what does a premature <28 week baby need
- respiratory support - ventilation
- Eyelids fused <24 weeks
- Thin, red skin
- Difficult fluid management
- need TPN
- Central access
- Long admission
what is a <28 week premature baby at risk of
- Difficult fluid management
- High risk of hypotension, infection
- Risk of IVH - intraventricular haemorrhage
what is the survival rate of a <28 weeks baby
~80%
what will a premature baby of 28-32 weeks need
- respiratory support – non-invasive
- feed via OG/NG tube
- developmental care
what is the survival rate of a 28-32 week old baby
~96%
what needs does a 33-36 week baby have
- Most able to feed if no respiratory distress
- May require O2
- Better able to control temperature
why do babies develop hypothermia
- Surface area : Volume ratio
- Fat stores
- Energy demand
- Losses: conduction, convection, radiation &
evaporation
Why are babies, especially premature or sick
babies at increased risk of low blood glucose?
- High demands
- Poor intake
- Poor reserves
- Lack of alternative fuels
what is the aetiology of respiratory distress syndrome
- Alveolar collapse
- Reduced compliance
- Increased dead space
- Inflammation
what cells make surfactant
T2 alveolar cells
what makes up surfactant
- 90% lipids, primarily phospholipids
- 10% proteins
when is surfactant produced
- Production at 30 – 32 weeks
- Decrease in both quantity and quality of surfactant in preterms
what is the characteristic clinical course of respiratory distress syndrome
- Immediate onset from birth
- ↑ distress
- Low oxygen
- High carbon dioxide
- Fatigue → apnoea, respiratory failure, death
what would you expect to see in a chest x-ray of a baby with RDS
- Ground glass
- Air bronchograms
- Under-aerated
what does RDS look like in severe and moderate cases
low lung volume
diffuse reticulogranular ground glass appearance
air bronchograms
what is the treatment for RDS
exogenous surfactant (i.e.
replacement therapy)
what is pulmonary interstitial emphysema
A complication of mechanical ventilation - too much pressure
* Alveoli hyperinflate →
rupture
* Air escapes into the
lung interstitium
what are some other respiratory diseases and how are they treated
Bronchopulmonary dysplasia / chronic lung disease
BPD / CLD
* Steroids
* Home oxygen
* Palivizumab – RSV monoclonal antibody
what medication do you give for neuroprotection
magnesium sulphate
- reduces risk of cerebral palsy
how does an intracentricular haemorrhage develop
- developmentally distinct tissue
– prominent 24-34 weeks – regressed by term
– neuroblasts + glioblasts – migrate out
– abundant around head of caudate nucleus
– highly vascular and metabolically active
– poor autoregulation
– changes in cerebral blood flow
– bleeding
how would you describe an IVH
grading - I, II, III, IV
where bleeding is -
- confined to matrix
- blood in ventricle
- parenchymal involvement
what is Periventricular Leukomalacia
Underperfusion of watershed regions surrounding ventricles
what is the prognosis of Periventricular Leukomalacia
- May resolve
- May progress to cystic degeneration
what does look like on USS
- Areas of echodensity in white matter
- Close to internal capsule, descending fibres
corticospinal tract: spastic diplegia
what are the 3 kinds of neonatal care
special care unit
local neonatal care
neonatal intensive care
Complications of prematurity
- RDS
- retinopathy of prematurity
- haemolytic anaemia
- meconium aspiration syndrome
- patent duct arteriosus
- apnoea of prematurity
- pulmonary interstitial emphysema
- intraventricular haemorrhage
- bronchopulmonary dysplasia
- necrotising enterocolitis
- sepsis
- periventricular leukomalacia
