WEEK 3: Born too small or too soon Flashcards
Define the following terms.
1. Neonate
2. Prematurity
Neonate = newborn; child less than 1 month old
Prematurity = born at gestational week (GA) < 37
What do the following mean:
* AGA
* SGA
* LGA
* Extreme immaturity
* LBW
* VLBW
* ELBW
- AGA = Appropriate for GA
- SGA = Small for GA; both birth weight (BW) and birth
length small for GA (less than 10th percentile) - LGA = Large for GA; BW large for GA (>90th Percentile)
- Extreme immaturity = born at GA < 28 weeks
- LBW = Low Birth Weight; BW 1500- 2499g
- VLBW = Very LBW; BW 1000 – 1499g
- ELBW = Extremely LBW; BW <1000g
The majority of all neonatal deaths occur during the first week of life,
and about 1 million neonates die within the first 24 hours.
State some causes of neonatal deaths.
- Prematurity, infections, perinatal asphyxia, malformations
Nearly how many % of babies worldwide are born with low birthweight?
How many million are born too soon every year?
Nearly 15 % of babies worldwide are born with low birthweight.
15 million are born too soon every year.
State Complications and injuries of prematurity in the following:
- Lung
- Brain
- Eye
- GIT
- Vascular
Lung: Respiratory distress syndrome - RDS
Bronchopulmonary dysplasia - BPD
Brain: Intraventricular hemorrhage - IVH
Periventricular leukomalacia - PVL
It involves damage to the white matter of the brain, particularly in the periventricular region, which surrounds the fluid-filled spaces (ventricles) in the brain.
PVL is often associated with complications of prematurity, such as hypoxic-ischemic injury, which occurs when there is reduced blood and oxygen supply to the brain. The exact cause of PVL is not fully understood, but it is believed to be related to a combination of factors, including immature blood vessels in the brain and inflammation.
The characteristic feature of PVL is the death or damage of the white matter, which consists of nerve fibers (axons) responsible for transmitting signals between different areas of the brain. This damage can lead to a variety of neurological problems, including motor and cognitive impairments.
Eye: Retinopathy of prematurity - ROP
It is characterized by abnormal blood vessel development in the retina, the light-sensitive tissue at the back of the eye. ROP is a leading cause of vision loss and blindness in premature infants.
Gastro: Necrotizing enterocolitis - NEC
NEC is characterized by inflammation and damage to the tissues of the intestines, particularly the colon (large intestine). In severe cases, this inflammation can lead to the death of the affected tissue, a condition known as necrosis.
The exact cause of NEC is not well understood, but it is believed to be multifactorial, involving a combination of factors such as prematurity, formula feeding, bacterial colonization of the intestine, and a compromised immune system. The premature infant’s immature digestive and immune systems may contribute to the development of NEC.
Vascular: Patent ductus arteriosus - PDA
A patent ductus arteriosus (PDA) is a congenital heart defect that occurs when the ductus arteriosus, a blood vessel that connects the pulmonary artery and the aorta in a fetus, fails to close after birth.
Tachypnea
Grunting
Retraction
Flaring of nostrils
Cyanosis
What is the diagnosis?
Respiratory distress syndrome.
Chronic lung disease that develops in preterm neonates treated with oxygen and positive-pressure ventilation.
Its development is associated with inflammation and injury to the developing lung tissue. The condition often arises in infants born very prematurely, typically before 28 weeks of gestation, and is more common in those who have experienced respiratory distress syndrome (RDS) or other complications that necessitate prolonged mechanical ventilation and oxygen supplementation.
What is the diagnosis?
Bronchopulmonary dysplasia
What is deterioration?
What may have caused the deterioration?
In the context of prematurity and neonatal health, “deterioration” refers to a decline in the overall health or well-being of a premature infant.
*Infection
* The tube plugged with secretions
* Not enough respiratory support
* Bleeding – where?
* Hypoxia in the intestinal vascular vessels – NEC?
* Cerebral intraventricular bleeding
Which examinations should we do?
- Clinical ex
- Hb
- Infectious parameters
- Weight and Head circumference
measurements - Percentiles
- Ultrasound caput
- X rays
*Asymptomatic sometimes
*Sudden deterioration of the in form of neurological signs like stupor, coma, seizures, postures or apneas
*Full fontanelle with sudden drop in hematocrit
*Can be accompanied by hyperglycemia, hyperkalemia, hypotension and bradycardia
*SIADH may be seen
*Gradual clinical deterioration with altered level f consciousness, hypotonia, abnormal extremity or eye movements.
Most likely differential diagnoses?
- Intraventricular hemorrhage
Intraventricular hemorrhage presentation.
90% occur in the first 3 days after birth.
Describe the following:
1. Catastrophic
2. Saltatory
3. Asymptomatic
- Catastrophic:
-Acute IVH with bulging fontanel, split sutures, -change in level of consciousness, pupillary and cranial nerve abnormalities,
-decerebrate posturing, and often with rapid decrease in Hb, blood pressure and/or hematocrit. - Saltatory:
-Gradual deterioration in neurological status, may be subtle abnormalities in level of consciousness, movement, tone, respiration and eye position/movement. - Asymptomatic: 25-50% of IVH.
-Discovered on Ultrasound.
-Fall in hematocrit or failure of hematocrit to rise with transfusion should cause concern.
Describe the IVH grading.
Grade I
Grade II
Grade III
Grade IV
IVH grading
Grade I: Bleeding confined to periventricular area
(germinal matrix)
Grade II: Intraventricular bleeding (10-50% of ventricular area on sagittal view)
Grade III: Intraventricular bleeding (>50% of ventricular area or distends ventricle)
Grade IV: Intra-parenchymal echo density represents periventricular hemorrhagic infarction.
PREVENTION of IVH is a primary goal of premature management.
How can IVH be prevented prenatal?
How can it be prevented postnatal?
Prenatal
- Prevention of prematurity
- Improved perinatal management
Postnatal
- Skilled resuscitation to avoid hypoxia,
hyperoxia and/or hypocarbia
- Hyperoxia refers to a condition where there is an excess of oxygen in the body, specifically in the blood.
*Hypocarbia, on the other hand, refers to a condition characterized by lower-than-normal levels of carbon dioxide in the blood.
- Circulatory support to avoid hypotension
and fluctuating arterial blood pressure - Correction of coagulation abnormalities and
Hb
Brain damage that involves the periventricular
white matter of the brain.
Results in the death of injured cells, leaving empty areas in the brain, cysts, which fill with fluid.
60-100% with are _________diagnosed with Cerebral Palsy that leads to intellectual impairment and spasticity that require therapy and treatment.
What is the diagnosis?
Periventricular leukomalacia
When does periventricular leukomalacia occur?
- Damage can occur at any time
- The unborn child is particularly vulnerable to PVL
somewhere between 26 and 34 weeks of
gestation - Premature birth is a high-risk factor for PVL; it is
most common in infants born prior to 32 weeks. - Severe IVH may also result in formation of cysts
