Week 3- Neurological Complications of Prematurity

Question 1

PART 1

Answer 1

PART 1

Question 2

What is Periventricular Leukomalacia (PVL)?

Answer 2

Symmetric, non-hemorrhagic, ischemic lesion to the brain of a premature infant.

Question 3

Dysfunction due to PVL is dependent on what?

Answer 3

location of lesion

Question 4

With PVL, the incidence of white matter damage increases with decreases in __________ age.

Answer 4

-gestational age

Question 5

PVL:

• Decreased CBF →
• Ischemia, decreased antioxidant defenses →
• Generation of free oxygen radicals and glutamate toxicity

Answer 5

1

Question 6

What are (4) ways PVL is diagnosed?

Answer 6

• Serial ultrasonography
• CT
• MRI
• PET

Question 7

PVL Medical Management:

• Prevention of intrauterine asphyxia
• Maintenance of adequate ventilation and perfusion
• Avoidance of systemic __________
• Control of ___________

Answer 7

• hypotension

- seizures

Question 8

What are Germinal Matrix Intraventricular and Paraventricular Hemorrhage?

Answer 8

The most common type of intracranial hemorrhage in neonates related to perinatal stress affecting the highly vascularized subependymal germinal matrix.

Question 9

Germinal Matrix Intraventricular and Paraventricular Hemorrhage:

• ______ common type of intracranial hemorrhage.
• Characteristic of infant less than ___ weeks ang weight less than _____g.
• Risk - ____ and _________

Answer 9

• most common
• less than 32 weeks and weighing less than 1500g
• RDS and ventilation

Question 10

Describe the grading scale of Germinal Matrix Intraventricular and Paraventricular Hemorrhage.

Answer 10

• Grade I- isolated germinal matrix hemorrhage
• Grade II – hemorrhage ruptures into the lateral ventricles but they are normal sized
• Grade III – Hemorhagge into ventricles with dilation
• Grade IV – hemorrhage into the periventricular white matter

Question 11

What is Hypoxic-Ischemic Encephalopathy HIE)?

Answer 11

Type of brain dysfunction that occurs when the brain doesn’t receive enough oxygen or blood flow for a period of time.

Question 12

With HIE, a period of ________ is when many of the complications that affect the metabolism, function, and structure of the brain occur.

Answer 12

-reperfusion

Question 13

What are some signs of HIE? (7)

Answer 13

• seizures
• abnormalities in state of consciousness
• tone
• posture
• reflexes (suck, swallow, gag, and tongue movements)
• respiratory pattern
• autonomic function

Question 14

• What are (3) HIE conditions associated with increased risk antenatally (before birth)?
• What are some HIE risks intrapartum (during birth)?

Answer 14

• Altered placenta exchange
• Reduced maternal blood flow to placenta
• Decreased maternal O2 sat

-traumatic delivery, prolonged labor, acute placental/cord problems

Question 15

• What is the most common pattern of injury observed with HIE?
• What are some others?

Answer 15

• Selective neuronal necrosis

- PVL, parasagittal cerebral injury, focal ischemic brain necrosis

Question 16

• What is Selective Neuronal Necrosis?

- What are some clinical findings consistent with Selective Neuronal Necrosis?

Answer 16

• Death of neurons in a widespread but characteristic pattern.
• Seizures, hypotonia, oral motor problems, ID, spastic quad, ataxia, bulbar and pseudobulbar palsy, ADHD

Question 17

• What is Parasagittal Cerebral Injury?

- What are some clinical findings consistent with Parasagittal Cerebral Injury?

Answer 17

• Lesion of the cerebral cortex and subcortical white matter (usually bilateral/symmetric with parietal/occipital regions most affected).
• spastic quad, ID

Question 18

-What is Focal Ischemic Brain Necrosis and Cavitation?

Answer 18

-Large, localized areas of neuronal death in the distribution of single or multiple major vessels in the cerebral cortex and subcortical white matter.

Question 19

What is Placenta Previa?

Answer 19

Baby’s placenta partially or totally covers mother’s cervix which can cause severe bleeding before or during delivery.

Question 20

• What is Placenta Insufficiency?

- What are some common causes?

Answer 20

• Placenta cannot bring enough O2 and nutrients to the baby.

- Diabetes, high BP, clotting conditions, smoking

Question 21

• What is Oligohydramnios?

- What is Polyhydramnios?

Answer 21

• Deficiency of amniotic fluid which protects the baby and aids in development of muscles, limbs, lungs, and digestive system.
• Excessive accumulation of amniotic fluid.