Week 5- preterm infant Flashcards
When is a baby considered pre-term?
Birth before 37 weeks gestation.
When is a baby considered to be extremely preterm?
22-28 weeks
When is a baby considered to be very preterm?
22-32 weeks
Why is the number of preterm babies being born increasing?
Increased maternal age
Increasing in rate of pregnancy-related complications
Greater use of infertility treatments
More caesarean deliveries before term
What things cause preterm births?
Spontaneous preterm labour Multiple pregnancies Preterm pre labour rupture of membranes Pregnancy associated hypertension Intrauterine growth restriction Antepartum haemorrhage Cervical incompetence/uterine malformation
What risk factors are there for preterm birth?
Smoking, alcohol and illicit drugs
2 or more previous babies preterm increases risk by 70%
Abnormally shaped uterus
Multiple pregnancies
Interval of less than 6 months between pregnancies
Conceiving through IVF
Whats the difference between preterm babies and term babies in terms of effectiveness of breathing?
They get colder faster
They have more fragile lungs
They don’t breathe effectively
They have fewer reserves
What is the difference between assistance or resuscitation?
Assistance is helping them to transition to air breathing, however they are born in generally good condition. Whereas babies who need resus are in a worse condition.
When should you clamp the cord?
Wait a minute for placental transfusion to finish. Only do it if the baby is warm and well.
How do you keep preterm babies warm?
Best approach is to place them in a small plastic bag while still wet and then later under a radiant heater.
Why do you have to be careful with lung inflation in preterm babies?
Their lungs are fragile and overinflation can lead to inflammation and long term morbidity.
Why is thermal regulation in the newborn more ineffective than that of a term baby?
Low body mass ratio
Minimal muscular activity
Subcutaneous fat insulation is negligible
High surface area to body mass ratio.
How do babies lose heat?
Convection
Conduction
Radiation
Evaporation
Other than using a plastic bag, what other ways can you keep a preterm baby warm?
Skin to skin contact
Incubators
Transwarmer mattress.
Why are preterm babies at greater risk of nutrient compromise?
They have less reserves
Immature metabolic pathways
Increased nutrient demands
What is gestational correction?
How do you work out how many weeks premature a baby is?
How long should you use gestational correction for?
It adjusts the growth chart plot for the number of weeks the baby was born premature.
40- the baby’s gestational age in weeks.
If the baby is born 32-36 weeks, for a year. If before 32 weeks, 2 years.
When is early neonatal sepsis acquired?
During pregnancy or delivery.
When is late neonatal sepsis acquired?
After delivery.
What organisms cause neonatal sepsis?
Group B strep
Gram positive e.g. staph aureus, coagulase neg staph, strep pneumoniae, step pyogenes.
Gram negative e.g. Klebsiella, E coli, pseudomonas and salmonella
How do you manage neonatal sepsis?
Prevention- hand washing, infection control, judicial use of antibiotics.
NOTE
INCUBATORS INCREASE INFECTION.
What respiratory complications can occur as a result of prematurity?
Respiratory distress syndrome
Apneoa of prematurity
Bronchopulmonary dysplagia
What is respiratory distress syndrome?
Primary issue- There isn’t enough surfactant meaning the lungs can’t inflate properly.
Secondary issues because of this- alveolar damage, formation of exudate from leaky capillaries, inflammation and repair.
How does RDS present?
Tachypnoea Grunting Intercostal recessions Nasal flaring Cyanosis
It worsens over minutes to hours.
How do you manage RDS?
Maternal steroid- to mature the lungs before birth
Surfactant
Ventilation- could be invasive or non- invasive.
What is invasive ventilation?
When the ventilation penetrates through the mouth, nose or skin.
What is non-invasive ventilation?
Airway support administered through a face mask or endotracheal tube.
What cardiovascular concerns are there for preterm infants?
Patent ductus arteriosus
Systemic hypotension
What disease do the symptoms of patent ductus arteriosus mimic?
they mimic congestive heart failure e.g. SOB, swelling in legs, ankles and feet, rapid HR, fatigue and weakness.
Where does intraventricular haemorrhage bleeding start in preterm infants?
Germinal matrix.
What are the two major risk factors for intraventricular haemorrhage?
Prematurity
RDS
What preventative measures can you give to stop intraventricular haemorrhage of the newborn?
Antenatal steroids
Prompt and appropriate resuscitation
Avoid haemodynamic instability.
Avoid- hypoxia, hypercarbia, hyperoxia, hypocarbia
If a baby is classified as having a grade 1 and 2 inter ventricular haemorrhage, what does that mean?
Neurodevelopment delay up to 20%
Mortality 10%
Basically 20% likely to have a neurodevelopmetnal delay.
If a baby is classified as having a grade 3 or 4 inter ventricular haemorrhage, what does that mean?
Neurodevelopment delay up to 80%
Mortality 50%
basically 80% likely to have a neurodevelopment delay.
What is necrotising enterocolitis?
Tissue in the gut becomes inflamed and starts to die. This can lead to perforation.
What clinical picture will necrotising enterocolitis present as?
Usually after recovering from RDS
Early signs are lethargy and gastric residuals
Bloody stool, temperature instability, apnoea and bradycardia.
