Week 5- preterm infant

Question 1

When is a baby considered pre-term?

Answer 1

Birth before 37 weeks gestation.

Question 2

When is a baby considered to be extremely preterm?

Answer 2

22-28 weeks

Question 3

When is a baby considered to be very preterm?

Answer 3

22-32 weeks

Question 4

Why is the number of preterm babies being born increasing?

Answer 4

Increased maternal age
Increasing in rate of pregnancy-related complications
Greater use of infertility treatments
More caesarean deliveries before term

Question 5

What things cause preterm births?

Answer 5

Spontaneous preterm labour
Multiple pregnancies 
Preterm pre labour rupture of membranes
Pregnancy associated hypertension
Intrauterine growth restriction
Antepartum haemorrhage
Cervical incompetence/uterine malformation

Question 6

What risk factors are there for preterm birth?

Answer 6

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

Question 7

Whats the difference between preterm babies and term babies in terms of effectiveness of breathing?

Answer 7

They get colder faster
They have more fragile lungs
They don’t breathe effectively
They have fewer reserves

Question 8

What is the difference between assistance or resuscitation?

Answer 8

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.

Question 9

When should you clamp the cord?

Answer 9

Wait a minute for placental transfusion to finish. Only do it if the baby is warm and well.

Question 10

How do you keep preterm babies warm?

Answer 10

Best approach is to place them in a small plastic bag while still wet and then later under a radiant heater.

Question 11

Why do you have to be careful with lung inflation in preterm babies?

Answer 11

Their lungs are fragile and overinflation can lead to inflammation and long term morbidity.

Question 12

Why is thermal regulation in the newborn more ineffective than that of a term baby?

Answer 12

Low body mass ratio
Minimal muscular activity
Subcutaneous fat insulation is negligible
High surface area to body mass ratio.

Question 13

How do babies lose heat?

Answer 13

Convection
Conduction
Radiation
Evaporation

Question 14

Other than using a plastic bag, what other ways can you keep a preterm baby warm?

Answer 14

Skin to skin contact
Incubators
Transwarmer mattress.

Question 15

Why are preterm babies at greater risk of nutrient compromise?

Answer 15

They have less reserves
Immature metabolic pathways
Increased nutrient demands

Question 16

What is gestational correction?
How do you work out how many weeks premature a baby is?
How long should you use gestational correction for?

Answer 16

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.

Question 17

When is early neonatal sepsis acquired?

Answer 17

During pregnancy or delivery.

Question 18

When is late neonatal sepsis acquired?

Answer 18

After delivery.

Question 19

What organisms cause neonatal sepsis?

Answer 19

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

Question 20

How do you manage neonatal sepsis?

Answer 20

Prevention- hand washing, infection control, judicial use of antibiotics.

Question 21

NOTE

Answer 21

INCUBATORS INCREASE INFECTION.

Question 22

What respiratory complications can occur as a result of prematurity?

Answer 22

Respiratory distress syndrome
Apneoa of prematurity
Bronchopulmonary dysplagia

Question 23

What is respiratory distress syndrome?

Answer 23

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.

Question 24

How does RDS present?

Answer 24

Tachypnoea 
Grunting
Intercostal recessions
Nasal flaring
Cyanosis 

It worsens over minutes to hours.

Question 25

How do you manage RDS?

Answer 25

Maternal steroid- to mature the lungs before birth
Surfactant
Ventilation- could be invasive or non- invasive.

Question 26

What is invasive ventilation?

Answer 26

When the ventilation penetrates through the mouth, nose or skin.

Question 27

What is non-invasive ventilation?

Answer 27

Airway support administered through a face mask or endotracheal tube.

Question 28

What cardiovascular concerns are there for preterm infants?

Answer 28

Patent ductus arteriosus

Systemic hypotension

Question 29

What disease do the symptoms of patent ductus arteriosus mimic?

Answer 29

they mimic congestive heart failure e.g. SOB, swelling in legs, ankles and feet, rapid HR, fatigue and weakness.

Question 30

Where does intraventricular haemorrhage bleeding start in preterm infants?

Answer 30

Germinal matrix.

Question 31

What are the two major risk factors for intraventricular haemorrhage?

Answer 31

Prematurity

RDS

Question 32

What preventative measures can you give to stop intraventricular haemorrhage of the newborn?

Answer 32

Antenatal steroids
Prompt and appropriate resuscitation
Avoid haemodynamic instability.
Avoid- hypoxia, hypercarbia, hyperoxia, hypocarbia

Question 33

If a baby is classified as having a grade 1 and 2 inter ventricular haemorrhage, what does that mean?

Answer 33

Neurodevelopment delay up to 20%
Mortality 10%

Basically 20% likely to have a neurodevelopmetnal delay.

Question 34

If a baby is classified as having a grade 3 or 4 inter ventricular haemorrhage, what does that mean?

Answer 34

Neurodevelopment delay up to 80%
Mortality 50%

basically 80% likely to have a neurodevelopment delay.

Question 35

What is necrotising enterocolitis?

Answer 35

Tissue in the gut becomes inflamed and starts to die. This can lead to perforation.

Question 36

What clinical picture will necrotising enterocolitis present as?

Answer 36

Usually after recovering from RDS
Early signs are lethargy and gastric residuals
Bloody stool, temperature instability, apnoea and bradycardia.