Birth defects due to nicotine use during pregnancy
Premature birth, cleft lip, bleeding of placenta, risk factor for SUIDS
SUIDS
Sudden death in infant less than 1 year occurs during sleep.
Types: SIDS, and accidental suffocation.
Sleep on back, firm surface, near parents. No smoking.
Two studies involving vaping
EVALI, PARDS
Marijuana use while pregnant
Low birth weight, developmental and cognitive delays. Anxiety, asocial behavior.
Neonatal opioid withdrawal syndrome and long term symptoms
Hyperactivity of CNS
At birth, drug supply is immediately cut off. Cry is higher, irritable, tremors, swearing
Treat with morphine taper.
Long term: Lower IQ, poor social skills.
Methamphetamine use during pregnancy
Increased risk of miscarriage or premature
Feeding difficulties
ADHD symptoms.
Anxiety, depression.
Alcohol use during pregnancy symptoms
Growth def
Neuro developmental delays
Facial dysmophism.
Prematurity is less than how many weeks
Very preterm
Extremely preterm
premature: 37 weeks.
Very: Less than or equal to 32
Extreme: Less than or equal to 28
Low birth weight
Very LBW
Extremely LBW
Low: Less than 2,500g (5.5)
Very low: Less than 1,500g (3.4)
Extremely low: Less than 1,000g (2.2)
Premature risk factors
Maternal age less than 16 Multiples Medical conditions Infections during pregnancy Cigarette smoking ETOH 1x per day Drug use Poor nutrition Stress
Systemic complications of preterm birth
- Respiratory
- GI
- Infection risks
- Hearing
- Cardiovascular
- Neuro
- Ophthalmic
- Respiratory: Respiratory distress syndrome. 80% born before 27 weeks. Up to 5% mortality. Tx with respiratory support.
- GI
- Infection risks bc immature immune system
- Hearing impairment. 1-5% at less than 26 weeks.
- Cardiovascular. Patent Ductus Arteriosus. 5% less than 1,500g. May cause HF.
- Neuro.
- Interventricular hemorrhage. Up to 11% less than 1,500g.
- Periventricular leukomalacia. (PVL) Lesions may lead to neuro delay or vision impairment. - Ophthalmic. Myopia or retinopathy or prematurity.
Myopia of prematurity
Negative correlation with birth weight/gestational age.
Non axial- steeper cornea, shallow AC, increased lens thickness.
Retina is avascular until __ month
4th
Development of central retinal artery (along with photoreceptors)
Time it takes artery to reach equator and nasal periphery.
equator: 5 months.
Nasal periphery: 8 months.
ROP (retinopathy of prematurity) risk factors
Birth weight, gestational age, oxygen. Retinal blood vessels regulate based on oxygen- changing amount can cause blood vessels to freak out.
ROP screening criteria
If gestational age is less than/equal to 30 weeks.
Birth weight less than/equal to 1,500g.
Infants at risk determined by neonatology.
ROP screening schedule. When to do it?
31 weeks of 4 weeks post-natal age if delivered at 28 or 29 weeks.
ROP zones
Zone 1: Posterior pole. Radius 2x the ON to fovea.
Zone 2: Temporal equator to nasal ora.
Zone 3: Residual temporal and medial part of the retina.
ROP stages
- Demarcation line.
- Demarcation ridge
- Neovascularlization along the ridge.
4a: Partial retinal detachment without fovea.
4b: Partial retinal detachment with fovea. - Total RD. Will see funnel shape.
Plus disease
Dilation and tortuosity of vasculature in the posterior pole. High vascular activity and shunting due to highly active vessels. Need tx because it could progress to RD.
Treatments for ROP
Cryotherapy, laser tx (standard of care), and anti VEGF.
CRYO-ROP 88 study.
- What zones did they treat?
- Results
Treated zones 1 or II or zone 3 with plus.
50% decrease in RD but poor VA and structural outcomes.
ET-ROP 99 Study (laser)
Treatment groups
Results
Zone 1 any stage with plus.
Zone 1, stage 3 with or without plus.
Zone 3, stage 2 or 3 with plus.
Increase in myopia in zone treated.
BEAT-ROP 11 study (VEGF)
Bevacizumab (avastin)
Treated Zone 1 and 2 stage 3 with plus.
Tx did not destroy retina and did not result in high myopia.
May have long term safety problems associated with developmental delays.
PEDIG is looking for lowest conc to treat.
