Preterm

Question 1

What is considered preterm?

Answer 1

Babies born before 37 weeks gestation

Question 2

What is considered late preterm?

Answer 2

32 - 37 weeks

Question 3

What is considered very preterm?

Answer 3

28 - 32 weeks

Question 4

What is considered extremely preterm?

Answer 4

Less than 28 weeks

Question 5

Risk factors of preterm babies?

Answer 5

• History of preterm babies
• Infection
• Smoking/drug use
• IUGR
• 2nd trimester miscarriages
• Anaemia
• Abnormal uterine anatomy
• Placenta abruption
• Multiple gestation
• Placenta praevia
• Premature rupture of membranes
• Young mothers

Question 6

Characteristics of preterm baby?

Answer 6

• Lack of tone
• Large head in proportion to the baby
• Soft skull bones
• Ribs visible
• Thin limbs
• Nails not fully formed
• Normal reflexes
• Small genitalia
• Lanugo
• Small narrow chest
• No breast tissue

Question 7

What concerns would you anticipate with a preterm baby?

Answer 7

• Cold stress cycle (Hypoglycaemia, Hypoxia, Hypothermia)
• Underdeveloped lungs, reduced surfactant = anticipate resus
• Respiratory distress = grunting, nasal flaring, chest recession, increased RR and HR
• Feeding/suckling reflex may be absent
• Increased risk of jaundice
• Immature immune system = more susceptible to infection
• Developmental problems

Question 8

When is a foetus viable?

Answer 8

24 weeks gestation

Question 9

When does the alveoli duct develop?

Answer 9

By 24 weeks gestation

Question 10

When are lungs fully developed?

Answer 10

36 weeks gestation

Question 11

What is the concerns with less surfactant?

Answer 11

Surfactant phospholipids reduce alveoli surface tension allowing the mechanical stretch of the lungs for breathing. When surfactant is reduced, there are fewer phospholipids to reduce the surface tension meaning more surface tension in the lungs making inflation difficult. Also that they may develop respiratory aspiration syndrome as result.

Question 12

What are some major common complications for preterm babies?

Answer 12

• Respiratory distress syndrome
• Persistent ductus arteriosus
• Infections
• Cold stress cycle
• Jaundice
• Poor temperature control = less brown fat, greater SA to body weight ratio
• Anemia
• Bradycardia
• Apnoea

Question 13

What would be the management of a preterm baby in labour and birth?

Answer 13

• Consider prophylactic corticosteroids (use from 22+5 until 34+6)
• Continuous monitoring with CTG
• Call and inform paediatrics to attend birth
• Consult with obstetrics

Question 14

What gestation is resus of a newborn possible?

Answer 14

• From 23 weeks

Question 15

What would the ongoing care of a preterm newborn born between 35 and 37 weeks be if they are above 2000g?

Answer 15

• Care in maternity ward
• Weight plotted on customised grow chart
• O2 saturation monitoring
• O2 therapy
• Ensuring effective, frequent feeding to prevent cold stress cycle (hypothermia, hypoxia, hypoglycaemia)
• Top ups if required
• Keep warm
• Early skin to skin
• Pre-feed temperature check
• Full obs (RR, T, HR, WOB, colour, behaviour, feeding, O2, blood glucose)

Question 16

What obs and timeframes would be completed as per the news chart?

Answer 16

RR, T, HR, WOB, colour, behaviour, feeding = At 1 hour, 4 hours, 12 hours, and 24 hours
O2 sats = once between 12 and 24 hours
Blood glucose = 3 consecutive pre feed blood glucose levels 2.6mmol/L or above done every 3 hours

Question 17

Why are preterm babies more at risk of developing jaundice?

Answer 17

• Due to higher levels of fetal haemoglobin that break down after birth and overwhelm and immature liver
• A delayed in feeding due to lack of energy or suckling reflex = slow bowel peristalsis = slow excretion of bilirubin as output reduced = conjugated bilirubin becomes unconjugated and is reabsorbed

Question 18

What is necrotising enterocolitis?

Answer 18

Inflammatory disease of the bowel normally associated with septicaemia that can cause the intestinal tissue to die. Can cause a hole (perforation) in babies intestine where bacteria can leak into the abdomen or bloodstream. Requires surgery.

Question 19

Signs in newborn of necrotising enterocolitis?

Answer 19

• Distended abdomen
• Blood per rectum
• Bile stained aspirate

Question 20

What is retinopathy of prematurity?

Answer 20

Disease of the developing retinal blood vessels (in the eye) causing risk of O2 excess or fluctuating levels of what is required. This can cause hyperoxia that cause normal vascularisation to cease followed by rebound hypoxia that cause opaque fibrous tissues to form behind the lens causing impairment or blindness.