Preterm Bby

Question 1

Preterm bby is born before _______

Answer 1

37 weeks of gestation

Question 2

Premature births fell by ______ after ______

Answer 2

10%

Smoking Ban

Question 3

What strongly influences deaths in the 1st year of childhood?

Answer 3

• Pre-term Delivery
• Low Birth Weight

—other risk factors: Maternal Age, Smoking, poverty, ethnicity

Question 4

Why are pre-term deliveries rising every year?

Answer 4

• incr. Maternal age
• incr. rate in pregn.-related complications
• greater use of INFERTILITY
• more C-sections before term

Question 5

What are the top 3 causes of pre-term births?

Answer 5

1. Spontaneous
2. Multiple pregn
3. PPROM (preterm prelabour rupture of membranes)
4. pregn. associated Hypertension
5. cervical malformation incompetence
6. anterpartum hemorrhage
7. IUGR

Question 6

What are 3 risk factors of pre-term deliveries?

Answer 6

• > 2 pre-term deliveries= incr. risk of another by 70%
• ABNORMALLY shaped uterus incr. risk by 19%
• 9x more likely with multiple bbies
• IVF
• smoking, drinking, drugs
• <6 months interval btw pregnancies
• poor nutrition/multiple miscarriages

Question 7

What is diff. in managing a pre-term bby vs a term bby?

Answer 7

• needs MORE help with warmth
• can’t breathe effectively (fragile lungs)
• fewer reserves
• DELAY cord clamping !

Question 8

How is the bby kept warm?

Answer 8

• using PLASTIC bag under a radiant heater

Question 9

What are common problems with prematurity ?

Answer 9

• T* control
• feeding
• SEPSIS
• system immaturity: RDS (respir. distress $) , PDA, IVH (intraventricular hemorrhage in brain), NEC (necrotising enterocolitis)

Question 10

What incr. ALL pre-term morbidities?

Answer 10

hypothermia !

Question 11

Why is thermal regulation diff. in a newborn?

Answer 11

• LOW BMR
• Minimal Muscular activity
• Preterm: v. low subcutaneous FAt insulation
• high ratio of S.A to body mass

Question 12

Name methods/equipment used to keep preterm bbies warm?

Answer 12

• Wraps/bags
• Skin-to-skin care
• Transwarmer mattress
• Prewarmed incubator

Question 13

Why does a preterm bby have an incr. risk of Nutritional compromise?

Answer 13

• LIMITED nutrient reserves
• GUT immaturity
• immature metabolic pathways
• incr. nutrient demands

Question 14

What are the 2 types of Neonatal sepsis?

Answer 14

1. Early Onset (EOS) - d.t bacteria acquired BEFORE and DURING delivery
2. LOS (late onset)- acquired after delivery (community acq.)

Question 15

Causes of EO Sepsis?

Answer 15

• Gr. B streptococcus

- Gram (-)ves

Question 16

Causes of LOS?

Answer 16

• Gram (-ves)
• Coagulase -ve Staph
• Staph. aureus

Question 17

Why are premature bbies at a high risk of complications?

Answer 17

• immature immune system
• intensive care env.
• indwelling TUBES and LINES

Question 18

How do you ensure pre-term bby is not put at risk of other complications?

Answer 18

• handwashing
• super vigilant and INFECTION screening should be done
• judicious use of antibiotics
• supportive measures

Question 19

What respiratory conditions may occur wtih prematurity?

Answer 19

• RDS- respiratory distressed $
• Apnoea of prematurity
• Bronchopulmonary Dysplasia

Question 20

What is the pathophysiology of THE RDS?

Answer 20

• Primary: Surfacant deficiency, structural immaturity

> alveolar damage d.t exudate from leaky capillaries> INFLAMMATION and REPAIR

Question 21

How common is RDS in bbies born before 29 wks?

Answer 21

75% vs only 10% in those born after 32 wks

Question 22

What are the clinical fts of RDS?

Answer 22

• respir. distress
• tachypnoea (grunting/nasal flaring/cyanosis/ intercostal recessions)
• worsening over MINS to HRS
• Natural hx

Question 23

How to manage RDS?

Answer 23

• maternal steroid
• surfactant
• ventilation (invasive/non-invasive ventilation)

Question 24

How to grade intraventricular hemorrhage?

Answer 24

• Grades 1 and 2: neurodevelop. delay up to 20%

- Grades 3 and 4: neurdevelop. delay up to 80% (mortality 50%)

Question 25

How does NEC present as?

Answer 25

- poor feeding - bile stained vomitus - abdominal distension - blood-stained stools - +/- explosive diarrhoea - respiratory distress with acidosis - sepsis

Question 26

Risk factors of NEC?

Answer 26

- premature bby (50-80%) - congenital heart disease - perinatal asphyxia - decr. umbilical flow

Question 27

What are other complications of preterm bby?

Answer 27

- retinopathy of prematurity (6-8wks after delivery) - metabolic: Hypoglycemia and hyponatremia --EARLY osteopenia of prematurity --- LATE