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Prematurity & related issues (i) - Coggle Diagram
Prematurity & related issues (i)
Intro
clinical course, survival + long-term prognosis depend on gestational age @ birth
ext appearance + neuro findings can be scored to estimate gestational age
rate + severity of problems decline as gestational age increase
with modern intensive care prognosis is excellent after 32 wks
Increased need for resus @ birth
Resp problems
RDS
aka hyaline membrane disease
surfactant deficiency
supposed to lower surface tension
produced by type 2 pneumocytes on alv epithelium
results in alv collapse + inadequate gas exchange
more severe in boys
can also occur in term IDM
Tx
Surfactant therapy
given via ETT
calf/pig derived
give glucocorticoids if PTB anticipated
O2 / CPAP / artificial ventilation / HFOV
clinical signs
@ delivery/within 4hrs of birth
tachypnoea
laboured breathing
chest wall recession
nasal flaring
grunting
cyanosis if severe
CXR
diffuse granular "ground glass" appearance
Pneumothorax
in up to 10% of infants ventilated for RDS
prevention: use lowest pressures possible to provide adequate chest movement + blood gases
Presentation
increased O2 requirements
reduced breath sounds + chest movements on affected side
seen on transillumination
tx = chest drain
CXR
bilat here
Apnoea
Must look for underlying cause
hypoxia
infection
anaemia
electrolyte disturbance
hypoglyc
seizures
HF
aspiration
Usually the cause is immaturity of central resp control
Tx
breathing usually starts again after physical stim
Caffeine
CPAP necessary if episodes frequent
BPD
Infants who still have O2 requirement after cGA of 36wks
chronic lung disease
causes
trauma from artificial ventilation
O2 toxicty
infection
CXR
widespread opacification
cystic changes
fibrosis
Findings on exam
v thin skin
dark red colour
no testes in scrotum
prominent clitoris, labia minora protruding
no co ordinated sucking
faint cry
eyelids fused
limbs extended, jerky movements
Infection
often nosocomial
indwelling catheters
artificial ventilation
contributes to BPD + brain injury
Temp control
Hypothermia increases energy consumption
hypoxia
hypoglyc
FTT
Why are premies more susceptible to hypothermia?
Larger relative surface area compared to mass - greater heat loss
thin skin - permeable to heat + water
little subcut fat
can't conserve heat by curling up/shivering
Prevention of heat loss
clothe + cover head
avoid draughts
dry + wrap @ birth
place into plastic bag
nurse on heated matress
incubator
radiant heater
