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Prematurity & related issues (ii) - Coggle Diagram
Prematurity & related issues (ii)
Metabolic problems
Hypoglyc
electrolyte imbalance
hypocalc
osteopenia of prematurity
Jaundice
Brain damage
IVH
dx on CRUSS
usually in germinal matrix, contains fragile blood vessel network
usually occurs in 1st 72 hrs of life
pneumothorax = risk factor
most severe = unilat haemorrhagic infarct involving parenchyma - usually results in hemiplegia
can cause hydrocephalus
sutures separate
HC increases rapidly
tense fontanelles
ventriculoperitoneal shunt may be required
CSF can be removed by LPs or ventricular taps
CP risk
White matter injury doesn't always involve bleeds
inflamm
ischaemia
Periventricular leukomalacia (PVL)
multiple bilat cysts
high risk of spastic diplegia + cognitive impairment
NEC
ROP
vasc prolif
may progress to RD, fibrosis + blindness
risk factor = uncontrolled use of high O2 concs
tx
screening
laser
Anaemia of prematurity
Inguinal hernias
require surgical repair
PDA
bounding pulses
@ risk of circulatory overload + HF
do ECHO to confirm
if sx try pharm closure with PG synthetase i, indometacin, ibuprofen
if drugs don't work do surgical ligation
Fluids & nutrition
on 1st day of life 60-90 ml/kg of fluids required
premies have high nutritional requirement due to rapid growth
once 35-36 wks cGA can suck + swallow
before this use NG + OG tubes
if v preterm supplement breastmilk with phosphate, fortifier + ca to prevent poor bone mineralisation
should use donor breast milk if mother can't/won't express
increased risk of NEC from cow's milk based formula
parenteral nutrition sometimes needed
Fe supplements recommended - premies have low Fe stores
Following discharge
Fe + multivits recommended
@ home O2 sometimes needed for BPD
specialist community nursing support
consider RSV prophylaxis
monitor growth + development
Higher CP risk
Higher cognitive impairment risk
learning difficulties
issues with fine motor skills, abstract reasoning, multitasking
problems with concentration + behaviour