P RETERM PROBLEMS Matthew Beaumont. P RETERM : DELIVERY <____ GESTATION Extremely preterm (<28 weeks) Very preterm (28 to <32 weeks) Moderate/late preterm.

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Presentation transcript:

P RETERM PROBLEMS Matthew Beaumont

P RETERM : DELIVERY <____ GESTATION Extremely preterm (<28 weeks) Very preterm (28 to <32 weeks) Moderate/late preterm (32 to <37 weeks) Prognosis dependent on gestational age LBW: <2500g VLBW<1500g ELBW<1000g

O VERVIEW Risk hypothermia ____ Feeding problems- immature suck and swallow Increased risk infection Patent Ductus Arteriosus Brain injury: (Haemorrhage/ ischaemia)- cognitive difficulties/ CP

C ASE 1 You are the doctor on call… 28w very prem, 3hours old Signs: Tachypnoea >60RR Resp distress (Recession/ nasal flaring/ grunting/cyanosis).

CXR G_____________ appearanceNormal

R__________________ (___) (hyaline membrane disease)= surfactant deficiency. =widespread alveolar collapse and inadequate gas exchange. Common in very preterm infants. (more prem= more common)

T REATMENT 1. Antenatal S________: cause fetal surfactant production 2. Surfactant therapy: (animal lung) via tracheal tube 3. Oxygen therapy- raised ambient/ CPAP- nasal cannulae/ Endo tracheal ventilation

C ASE 2 You are the doctor on call… Same 28w very prem, 2days old BG: RDS, ET tube ventilation PC= desaturation, increasing O2 requirement O/E: Unilateral reduced breath sounds and chest movement Fibreoptic light: transilluminates chest wall

CXR RDS complicated by P________

P NEUMOTHORAX ___% prems ventilated for RDS- air tracks into p_____ space= pneumothorax Prevention: Use lowest possible pressures O2 Treat: Conservatively Tension: Chest drain

C ASE 3 You see the same prem baby at 37w PMA Struggling to wean from oxygen CXR= Fibrosed, over distended, Cystic changes

B__________________(BPD) = chronic lung disease. An O2 requirement >36w PMA Lungs damaged: by ventilation and oxygen. Treat: additional oxygen several months (CPAP/ ventilation/ raised ambient 02) Steroids (short course)

C ASE 4 You are the doctor on call… 2 week old prem PC: stop tolerating feeds, bile stained vomiting. O/E: Distended abdomen (tense + shiny skin), Shock Bloody stools

AXR

S UPINE AXR I. Distended bowel loops II. Intramural gas (pneumatosis coli) III. Gas in portal tract IV. Pneumoperitoneum (2dnry perf) Football sign Rigler sign Air under diaphragm

N ECROTISING E NTEROCOLITIS (NEC) Prems- first few weeks Bacteria invade ischaemic bowel wall C______ milk formula= Risk factor Significant morbidity Mortality 20%

T REATMENT NEC: Parenteral nutrition Broad spectrum ABX Artificial ventilation (distention) + Circulatory support Surgery= Bowel Perforation

ROP R______________ Vascular proliferation may lead to retinal detachment, fibrosis and blindness Uncontrolled use of __________ Still affects 35% VLBW Treat: Laser therapy (reduce impairment) + Ophthalmologist- screen VLBW/Very preterm- weekly.