PRETERM BABY
Incidence of undescended testis in preterm infants is:
| A |
<5% |
|
| B |
10% |
|
| C |
20% |
|
| D |
30% |
Incidence of undescended testis in preterm infants is:
| A |
<5% |
|
| B |
10% |
|
| C |
20% |
|
| D |
30% |
Which of the following is NOT used in a preterm infant to assess need for resuscitation?
| A |
Color |
|
| B |
Heart rate |
|
| C |
Rate of respiration |
|
| D |
Muscle tone |
Which of the following is NOT used in a preterm infant to assess need for resuscitation?
| A |
Color |
|
| B |
Heart rate |
|
| C |
Rate of respiration |
|
| D |
Muscle tone |
|
Signs |
0 |
1 |
2 |
|
Heartbeats per minute |
Absent |
Slow (<100) |
>100 |
|
Respiratory effort |
Absent |
Slow, irregular |
Good, crying |
|
Muscle tone |
Limp |
Some flexion of extremities |
Active motion |
|
Reflex irritability |
No response |
Grimace |
Cry or cough |
|
Color |
Blue or pale |
Body pink, extremities blue |
Completely pink |
If the score is
Ref: Raab E.L., Kelly L.K. (2013). Chapter 9. Normal Newborn Assessment & Care. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.
A preterm infant showed apnoea at birth associated with bradycardia. Apnoea is defined as cessation of respiration for at least:
| A |
2 sec |
|
| B |
5 sec |
|
| C |
10 sec |
|
| D |
20 sec |
A preterm infant showed apnoea at birth associated with bradycardia. Apnoea is defined as cessation of respiration for at least:
| A |
2 sec |
|
| B |
5 sec |
|
| C |
10 sec |
|
| D |
20 sec |
True about apnoea in a Preterm baby are all, EXFEPT:
| A |
Cessation of breathing for < 20sec |
|
| B |
Associated with bradycardia |
|
| C |
Leads to hypoxia |
|
| D |
May cause cyanosis |
True about apnoea in a Preterm baby are all, EXFEPT:
| A |
Cessation of breathing for < 20sec |
|
| B |
Associated with bradycardia |
|
| C |
Leads to hypoxia |
|
| D |
May cause cyanosis |
Apnea is defined as the cessation of breathing for more than 20 seconds or apnea or the cessation of breathing for less than 20 seconds if it is accompanied by bradycardia or oxygen (O2) desaturation.
Bradycardia in a premature neonate is considered clinically significant when the heart rate slows by least 30 bpm from the resting heart rate.
The presence and duration of central cyanosis should also be noted which is significant.
True about breast feeding –
| A |
Best for both preterm & term |
|
| B |
50% energy from protein |
|
| C |
Promote lactobacillus growth in bowel |
|
| D |
a and c |
True about breast feeding –
| A |
Best for both preterm & term |
|
| B |
50% energy from protein |
|
| C |
Promote lactobacillus growth in bowel |
|
| D |
a and c |
Ans. is ‘a’ i.e., Best for both preterm & term ‘c’ i.e., Promote lactobacillus growth in bowel
o Breast milk is beneficial for both preterm and term infants because the composition of breast milk varies according to
the needs and age of the infants. For example, preterm milk contains more protein `S’, sodium, iron, immunoglobulins
and calories as they are needed by the preterm baby.
o Breast milk and energy by different constituents
Carbohydrate 30-40%
Protein 7-10%
Fat 45-60%
o Breast milk contains N-acetyl-D glucose and lactose which promotes lactobacillus. On the other hand, high content of glucose and casein in formula feeds inhibits the growth of lactobacillus.
o Breast milk appears to be protective for necrotizing enterocolitis. Almost all patients of neonatal necrotizing enterocolitis are artificially fed.
o Low protein contents of breast milk along with a higher concentration of secretory IgA decreases the absorption of protein macromolecules -4 Less chances of allergy and asthma.
A non ventilated preterm baby in incubator is under observation. Which is the best way to monitor the baby’s breathing and detect apnaea ?
| A |
Infrared throraric movement study |
|
| B |
Capnography |
|
| C |
Nasal digital temperature monitoring |
|
| D |
Impedence technique |
A non ventilated preterm baby in incubator is under observation. Which is the best way to monitor the baby’s breathing and detect apnaea ?
| A |
Infrared throraric movement study |
|
| B |
Capnography |
|
| C |
Nasal digital temperature monitoring |
|
| D |
Impedence technique |
Ans. is ‘d’ i.e., Impedence technique
o The respiratory monitor based on impednace technique measures changes in the electrical resistance during breathing.
The electrode is fixed on the chest wall to pick up signals which are displayed as respiratory rate.
o Capnography – It is a simple non invasive method to assess arterial CO2.
o It is used to assess the placement of ET tube in esophagus or trachea.
The following factors contribute to hypothermia in preterm babies except –
| A |
Decreased subcutaneous fat and brown fat |
|
| B |
Large surface area in relation to body weight |
|
| C |
Less oxygen consumption |
|
| D |
Increased muscular activity |
The following factors contribute to hypothermia in preterm babies except –
| A |
Decreased subcutaneous fat and brown fat |
|
| B |
Large surface area in relation to body weight |
|
| C |
Less oxygen consumption |
|
| D |
Increased muscular activity |
Ans. is ‘d’ i.e., Increased muscular activity
Blood volume in preterm neonate is –
| A |
90 ml/kg |
|
| B |
80 ml/kg |
|
| C |
70 ml/kg |
|
| D |
60 ml/kg |
Blood volume in preterm neonate is –
| A |
90 ml/kg |
|
| B |
80 ml/kg |
|
| C |
70 ml/kg |
|
| D |
60 ml/kg |
Ans. is ‘a’ i.e., 90 ml/kg
Age Blood volume
Preterm 90-110 ml/kg (average 100 ml/kg)
Term 80-90 ml/kg (average 85 ml/kg)
1-3 months 75 ml/kg
3 months – adults 70 ml/kg
Late metabolic acidosis is seen in-
| A |
Term infant given formula feed |
|
| B |
Preterm baby getting cow milk |
|
| C |
Long term breast feeding |
|
| D |
None of the above |
Late metabolic acidosis is seen in-
| A |
Term infant given formula feed |
|
| B |
Preterm baby getting cow milk |
|
| C |
Long term breast feeding |
|
| D |
None of the above |
Ans. is ‘b’ i.e., Preterm baby getting cow milk
Late metabolic acidosis (LMA)
o Late metabolic acidosis is a special type of acidosis in apparently healthy premature infant.
o This hyperchloremic acidosis appeares during second and third week of life, and resolves spontaneously within a couple of weeks.
Definition
“An acidosis occuring after second day of life, in which base excess values are lower than -5meq/L on two consecutive estimations done at least 24 hours apart”.
Etiology
o Prematurity is the most important single predisposing factor in the development of LMA.
o The incidence varies considerably depending upon the gestational maturity and protein content of feeding formula.
o In preterm neonates fed on a modified cow’s milk the risk of developing LMA is very high.
Preterm infant is defined as –
| A |
Born between 37-42 weeks |
|
| B |
Born > 42 weeks |
|
| C |
Born < 37 weeks |
|
| D |
Born < 25 weeks |
Preterm infant is defined as –
| A |
Born between 37-42 weeks |
|
| B |
Born > 42 weeks |
|
| C |
Born < 37 weeks |
|
| D |
Born < 25 weeks |
Ans. is ‘c’ i.e., Born < 37 weeks
Term neonate (term baby)
o Any neonate born between 37 and < 42 weeks (259 - 293 days) of pregnancy irrespective of the birth weight. Preterm baby
o Any neonate born before 37 weeks (<259 days) of pregnancy irrespective of the birth weight. Post-term baby
o Any neonate born at or after 42 weeks (294 days or more) of pregnancy irrespective of the birth weight.
Physiological jaundice in preterm infant lasts upto:
September 2011
| A |
5 days |
|
| B |
7 days |
|
| C |
10 days |
|
| D |
14 days |
Physiological jaundice in preterm infant lasts upto:
September 2011
| A |
5 days |
|
| B |
7 days |
|
| C |
10 days |
|
| D |
14 days |
Ans. D: 14 days
Physiological jaundice usually appears on 2nd and 3rd day and disappears by 7-10th day, a little later in premature neonates Jaundice in paediatrics:
Unconjugated bilirubinemia:
– Criggler Najar syndrome (I and II)
– Physiological jaundice
– Breast milk jaundice
Conjugated bilirubinemia:
– MC cause: Idiopathic infantile hepatitis
– Biliary atresia (intra-hepatic and extra-hepatic)
In kernicterus, unconjugated bilirubin is increased
- In kernicterus, staining of brain is more in basal ganglia
- MC cause of jaundice of newborn within 24 hours is: Erythroblastosis fetalis
- Breast milk jaundice is due to pregnandiole
- In physiological jaundice, total bilirubin level rises less than 5 mg/ dl/ day
