Care of the Extremely Preterm Baby

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International conference «Actual approaches to the extremely preterm babies» (Kyiv, Ukraine, March 5-6, 2013)

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Care of the Extremely Preterm Baby

  1. 1. Care of the ExtremelyPreterm BabyEdward F. BellUniversity of IowaKyiv, 5 March 2013
  2. 2. Kyiv 2003
  3. 3. Specific Aspects of Preterm CareAddressed by Other Speakers Organization of care  Schunko, Stark, Stranak, Ognean, Sydorov, Tkachenko, Chernov Resuscitation and stabilization  Stranak, Dobryanskiy Early intervention  Curteanu
  4. 4. Specific Aspects of Preterm CareAddressed by Other Speakers Noninvasive and high-frequency ventilation  Marozsynska Ethical issues  Opitz Neuroprotection  Baud Anemia and transfusion  Bell
  5. 5. Specific Aspects of Preterm CareAddressed by Other Speakers Bronchopulmonary dysplasia  Rubenstein Jaundice  Stark Nutrition  Ziegler Ductus arteriosus  Schirtz
  6. 6. Other Specific Aspects of Care of theExtremely Preterm Infant Thermal care Intracranial hemorrhage Apnea of prematurity Infection Necrotizing enterocolitis Retinopathy of prematurity
  7. 7. Definitions Full-term: > 37 weeks 87.9% Preterm: < 37 weeks 12.1% Very Preterm: < 32 weeks 2.0% Extremely Preterm: < 28 weeks 0.7% Approximately 3500 per year in Ukraine
  8. 8. Hypothermia
  9. 9. The Influence of the Thermal Environment uponthe Survival of Newly Born Premature InfantsW. A. Silverman, J. W. Fertig, A. P. Berger Survival rate Birth weight range (g) 28 oC 32 oC < 1000 14% 50% 1001-1500 77% 86% 1501-2500 79% 93% PEDIATRICS, November 1958
  10. 10. Preventing Hypothermia
  11. 11. Kangaroo Care
  12. 12. Intracranial Hemorrhage and Periventricular Leukomalacia Periventricular Intraventricular IVH at postmortem leukomalaciahemorrhage (IVH) on ultrasound
  13. 13. Intracranial Hemorrhage Prevention  Prevent preterm birth  Antenatal corticosteroids to mother  Vitamin E at birth  Avoid blood pressure fluctuations, pneumothorax, high and low PCO2  Correct coagulation disorder Treatment  Nothing for hemorrhage itself, but posthemorrhagic hydrocephalus can be treated
  14. 14. Apnea of Prematurity Prevention  Prevent preterm birth Treatment  First, rule out underlying cause, such as atelectasis or infection, and treat cause  If it is true apnea, what is the predominant type of apnea – central or obstructive?  If central, treat with caffeine, theophylline, or aminophylline  If obstructive, consider CPAP
  15. 15. Infection Prevention  Mother should be immunized against hepatitis, tetanus, rubella, and possibly tuberculosis  Careful infection control practices, including meticulous hand hygiene (will be discussed by Dr. Schlösser)  Limit use of foreign bodies that enter the body, such as intravenous cannulae and endotracheal tubes, and remove these when they are no longer needed Treatment  Appropriate, focused antibiotics
  16. 16. Necrotizing Enterocolitis
  17. 17. Necrotizing Enterocolitis Prevention  Prevent preterm birth  Antenatal corticosteroids to mother  Breast milk, not formula  Probiotics Treatment  Stop enteral feedings, give intravenous nutritional support  Gastric suction  Antibiotics
  18. 18. Retinopathy of Prematurity
  19. 19. Retinopathy of Prematurity Prevention  Prevent preterm birth  Antenatal corticosteroids to mother  Careful monitoring of oxygen therapy  Before 32 weeks postmenstrual age, keep oxygen saturation 90-95%  Retinal examinations by qualified ophthalmologist Treatment  After 32 weeks postmenstrual age, if infant has ROP, keep oxygen saturation in the mid to high 90s  Laser ablation
  20. 20. Laser Treatment of Retinopathy of Prematurity
  21. 21. Success Brings New Challenges As you experience more success in reducing mortality of extremely preterm infants, you will see more patients with these complications  Hypothermia  Intracranial hemorrhage  Apnea of prematurity  Infection  Necrotizing enterocolitis  Retinopathy of prematurity
  22. 22. Jeff Hackbarth, 24 weeks gestation, 690 grams, university graduate

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