Care of the Extremely Preterm Baby

Edward F. Bell University of Iowa

Kyiv, 5 March 2013

Specific Aspects of Preterm Care Addressed by Other Speakers

 Organization of care   Schunko, Stark, Stranak, Ognean, Sydorov,

Tkachenko, Chernov

 Resuscitation and stabilization   Stranak, Dobryanskiy

 Early intervention   Curteanu

Specific Aspects of Preterm Care Addressed by Other Speakers

 Noninvasive and high-frequency ventilation   Marozsynska

 Ethical issues   Opitz

 Neuroprotection   Baud

 Anemia and transfusion   Bell

Specific Aspects of Preterm Care Addressed by Other Speakers

 Bronchopulmonary dysplasia   Rubenstein

  Jaundice   Stark

 Nutrition   Ziegler

 Ductus arteriosus   Schirtz

Other Specific Aspects of Care of the Extremely Preterm Infant

 Thermal care

  Intracranial hemorrhage

 Apnea of prematurity

  Infection

 Necrotizing enterocolitis

 Retinopathy of prematurity

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

Hypothermia

The Influence of the Thermal Environment upon the Survival of Newly Born Premature Infants

W. A. Silverman, J. W. Fertig, A. P. Berger

PEDIATRICS, November 1958

Birth weight range (g) 28 oC 32 oC

< 1000 14% 50%

1001-1500 77% 86%

1501-2500 79% 93%

Survival rate

PreventingHypothermia

KangarooCare

Intracranial Hemorrhage and Periventricular Leukomalacia

Intraventricularhemorrhage(IVH)onultrasound

IVHatpostmortem Periventricularleukomalacia

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

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

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

Necrotizing Enterocolitis

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

Retinopathy of Prematurity

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

Laser Treatment of Retinopathy of Prematurity

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