care of the extremely preterm baby

Care of the Extremely

Preterm Baby

Edward F. Bell

University of Iowa

Kyiv, 5 March 2013

Kyiv 2003

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

Preventing Hypothermia

Kangaroo Care

Intracranial Hemorrhage and

Periventricular Leukomalacia

Intraventricular

hemorrhage (IVH)

on ultrasound

IVH at postmortem Periventricular

leukomalacia

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

Jeff Hackbarth, 24 weeks gestation, 690 grams,

university graduate