care of the extremely preterm baby
TRANSCRIPT
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Care of the Extremely
Preterm Baby
Edward F. Bell
University of Iowa
Kyiv, 5 March 2013
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Kyiv 2003
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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
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Specific Aspects of Preterm Care
Addressed by Other Speakers
Noninvasive and high-frequency ventilation
Marozsynska
Ethical issues
Opitz
Neuroprotection
Baud
Anemia and transfusion
Bell
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Specific Aspects of Preterm Care
Addressed by Other Speakers
Bronchopulmonary dysplasia
Rubenstein
Jaundice
Stark
Nutrition
Ziegler
Ductus arteriosus
Schirtz
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Other Specific Aspects of Care of the
Extremely Preterm Infant
Thermal care
Intracranial hemorrhage
Apnea of prematurity
Infection
Necrotizing enterocolitis
Retinopathy of prematurity
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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
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Hypothermia
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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
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Preventing Hypothermia
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Kangaroo Care
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Intracranial Hemorrhage and
Periventricular Leukomalacia
Intraventricular
hemorrhage (IVH)
on ultrasound
IVH at postmortem Periventricular
leukomalacia
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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
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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
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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
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Necrotizing Enterocolitis
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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
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Retinopathy of Prematurity
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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
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Laser Treatment of Retinopathy of Prematurity
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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
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Jeff Hackbarth, 24 weeks gestation, 690 grams,
university graduate
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