Professional Documents
Culture Documents
PREMATURITY
.born too soon
MOA
In response to glucocorticoid, the fetal lung fibroblast produces a
protein, fibroblast-pneumonocyte factor , which in turn stimulates
the formation of saturated phosphatidylcholine
advantages disadvantages
Consistent pressure Compressed gas supply
Control of PEEP and PIP Pressures should be set up prior
Reliable delivery of 100% O2 Changing inflation pressure
No fatigue during resuscitation- difficult
Risk of prolonged inspiratory
time
Targeted saturations
1 min 60-65%
2 min 65-70%
3 min 70-75%
4 min 75-80%
5 min 80-85%
10 min 85-95%
Transport in prewarmed incubator with blended O2 and CPAP
facility
Temperature and humidity control- with neutral thermal
environment
A. incubators and hybrid incubators-prewarmed double wall
incubators
B. humidification-warm humidification within incubator
1) use a respiratory care humidifcation unit- inline humidification of
ventilator gas circuits
2) minimize nosocomial infection in humidified environment
C. monitoring and maintenance of body temperature
1) maintain axillary skin temperature of 36.0C to 36.5C
2) record skin temperature
3) record the incubator humidity
4) weigh LBW infants once daily for management of fluids and
electrolytes
FLUIDS AND ELECTROLYTES
1000-1,250 56
1251-1500 46
>1500 26
Birth Fluid
weight(kg) rate(ml/kg/day)
<24hrs 24-48 hrs >48 hrs
Contraindications
Severe hemodynamic instability
Suspected or confirmed NEC
Evidence of ileus
Clinical-intestinal pathology
Feeding problems
Difficulty in self feeding
In coordination of sucking and swallowing
Abdominal distension
Regurgitation and aspiration
Feeding advancements
Use full strength, 67kcal/100 ml human milk or preterm formula
The initial volume- atleast 24 hrs prior to advancement
80ml/kg/day reached- feeds Q2-3H
More rapid advancement- 100ml/kg/day
Do not exceed increments-15 ml/kg every 12 hours
Volume goal-140-160 ml/kg/day
Birth weight (g) Initial rate (ml/kg/day) Volume increase (ml/kg
every 12 hours)
1001-1250 10-20 10
1251-1500 20-30 10-15
1501-1800 30 15
1801-2500 30-40 15-20
Caloric density:
For human milk fed babies- caloric density advanced by 6-12
kcals/100 ml- HMF
Maintained for 24hrs before advancement schedule
As enteral feeds are increased- IV fluids reduced accordingly
RESPIRATORY ISSUES
Poor development of respiratory muscles- CPAP or ventilator support
APNEA
Due to developmental immaturity of central respiratory drive
REM sleep predominates in preterm infants
Chemoreceptor response
In preterms-hypoxia-transient hyperventilation-hypoventilation-
apnea
Ventilatory response to increased CO2 is decreased
Active reflexes- by stimulation of posterior pharynx, lung inflation,
fluid in larynx or chest wall distortion
Ineffective ventilation- impaired coordination of respiratory muscles
Nasal obstruction
inhibitory neurotransmitters
MONITORING AND EVALUATION
For atleast 1 week- heart rate , desaturations
Bradycardia, cyanosis, airway obstruction
Tactile stimulation, ventilation with bag and mask
Other causes ruled out- infection, impaired oxygenation, metabolic
disorders, drugs, temperature instability,intracranial pathology
Evaluation history,physical examination, ABG, CBC, GRBS, Ca and SE
TREATMENT-
Specific therapy
Supplemental O2
Avoid reflexes
Positioning
Nasal CPAP- <32 to 34 wks, residual lung disease
CAFFEINE- a methylxanthine
-respiratory centre stimulation
-antagonism of of adenosine
-improvement of diaphragmatic contractility
Reduces rate of BPD
All infants <1250 gms
Prior to extubation
Loading dose- 20mg/kg of caffeine citrate oral/i.v- 30 min
Maintenance dose-5-8 mg/kg OD- 24 hrs after 1st dose
Serum levels- 5-20mcg/ml- therapeutic
Discontinued-34-36 wks if no apneic spells for 5-7 days
Risks- weight gain was less during 1st 3 weeks
Severe apneas, bradycardia,PCV<25%- PRBCs transfusion
Mechanical ventilation
NEUROLOGIC
Perinatal depression
ICH- from fragile involuting vessels
Maintain stable perfusion maintain normal BP, volume ,
electrolytes, blood gases
Head USG at 5-7 days
CARDIOVASCULAR
A) hypotension-
hypovolemia
cardiac dysfunction
sepsis induced vasodilation
B) PDA- between 24-48 hrs of birth
pulmonary over circulation and diastolic hypotension
PDA- monitor clinically
ECHO to r/o other structural defects, confirm PDA
over hydration avoided
30% PDAs close spontaneously
hemodynamically significant- indomethacin/ ibuprofen
persistent or recurrent PDA- second dose
recurrence of PDA with L-R shunt- surgical ligation
HEMATOLOGIC-
A) anaemia- exaggeration of normal physiologic anaemia
no treatment required
TRANSFUSION- low RBC volume, low hematocrit <40%
transfusion guidelines