Treatment of other conditions in premature babiesTTreatment of other conditions in premature babiesTreatment of other conditions in premature babiesEnglishNeonatologyPremature;Newborn (0-28 days);Baby (1-12 months)BodyNADrug treatment;Non-drug treatmentPrenatal Adult (19+)NA2009-10-31T04:00:00ZAndrew James, BSc, MBChB, FRACP, FRCPCAideen Moore, MD, FRCPC, MRCPI, MHSc12.000000000000030.0000000000000160.000000000000Flat ContentHealth A-Z<p>Learn about treatments for other conditions that might affect your premature baby, such as jaundice, osteopenia, and retinopathy of prematurity.</p><p>Premature babies are at risk for several different types of medical conditions other than those affecting the lungs, heart, brain and digestive system. Some of the other conditions that can affect premature babies are infection, anemia of prematurity, apnea of prematurity, retinopathy of prematurity (ROP) and osteopenia of prematurity. Like problems associated with the heart, lungs, digestive system and brain, the conditions addressed here can range widely in their course, complexity and severity. </p><h2>Key points</h2> <ul><li>There are several other conditions that can affect premature babies including infection, anemia, apnea, jaundice, retinopathy of prematurity and osteopenia.</li> <li>As with conditions that affect the lungs, heart, brain and digestive system, treatment for these other conditions will depend on the severity of the condition and the severity of prematurity of the baby.</li></ul>
Traitement d’autres conditions chez les bébés prématurésTTraitement d’autres conditions chez les bébés prématurésTreatment of other conditions in premature babiesFrenchNeonatologyPremature;Newborn (0-28 days);Baby (1-12 months)BodyNADrug treatment;Non-drug treatmentPrenatal Adult (19+)NA2009-10-31T04:00:00ZAndrew James, BSc, MBChB, FRACP, FRCPCAideen Moore, MD, FRCPC, MRCPI, MHSc12.000000000000030.0000000000000160.000000000000Flat ContentHealth A-Z<p>Renseignez-vous sur les traitements d’autres conditions qui peuvent affecter votre bébé prématuré, comme l’ictère, l’ostéopénie, et la rétinopathie de la prématurité.</p><p>Les bébés prématurés sont à risque de présenter différents types de troubles médicaux autres que les troubles qui affectent les poumons, le cœur, le cerveau et l’appareil digestif. On compte parmi ces autres troubles les infections, l’anémie de la prématurité, l’apnée de la prématurité, la rétinopathie de la prématurité et l’ostéopénie de la prématurité. Tout comme pour les troubles associés au cœur, aux poumons, à l’appareil digestif, et au cerveau, les troubles expliqués ici peuvent varier grandement dans leur évolution, leur complexité et leur gravité.</p><h2>À retenir</h2> <ul><li>Il existe plusieurs autres troubles auxquelles les bébés prématurés peuvent faire face dont les infections, l’anémie, l’apnée, la jaunisse, la rétinopathie de la prématurité et l’ostéopénie.</li> <li>Tout comme pour les troubles associés aux poumons, au cœur, au cerveau et à l’appareil digestif, le traitement de ces autres troubles variera en fonction de la gravité de la maladie ainsi que de la prématurité du bébé.</li></ul>

 

 

Treatment of other conditions in premature babies1847.00000000000Treatment of other conditions in premature babiesTreatment of other conditions in premature babiesTEnglishNeonatologyPremature;Newborn (0-28 days);Baby (1-12 months)BodyNADrug treatment;Non-drug treatmentPrenatal Adult (19+)NA2009-10-31T04:00:00ZAndrew James, BSc, MBChB, FRACP, FRCPCAideen Moore, MD, FRCPC, MRCPI, MHSc12.000000000000030.0000000000000160.000000000000Flat ContentHealth A-Z<p>Learn about treatments for other conditions that might affect your premature baby, such as jaundice, osteopenia, and retinopathy of prematurity.</p><p>Premature babies are at risk for several different types of medical conditions other than those affecting the lungs, heart, brain and digestive system. Some of the other conditions that can affect premature babies are infection, anemia of prematurity, apnea of prematurity, retinopathy of prematurity (ROP) and osteopenia of prematurity. Like problems associated with the heart, lungs, digestive system and brain, the conditions addressed here can range widely in their course, complexity and severity. </p><h2>Key points</h2> <ul><li>There are several other conditions that can affect premature babies including infection, anemia, apnea, jaundice, retinopathy of prematurity and osteopenia.</li> <li>As with conditions that affect the lungs, heart, brain and digestive system, treatment for these other conditions will depend on the severity of the condition and the severity of prematurity of the baby.</li></ul><figure> <img src="https://assets.aboutkidshealth.ca/akhassets/NICU-baby-bonnet-BRAND-PHO_EN.jpg" alt="" /> </figure> <h2>Infection</h2><p>Newborns, especially premature babies, are at high risk for infection.</p><p>If infection is suspected, treatment with antibiotics will begin before the diagnosis has been confirmed. Many infections can be treated with ampicillin and an <a href="/Article?contentid=69&language=English">aminoglycoside </a>, however, there are some organisms that are not affected by these two antibiotics. Other antibiotics that might be used include vancomycin, cefotaxime, <a href="/Article?contentid=65&language=English">acyclovir</a> and <a href="/Article?contentid=74&language=English">amphotericin </a>. As treatment must begin before the doctors know exactly what organism they are dealing with, administering antibiotics in this way provides the greatest chance that the infection will be already clearing up by the time specific results come back from the laboratory.</p><p>It may take two or three days for cultures to come back from the laboratory definitively identifying the infection. These tests may include investigations of the blood, urine, and cerebrospinal fluid, which is obtained by lumbar puncture. A chest x-ray taken to check for pneumonia, and secretions from the nose and windpipe may be tested for infection. Once the offending organism, or germ, has been identified, the type of antibiotic given to the baby may change. Some antibiotics target specific organisms, are highly effective, and have fewer effects on the rest of the body’s functioning.</p><p>The length of treatment with antibiotics depends on the severity and type of infection. Sometimes, the suspected infection comes back negative and so the antibiotic will be stopped immediately. If infection is confirmed by the laboratory tests, treatment with antibiotics will continue for as long as needed to clear it up. Sometimes, in cases where suspicion of infection is strong, antibiotics may be continued despite a negative culture result.</p><p>Although antibiotics are usually effective, infection can be serious. Additionally, the baby may have other problems that may complicate treatment. Some babies requiring antibiotics are very ill and will need additional support while they fight off the infection. This may include blood products such as red blood cells, white blood cells, and platelets. Sometimes additional blood clotting agents such as fresh frozen plasma and cryoprecipitate are given.</p><p>At times, babies with an infection may develop breathing problems or difficulty maintaining adequate circulation of the blood. If this is the case, the baby will be supported in these areas with mechanical ventilation, fluids and other medications.</p><h2>Anemia of prematurity</h2><p>Anemia is a condition in which the body does not produce enough red blood cells (RBCs).</p><p>The best way to treat anemia is to create conditions that reduce the likelihood of its development. To help prevent anemia, the smallest possible amount of blood is taken from a premature baby whenever a blood test is needed. Additionally, optimal nutrition can decrease the likelihood that an iron or vitamin deficiency will occur. Supplemental iron will likely also be administered once the baby is a few weeks old.</p><p>If anemia does occur, these two strategies will continue but may be augmented by other treatments. The decision to provide additional treatment is influenced by the gestational age, birthweight, postnatal age, and general condition of the premature baby. Additional treatment may not be necessary, especially if the anemia is mild and there do not appear to be any adverse effects for the premature baby.</p><p>On the other hand, a blood transfusion may be recommended. Generally speaking, while blood transfusion has the immediate effect of increasing RBC levels, it also often has the effect of suppressing the baby’s erythropoietin level. Erythropoietin is a hormone which stimulates the production of RBCs, so when the transfusion suppresses erythropoietin, it slows down the ongoing production of RBCs. However, the baby will usually begin producing their own erythropoetin shortly after the blood transfusion.</p><p>Blood for transfusion is cross-matched to avoid blood group incompatibility between the donor and the premature baby. The blood is carefully screened for the hepatitis A, B, and C viruses, cytomegalovirus, and human immunodeficiency virus (HIV) to minimize the likelihood of transmission of a viral infection.</p><p>In many hospitals, it is possible for the premature baby’s parent to make a directed donation to the baby. The parent and baby must have compatible blood groups, and the parent’s blood must be free of infection. A directed donation is no safer than a donation from any other suitable donor.</p><p>A drug called a diuretic, which causes an increased urine output, may be given during or shortly after a blood transfusion if there is concern that the baby is experiencing fluid overload. There is no need to give a diuretic routinely with a blood transfusion. Furosemide is the most commonly used diuretic.</p><p>Since the physiological anemia of infancy occurs as a result of a lack of erythropoietin, there has been considerable interest in giving supplemental erythropoietin to premature babies. Supplemental erthyropoetin is generally given by injections under the skin one to three times a week for a period of four to six weeks. RBC production increases and the impact of the physiological anemia of infancy can be reduced. However, blood transfusions are still required, especially during the first few days of life.</p><p>Although erythropoietin is not used routinely for the treatment of anemia of prematurity, it may be useful in special circumstances. Erythropoietin may make a valuable contribution to the care of those premature babies whose parents are Jehovah Witnesses, who usually refuse blood transfusions on religious grounds.</p><h2>Jaundice</h2><p>Jaundice occurs because of an inability to process bilirubin, which eventually accumulates in the body with adverse, though usually mild, effects.</p><p>The most common treatment for jaundice is phototherapy. This consists of special light that changes the form of bilirubin, making it easier for the body to dispose of the bilirubin. Though the treatment is safe and rarely produces complications, premature babies will likely be given special eye patches to protect the eyes during phototherapy. White, blue, or green coloured lights are shone down on the baby with as much exposure of skin as possible. The baby’s blood will be tested to check that the level of the bilirubin is going down. A reduction in bilirubin level can be seen in as little as four to six hours.</p><p>Premature babies can continue to be fed while under phototherapy. Minor problems such as loose stools or a rash may occur but usually resolve after phototherapy is discontinued.</p><h3>Rebound jaundice</h3> <figure> <img alt="Nurse and preemie under phototherapy lights" src="https://assets.aboutkidshealth.ca/akhassets/nurse_preemie_phototherapy_EN.jpg" /> </figure> <p>Occasionally, so-called “rebound jaundice” occurs. In these cases, jaundice is successfully treated with phototherapy but reappears, usually within 24 hours, and will require monitoring and sometimes additional phototherapy.</p><p>Phototherapy should not be given to babies whose jaundice is mainly due to elevated levels of conjugated bilirubin since this form of bilirubin does not injure the brain. These babies turn a muddy brown if given phototherapy as they develop the ”bronzed baby” syndrome. Their colour returns to normal slowly over the next few weeks.</p><p>Depending on the cause and severity of the jaundice and the baby’s response to phototherapy, it is possible that an exchange transfusion will be performed, although this is rarely necessary. During an exchange transfusion, a premature baby’s blood is removed and immediately replaced with fresh, compatible donor blood in a process that usually takes two to three hours. Exchange transfusions are performed much less frequently than in the past because phototherapy has been so effective. Although the benefits of exchange transfusion outweigh the risks, complications occur in as many as 5% of cases.</p><h2>Apnea of prematurity</h2><p>Apnea, which is characterized by intermittent breathing, is common in premature babies, more so the younger the baby’s gestational age. Apnea is generally not dangerous and usually resolves, with some help, as the baby matures. Depending on its severity, apnea is treated in several ways in the Neonatal Intensive Care Unit (NICU).</p><p>Apnea may have a specific, underlying cause such as infection or a low level of blood glucose. Treatment of the underlying cause should reduce the frequency and severity of the apnea.</p><p>Apnea is also treated by simply making the baby’s task of breathing easier. Creating a “neutral thermal environment,” in other words, keeping the baby’s environmental temperature at a level where his consumption of oxygen is lowest, will help reduce apnea. Along the same line of reasoning are strategies to keep the airways open. This can be accomplished by positioning the baby in a way that opens the airways to a maximum extent. Additionally, gently suctioning out nasal secretions will also help keep the airways open.</p><p>Premature babies with apnea are usually stimulated, which encourages them to breathe more regularly. This can be done by touch, such as gently tickling the feet, or with chemical stimulants, most commonly caffeine. Less frequently, theophyllines and doxapram may be used. These three drugs are stimulants which affect not only the respiratory centre, but also every cell in the premature baby’s body. There may be undesirable side effects of the chemical stimulant that may prevent its use.</p><p>A baby may also be given continuous positive airway pressure (CPAP) through nasal tubes. The CPAP delivers tactile stimulation that frequently, but not always, encourages adequate and regular breathing.</p><p>Sometimes mechanical ventilation is required to treat apnea of prematurity because the frequency and/or severity of the apnea are not minimized by either drugs or CPAP.</p><h2>Retinopathy of prematurity (ROP)</h2><p>Retinopathy of prematurity (ROP) is an abnormal growth of blood vessels in the eye that can interfere with vision. Although usually mild, in its most severe form, ROP can cause a partial or complete detachment of the retina. Treatment of ROP depends on the extent of the condition and its location in the eye. Since they are known to be at risk, all at risk premature babies are examined for ROP until the blood vessels reach the peripheral, or outer parts of the retina. If assessment shows any indication of ROP, assessment of the retina will continue at regular intervals. In a small number of cases, the growth of abnormal vessel may require treatment.</p><h2>Surgical treatment of ROP</h2><p>Treatment of ROP consists of laser surgery or, less frequently, cryotherapy. The purpose of these surgical procedures is the same, in that they aim to stop the growth of abnormal blood vessels. Laser photocoagulation is done using a laser to remove parts of the retina which have not yet developed blood vessels. Cryotherapy uses freezing to accomplish the same goals.</p><p>Cases that do not resolve themselves and show signs of progression are usually treated by laser therapy to destroy the peripheral avascular retina, the area of the retina that has not developed abnormal blood vessels which is short of oxygen. This leads to the regression of abnormal blood vessels and allows normal vessels to grow.</p><p>It is possible for the disease process to continue in spite of treatment with laser or cryotherapy. In these cases, partial or full detachment of the retina may develop and in some cases this will require surgery. The severity of the detachment will be the major determining factor for long-term vision. Although surgical procedures can sometimes successfully reattach a retina, most patients will have some kind of visual impairment. Those few babies with a fully detached retina will likely be blind or nearly blind in that eye. In many cases, babies with a partial detachment will go on to have useful, though not perfect, vision in that eye.</p><h2>Osteopenia of prematurity</h2><p>Osteopenia is a decrease in bone density and ultimately bone strength. Sometimes osteopenia is accompanied by rickets, a further weakening of the bones due to a lack of calcification. Osteopenia is diagnosed using X-rays, ultrasound, and measurements of calcium, phosphorus, and alkaline phosphatase in the blood. If a diagnosis is confirmed, a premature baby will likely receive several therapies.</p><p>Osteopenia is frequently caused by a lack of or an inability to process vitamin D. As part of the treatment for osteopenia, babies are usually given supplemental vitamin D.</p><p>A premature baby’s formula or breast milk diet may be supplemented with calcium and phosphorus. A baby may also be gently exercised: his arms and legs will be given physiotherapy to promote strength and growth.</p><p>If a premature baby has a fracture due to osteopenia, the therapies will encourage healing. However, the baby will be at risk for further fractures, especially at the same location, for at least a year. There is also some evidence to suggest that premature babies who have osteopenia are at greater risk of developing osteoporosis as adults.</p>https://assets.aboutkidshealth.ca/akhassets/NICU-baby-bonnet-BRAND-PHO_EN.jpgTreatment of other conditions in premature babies

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