Infant premature baby

Following birth, the amount of red blood cell DHA in premature infants decreases therefore the amount of DHA available to the premature infant assumes critical importance. Preterm infants have a limited ability to convert LNA to DHA (Figure 2) therefore, a number of studies have been carried out on the DHA status of the premature infant. Premature babies have decreased amounts of DHA, but human milk contains... 

One of the last developed version of this system (Neotrend) was developed to monitor blood gases continuously and directly in critically-ill premature babies. The system is equipped with a tiny optical fibre catheter (0.5 mm in diameter) which is inserted into the infant s descending aorta by means of an umbelical artery catheter. A sketch of the probe is shown in Figure 4. 

A jaundiced one-day-old premature infant with an elevated free bilirubin is seen in the premature-baby nursery The mother received an antibiotic combination preparation containing sulfamethizole for a urinary tract infection (UTI) one week before deliver)1 You suspect that the infant s findings are caused by the sulfonamide because of the following mechanism ... 

A liposomal formulation containing a surfactant, which usually coats the mucosa of the bronehi and prevents a collapse of the alveolar vesieles of the lung, has been developed for patients who suffer from infant respiratory distress syndrome (IRDS) or adult-aequired respiratory distress syndrome (ARDS). Premature babies often suffer IRDS before the development of a funetional lung surfaetant and pulmonary gas exehange. ARDS is also a life-threatening failure and loss of the lung function and is usually acquired by illness or accident. Clinieal trials with liposomal surfactant have proved to be effective in prophylaetie treatment of IRDS and ARDS. 

Failure to synthesise sufficient surfactant or the synthesis of abnormal surfactant, so that surface tension cannot be lowered, may play a role in several conditions respiratory distress syndrome of the newborn sudden infant death ( cot death ) and adult respiratory distress syndrome. The enzymes involved in the synthesis of surfactant only appear during the third trimester of pregnancy, so that surfactant is not produced in premature babies and they have difficulty breathing. 

As discussed in section 8.2.5, lysozyme has been isolated from the milk of a number of species human and equine milks are especially rich sources. In view of its antibacterial activity, the large difference in the lysozyme content of human and bovine milks may have significance in infant nutrition. It is claimed that supplementation of baby food formulae based on cows milk with egg-white lysozyme gives beneficial results, especially with premature babies, but views on this are not unanimous. 

The use of compressed oxygen can benefit not only athletes, but also vulnerable premature babies. Premature babies can be afflicted with hyaline-membrane disease. This condition prevents the alveoli in their lungs from inflating, which leads to serious breathing difficulties. Placing these babies in an oxygen-rich environment such as an HBO or an incubator (Figure 11.28) helps inflate the alveoli. This increases the infants chances for survival. 

Since lipoprotein lipase activity is reduced in premature babies and babies who are small for gestational age, and since bacterial and viral infections adversely affect lipoprotein lipase activity and can precipitate fat overload, it follows that fat emulsion should be administered with great caution, or even temporarily withheld, in small infants with proven or suspected sepsis (134). 

In newborn infants the benefit of accurate assessment of gestational age by examination of the anterior vascular capsule of the lens and the value of funduscopic examination in ill premature babies must be weighed against the possible risks of the associated increase in blood pressure produced by the pupillary dilators. Since there is no increase in mydriatic effect with repeated instillation or increasing concentration, and their small body mass places premature neonates at increased risk of phenylephrine overdose, it is prudent to use the lowest possible concentration, as well as the most effective combination of mydriatics for indirect ophthalmoscopy in premature infants when such examination is absolutely necessary. The hypertensive effect is likely to be maximal at some time within the first 20 minutes, and whenever possible (or when risk factors are present) the blood pressure should be monitored. 

Kernicterus can occur in small and premature babies, even after small doses of vitamin K, probably because of immature liver function. In its 1997 clinical practice guidelines, the Canadian Paediatric Society recommended that, in order to prevent haemorrhagic disease of the newborn, phytomenadione be given as a single intramuscular injection to all newborns within 6 hours of birth, in a dose of 1 mg for infants with a birth weight of more than 1500 g and half this dose for smaller infants. The dose is crucial, since overdosage carries a serious risk of kernicterus, especially in premature infants. There is only a remote possibility that this treatment might increase the risk of childhood cancer. 

The volume of food ingested by the infant is small, iodine content in formula preparations is insufficient, and parenteral nutrition does not supply enough iodine. This problem is not exclusive to Spanish premature babies, as the iodine content of many formulas in other countries is also inadequate. Therefore, supplements should be added if iodine intake is found to be inadequate. Breast milk appears to be the best source of iodine for the premature infant. 

A premature baby being treated for refractory atrio-ventricular tachycardia with high doses of flecainide (40 mg/kg daily or 25 mg every 6 hours) developed flecainide toxicity (seen as ventricular tachycardia) when his milk feed was replaced by dextrose 5%. His serum flecainide levels ap-proximafely doubled, fhe conclusion being fhaf fhe milk had reduced the absorption. Milk-fed infants on high doses of flecainide may fherefore possibly need a reduced dosage if milk is reduced or stopped. Monitor the effects. 

Premature baby care. Pediatric medicine focuses on the diagnosis and, medical treatment of diseases in infants and children. (BSIP/Photo Researchers, Inc.)... 

Use in premature babies or full-term infants less than 1 month of age, in whom the metabolic pathway for tetracaine may not be fully developed, is not recommended. In addition, it should be avoided if patients have known hypersensitivity to any of the local anesthetics of the ester type. 

TyrasinBtnia (neonatal tyrcsinetnial Insufficient levels of the enzyme hydroxyphenylpyruvic acid oxidase or tyrosine transaminase. Trsnsjent condhion of newtnms inixeased levels of tyrosine in blood arxl urite ttop as iriam matures not assodaled wnh specific symtoms. Tyrosine in blind and urine returns to normal as infant matures. Vitamin C helps reduce blood levels. Reduced protein intake beneficial oiieti occurs in premature babies. 

Consequently, the workshop recommends specific monitoring of iodine intake of mothers and infants in Europe by periodic analysis of urinary iodine levels, and to the extent feasible, of serum TSH and thyroid hormone measures. The daily intake of iodine should be at least 200 pg in pregnant and lactating women and 90-120 pg in young infants. To reach these objectives, the mothers diet should be systematically supplemented with iodine whenever necessary, by vitamins/minerals tablets as prescribed by physicians. Breast milk is the best source of iodine for the infant, and exclusive breast feeding for 4-6 months should be encouraged. However, when circumstances require that infants receive formula, the iodine content of formula milk should be increased fiom the traditional recommendation of S pg/dl milk to 10 pg/dl for full term and 20 pg/dl for premature babies. 

In a few studies it has been demonstrated that taurine supplementation improves retinal development in premature babies receiving parenteral nutrition. Human data on the efficacy of taurine supplementation in so-called energy drinks are very limited. In the absence of taurine supplementation in children taurine concentrations drop, suggesting its conditional indispensability also in the postneonatal period. This has led to the addition of taurine to standard feeding formulas for infants and growing children. 

The symptom of vitamin K deficiency is increased risk of haemorrhage, ease of bruising, nose bleeding and blood in the urine. In infants, vitamin K deficiency may result in intracranial bleeding. Vitamin K deficiency is rare in adults although vitamin K status is assessed in the newborn and in the USA a routine injection of vitamin K is recommended for newborn babies, particularly premature babies where the vitamin K cycle may not be fidly established. Human breast milk is relatively low in vitamin K. There has been some controversy over whether or not childhood leukaemia can be linked to injection of newborns with vitamin K, but a large retrospective study fotmd no link. Certain dmgs such as warfarin, sulphona-mides and cephalosporins can affect vitamin K function. 

High doses of DEHP have been found to cause liver cancer in rats and mice and it is on the Reasonably Anticipated to Be Human Carcinogens list. In 2000 a report by the National Toxicology Program found serious concern that DEHP in vinyl medical devices may harm the reproductive organs of critically ill and premature male infants exposed during medical treatment. They also expressed concern that development of male unborn babies would be harmed by the pregnant mothers exposure to DEHP or that... 

Up to 15% of premature infants and even some babies delivered by cesarean section have inadequate levels of surfactant, producing respiratory distress syndrome, which is characterized by cyanosis and symptoms of labored breathing. 

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