Neonates/newborns premature

Standard AIO admixtures are used in most adults patients. However, the patients requirements regarding calories and electrolytes may vary. Dialysis patients require restricted administration of electrolytes, however patients with severe diarrhoea need a higher amount of electrolytes. Standard parenteral nutrition admixtures cannot be used in severely ill paediatric patients, neonates and premature newborns. These patients need individualised admixtures. In premature infants and newborns the all-in-two system is preferred [53]. The lipid emulsion is mixed with the vitamin combination in a separate container and either administered with the amino acid/glucose/electrolyte admixture in parallel (Y-site) or via a separate venous access. 

A common problem for premature babies is their lack of pulmonary surfactant. The pulmonary surfactant is formed late in pregnancy, and a premature baby born without the surfactant can experience respiratory distress syndrome, whereby the alveoli can collapse, a potentially fatal condition. Treatment of newborn premature babies with a lung surfactant therapy was a major advance in neonatal medicine. 

Infant respiratory distress syndrome (IRDS), also known as hyaline membrane disease, is one of the most common causes of respiratory disease in premature infants. In fact, it occurs in 30,000 to 50,000 newborns per year in the U.S. — most commonly in neonates bom before week 25 of gestation. IRDS is characterized by areas of atelectasis, hemorrhagic edema, and the formation of hyaline membranes within the alveoli. IRDS is caused by a deficiency of pulmonary surfactant. Alveolar type II cells, which produce surfactant, do not begin to mature until weeks 25 to 28 of... 

The forms of phototherapy in common use include (i) the phototherapy of jaundice (neonatal hyperbilirubinemia) in the newborn, and especially in the prematurely born 5 (ii) the treatment of psoriasis using light in the UV-A range (320 100 nm) and an administered photosensitizer, such as 8-methoxypsoralen 6 (iii) the treatment of the wet form of age-related macular degeneration with a photosensitizer such as a benzoporphyrin derivative (VISUDYNE ), and a laser light source 7 and (iv) the treatment of certain cancers with a photosensitizer such as a porphyrin derivative, and red light.8... 

In the same way as volatiles from the whole breast, odorants carried in human colostrum/milk are arousing and attractive to newborns (Mizuno, Mizuno, Shino-hara and Noda 2004 Marlier and Schaal 2005). Interestingly, neonatal responsiveness to these milk cues does not seem to depend on breastfeeding experience as term-born infants exclusively fed formula (Marlier and Schaal 2005), and premature infants (Bingham et al. 2003), react to them in the same way as regularly breast-fed infants. 

Neonates Based on the prolonged half-life seen in premature newborns (gestational age 26 to 29 weeks), these children, in the first 2 weeks of life, should receive P.985... 

Phasic muscle twitches are one of the major REM phasic activities in neonates and also comprise prominent neonatal behavior. A similar feature is found not only in rats but also in other rodents and humans. The period that shows frequent muscle twitches is the first 4 weeks in the rat (4), the first 40 days in the kitten (8), and the first 8 months in the human newborn (13). In humans, this feature is more typical in the premature fetus (14). This activity appears primarily during REM sleep but also in a small portion of NREM sleep, i.e., half-activated sleep (4). The rate of muscle twitches is only 1.5/min and 0.3/min during quiet sleep compared to the rate of 7.5/min and 3/min, respectively, during REM sleep at the same age in PN 10 and PN 20 kittens (8). The number of phasic events dramatically decreases as animals mature (8,9,13,15). It is of interest to note that the dramatic reduction of phasic activities in REM sleep is associated with the increase of wakefulness. 

Two premature neonates, who already had epileptic manifestations related to severe hypoxic ischemic encephalopathy, developed seizures (one tonic and the other tonic-clonic) within a few seconds of receiving intravenous midazolam (0.15 pg/kg) for sedation (25). In one, the seizure recurred after rechallenge on the same day. Benzodiazepines occasionally cause tonic seizures, especially after intravenous administration to children with Lennox-Gastaut syndrome. This seems to be the first report related to midazolam in newborns. 

Pancreatic enzyme activity may be low at birth, but enzymes such as amylase, lipase, and trypsin develop to adult levels within the first year of life. Premature infants appear to have lower amylase levels than do full-term infants. Low concentrations of pancreatic enzymes may be the reason why newborns have a decreased ability to cleave prodrug esters such as chloramphenicol palmitate. Lipid-soluble drugs may not be well absorbed by neonates because of low lipase concentrations and bile acid pool. ... 

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. 

Surfactant aerosol also has been tested in chronic bronchitis the modest improvement in FEV1 was small, and its expense would not justify use based on these data [175]. In tests of aerosol surfactant in adults with CF treated over 5 days, no improvement was found [176]. Although instilled surfactant has become common practice for the neonatal respiratory distress of premature infants, aerosol delivery is not yet adequately developed. A recent study showed no difference in outcome for spontaneously breathing newborns who inhaled either surfactant or placebo via a CPAP mask [177]. There continues to be great appeal for the use of surfactant in adults because of the apparent success in neonates, but its use should not become practice until well-controlled trials document clinically meaningful efficacy. 

RDS, historically known as hyaline membrane disease (HMD), is more appropriately termed surfactant-deficiency RDS. RDS is associated with considerable morbidity and mortality. Before 35 weeks gestation, the risk of RDS and the severity of disease increase with greater degree of prematurity and, in the absence of appropriate antenatal interventions, occurs in over 50% of newborns of 30 weeks or less gestation. The Vermont Oxford Network experience for 1999 describes over 27,000 neonates below 1500 g from 325 neonatal intensive care unit (NICU) sites. The annual report noted that RDS occurred in over 80% of premature infants below 1000 g and that there was a gradual decline to about 42% of neonates with birth weights between 1400 and 1500 g. 

The liver of a newborn baby may not be capable of conjugating all the bilinibin presented to it. The consequence is neonatal jaundice, and many babies become jaundiced during the first week of life. In full-term babies this usually resolves rapidly. In premature babies whose liver function is not fully mature the jaundice may be more severe and the bilirubin concentration takes longer to fall. 

Iodine is readily absorbed when PVP-I is applied to the skin of a newborn infant, because of high cutaneous permeability, and neonates are very sensitive to iodine overload, as described previously. Topical PVP-I therapy is associated with a significant risk of hypothyroidism in neonates, especially very-low-weight babies (Smerdely et ai, 1989). Many cases of hypothyroidism induced by topical use of PVP-I have been reported in newborn infants, mainly from iodine-deficient regions (Markou et ai, 2001). However, a case of severe hypothyroidism in a neonate was also reported from North America, an iodine-sufficient region (Khashu et al. 2005). A premature infant developed severe hypothyroidism that required L-thyroxine replacement therapy after application of PVP-I for 20 days. 

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