Premature babies

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. 

Figure 4. Sketch of the probe used for the detection of blood gases in critically-ill premature babies...

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 ... 

The activity of glucuronidation is low in the newborn, especially in premature babies (6). This is evident in the jaundice observed in many newborns because the major clearance pathway for bilirubin is glucuronidation. This can also lead to increased toxicity of some drugs in the newborn such as the grey baby syndrome seen in newborns treated with chloramphenicol. 

Premature babies do not have enough of this surfactant, and their lungs can t expand on their own. Understanding surface tension has allowed doctors to manufacture surfactants to help these babies breathe until they can make their own. 

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. 

The specific gluconeogenic enzymes in the liver of the foetus develop late in pregnancy, so that premature babies can develop hypoglycaemia soon after birth and provision of glucose is essential for their survival. 

It is present at a high concentration in human milk, presumably to ensure that it is available for the developing brain, but its concentration is very low in cow s milk. It is added to the feeding solutions used for premature babies and neonates. 

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. 

More and more babies are being born prematurely (elective Caesarian sections for pregnancy-induced hypertension, diabetes, foetal distress of varying kinds). Neonatal units need highly specialized skills in managing these tiny creatures - occasionally as much as 10-12 weeks premature. Among the very many special problems of the premature baby are those related to drug administration and elimination. 

Gray baby s5mdrome Premature babies develop vomiting, hypothermia, abdominal distension, shallow irregular respiration and further leading to gray cyanosis, vascular collapse, shock and death. 

Age does not have a major influence on amino acid levels, with exception of the neonatal period. Premature babies may have underdeveloped hepatic and renal function, leading to increased tyrosine and methionine in their plasma as well as enhanced urinary losses of cystine, lysine, glycine, proline, hydroxyproline, and cystathionine. Taurine levels are generally increased in the first days of life. 

Size exclusion chromatography coupled to an ICP-QMS with an octopole collision cell was employed for the multi-elemental speciation of essential elements (P, S, Cr, Mn, Fe, Co, Cu, Zn, Br, Se and I) and Al as a toxic element in premature human milk.28 Comparison of speciation results demonstrates that premature human mothers milk differs significantly from formula milks in terms of the element binding pattern to the biomolecules. It was found that premature human milk is very rich in high molecular weight species associated with metals. The authors concluded that more attention must be paid to the chemical form in which essential elements are added to the formulas, particularly those used for the nutrition of premature babies.28... 

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. 

Povidone-iodine is contraindicated in premature babies and neonates this also applies to prophylactic disinfection of the umbilical stump. 

Glucagon infusion in premature babies is risky more information is necessary. 

The lung possesses a variety of epithelial cells, with different types found in different regions. Alveolar type II cells represent a potentially important target for the delivery of intracellular enzymes, such as superoxide dismutase (SOD) and catalase, which do not reach their full complement until the final 10-15% of gestation. Until the enzymes do reach their full complement, the premature baby... 

Outbreaks of disease have been caused by those with artificial fingernails. In 2004 there was an outbreak of Klebsiella pneumoniae among premature babies in a US intensive care unit, caused by bacteria from a nurse s artificial nails. A few years previously it was Pseudomonas aeruginosa that threatened several newborn babies in a New York hospital and this was traced to the same cause. In Canada three patients who had had surgery on their spinal cord developed Candida infections of the spinal disks and this was traced to an operating theatre technician who had artificial nails. An intensive care unit in Oklahoma City saw 16 patients die as a result of contracting Pseudomonas aeruginosa from two nurses who had artificial nails. Thankfully such outbreaks are now extremely rare. 

From a nutritional viewpoint, it is necessary to stress the current importance of carrying out the multielemental analysis of milk samples (either human, cow s, or formula milk) in order to establish the reference values of essential elements and quantify the levels of potentially toxic elements. This fact is more relevant to formula milk production for premature babies as some essential elements are not stored by the fetus during its development in the uterus. Attention has been already paid to the qualitative and quantitative composition (analysis) of proteins, lipids, carbohydrates, and, of course, essential elements. However, in the case of human nutrition, knowledge on the particular species (compounds) in which a given element is present (chemical speciation) is now urgently needed, because the absorption and bioavailability of the essential element will strongly depend on that particular chemical form. Thus, although only the total element daily requirements have been considered here, it is important to stress that more attention must be paid to the chemical form in which essential and potentially toxic elements are present in milk. Such aspects are dealt with in detail in Chapter 13 by B. Michalke et al. 

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. 

The inhaling of small quantities of nitric oxide can help premature babies (or babies with holes in the heart) to breathe and prevent serious lung disorders. 

Primary intraventricular hemorrhage is very unusual, except in premature babies. In adults, a cause is not always found. Some may be secondary to a vascular malformation in the ventricular wall (Gates et al. 1986 Darby et al. 1988). The clinical features may be indistinguishable from subarachnoid hemorrhage and it may only be differentiated at autopsy. 

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