Preterm infants

Inhaled NO has been used for treatment of persistent pulmonary hypertension of newborn infants, critical respiratory failure of preterm infants, and acute hypertension of adult cardiac surgery patients. PDE-5 inhibitors such as sildenafil are also effective for treatment of pulmonary hypertension. The combination of PDE-5 and NO inhalation yields additive beneficial effects on pulmonary hemodynamics. On the other hand, measurement of exhaled NO is a noninvasive and reproducible test that is a surrogate measure of airway inflammation in patients with bronchial asthma. 

Donovan, S.M., Atkinson, S.A and Lonnerdal, B. 1986 Total nitrogen and non-protein nitrogen balance in preterm infants fed preterm human milk. In Jensen, R.G. and Neville, M.C., eds.. Human Lactation 2. Maternal and environmental factors. New York, Plenum Press 603-610. 

Camitine deficiency can occur particularly in the newborn—and especially in preterm infants—owing to inadequate biosynthesis or renal leakage. Losses can also occur in hemodialysis. This suggests a vitamin-fike dietary requirement for carnitine in some individuals. Symptoms of deficiency include hypoglycemia, which is a consequence of impaired fatty acid oxidation and hpid accumulation with muscular weakness. Treatment is by oral supplementation with carnitine. 

Sutton AM, Harvie A, Cockburn F, Farquharson J, Logan RW (1985) Copper defidency in preterm infants of very low birthweight. Four cases and a reference range for plasma copper. Arch Dis Childh 60 644-651. 

Criteria developed in the National Institute of Medicine Study (Gortmaker 1979) was used to establish the adequacy of prenatal care. In 67 Dercent of our 12 cases. Drenatal care durina nrea-nancy was inadequate. However, among mothers of preterm infants, care was inadequate in all cases. Thirty-three percent of all mothers received no prenatal care. ... 

Mothers of preterm infants were also more likely than mothers of full-term infants to have obstetrical complications at the time of delivery. Eighty percent of mothers of preterm infants had three or more obstetrical complications. Possible complications included premature labor, oremature rupture of membranes, prolonged rupture of membranes, Caesarean section, chorioamnionitis, and marginal placenta abruption. In contrast, only one mother of a full-term infant developed obstetrical complications during the perinatal period. 

However, the pregnancies of 67 percent of all mothers were complicated by a variety of medical problems including anemia, hepatitis B, syphilis, and psychiatric emergencies. At the time of delivery, 57 percent of mothers of full-term infants and 80 percent of mothers of preterm infants were noted to have had one or more medical problems during the pregnancy. Seventy-five percent of... 

Transdermal Administration. The development of the stratum corneum is complete at birth and is considered to have permeability similar to that of adults, except in preterm infants [81], Preterm neonates and infants have an underdeveloped epidermal barrier and are subject to excessive absorption of potentially toxic ingredients from topically applied products. 

R. Heimler, B. Doumas, B. Jendrzeczal, P. Nemeth, R. Hoffman, and L. Nelin, Relationship between nutrition, weight change and fluid compartments in preterm infants during the first week of life, J. Pediatr, 122, 110 (1993). 

Daily fluid requirements for children and preterm infants who weigh less than 10 kg are at least 100 mL/kg. An additional 50 mL/kg should be provided for each kilogram of body weight between 11 and 20 kg, and 20 mL/kg for each kilogram above 20 kg. 

PN should be considered after suboptimal nutritional intake for 1 day in preterm infants, 2 to 3 days in term infants, 5 to 7 days in well-nourished children, and 7 to 14 days in older children and adults. The route and type of PN depend on the patient s clinical state and expected length of PN therapy (Fig. 60-1). 

Human breast milk is the best nutrient for preterm infants and is often delivered via gavage feeding methods before the baby s sucking skills mature. Because sufficient quantities of the mother s fresh breast milk may not be available, milk may be frozen for later consumption or be provided by donor mothers. To protect against the risk of disease transmission, donor milk is usually pasteurized. In the present study, we assessed preterm infants responses to the odours of different categories of milk that are routinely available in neonatal intensive care nurseries. 

Nyqvist, K.H., Sjoden, P.-O. and Ewald, U. (1999) The development of preterm infants breastfeeding behavior. Early Human Dev. 55, 247-264. 

Pinelli, J. and Symington, A. (2005) Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants. Cochrane Database Syst. Rev. 19, CD001071. 

Wight, N.E. (2001) Donor milk for preterm infants. J. Perinatol. 21, 249-254. 

Calcium and Phosphate Needs of Preterm Infants Requiring Prolonged Intravenous Feeding... 

To define the incidence of fractures and rickets that we were encountering in infants who required prolonged parenteral feeding, we reviewed the roentgenograms of a series of preterm infants who developed necrotizing enterocolitis and who required at least four weeks of total parenteral nutritional support (4). These data are recorded in Table I. 

The observed calcium/phosphate ratio of 4.5 at the intercept of the calcium and phosphate retention curves that should minimize the sum of the urine calcium plus urine phosphate losses was difficult to believe in view of both the known Ca/P ratio of bone and the amounts we were adding to these solutions. This disparity between the optimal ratio determined experimentally and what we had assumed this ratio should be on the basis of known body composition is partially reconciled by the experiment of Sutton and Barltrop. They fed preterm infants stable Ca46 and observed that up to 20% of the isotope absorbed was subsequently excreted in the stool. Our infants also were undoubtedly having unmeasured calcium losses from the bile, pancreatic juice and succus entericus secreted into their intestine... 

Pregnancy Category B (ethacrynic acid, torsemide) Category C (furosemide, bumetanide). Since furosemide may increase the incidence of patent ductus arteriosus in preterm infants with respiratory-distress syndrome, use caution when administering before delivery. 

Percutaneous drug absorption can present special problems in newborns, especially in preterm infants. While the skin of a newborn term infant may have the same protective capacity as the skin of an adult, a preterm infant will not have this protective barrier until after 2 to 3 weeks of life. Excessive percutaneous absorption has caused significant toxicity to preterm babies. Absorption of hexachlorophene soap used to bathe newborns has resulted in brain damage and death. Aniline dyes on hospital linen have caused cyanosis secondary to methemoglobinemia, and EMLA (lidocaine/prilocaine) cream may cause methemoglobinemia when administered to infants less than 3 months of age. 

---