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AggressiveManagementofVeryPrematureVeryLow-birthWeightBabiesPP.pptxAggressive Management of Very Premature, Very Low-birth Weight Babies
Introduction
Premature births, also called preterm births, occur when babies are born in less than 37 weeks of pregnancy.
The older the fetus, the heavier the birth weight at birth.
Preterm births that occur too early in the gestation period result in significantly low birth weight of the babies.
There are several risk factors of preterm birth including diabetes, stress, hypertension, infection among others.
Every year, about 15 million babies are born prematurely around the world (Ali et al., 2016).
Preterm births are one of the most challenging things that obstetricians are faced with. According to Ali et al. (2016), about 15 million babies are born prematurely around the world. The global preterm birth rate ranges between 5% and 18%, and India’s rate of 21% makes the country have the highest preterm birth rate in the world. Ali et al. argue that the mode of delivery of preterm babies does not affect the survival of the neonates. However, it is advisable to conduct cesarean delivery when other obstetric considerations need to be made aside from the birth itself.
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Delivery of Preterm Babies
Aggressive management of very premature, very low-birth weight babies starts from the time the babies are delivered.
Although nearly half of preterm births occur spontaneously, aggressive delivery may be used in some cases (Ali et al., 2016).
Even though the survival rate of preterm births occurring in the low 20s of the gestational period have very neonatal mortality rates, advances in neonatal intensive care unit (NICU) technology have improved survival rates of very premature babies (Ali et al., 2016).
Very premature and very low-birth weight babies are increasingly surviving even at low gestational age. This is because the combined use of neonatal intensive care units and antenatal corticosteroids has increased salvageability of premature babies born at very low gestational age (Ali et al., 2016). One of the main challenges regarding the issue of preterm births is very low awareness among members of the public.
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Conditions Threatening Premature Babies
Very low-birth weight and premature babies are very susceptible to infections, diseases and health conditions which expose the babies to neonatal morbidity and mortality.
These conditions include:
Hyperbilirubinemia.
Respiratory distress syndrome (RDS).
Sepsis.
Patent ductus arteriosus (PDA).
Retinopathy of prematurity (ROP)
According to Ali et al. (2016), preterm babies are very likely to suffer from sepsis, respiratory distress syndrome, intra-ventricular hemorrhage and hyperbilirubinemia. Intra-ventricular hemorrhage results from patent ductus arteriosus (PDA). PDA is very common in very premature babies. Perez & Laughon (2015) argue that PDA has an incidence of up to 75% in preterm babies born at less than 28 weeks of gestation. PDA is very dangerous because it decreases the blood flow in body organs, therefore depriving tissues of sufficient oxygen. In addition, Shah, Narendran & Kalpana (2016) note that retinopathy of prematurity (ROP) is also common among premature babies.
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Conditions Threatening Premature Babies
In order to control these conditions, aggressive management of very premature, very low-birth weight babies is required.
This is because management of these conditions reduces neonatal mortality by a significant margin.
Aggressive management of very premature, very low-birth weight babies is important because preterm birth is the most common cause of death among infants.
It is necessary to aggressively manage preterm babies in order to improve their chances of survival. Conditions like patent ductus arteriosus (PDA) result in numerous morbidities of prematurity (Perez & Laughon, 2015). PDA can be managed through pharmaceutical means using ibuprofen, acetaminophen and indomethacin. Surgical management of PDA is done through cardiac catheterization. Shah, Narendran & Kalpana (2016) recommend aggressive management of retinopathy of prematurity (ROP) because some forms of ROP can result in blindness if untreated.
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Neonatal Intensive Care Unit
Neonatal intensive care units (NICU) are intensive care units which are designed for the sole purpose of caring for premature babies.
They are also known as intensive care nurseries (ICN).
The main equipment used in the NICU is an incubator.
Incubators are used to maintain favorable environmental conditions for the care of preterm babies and newborns.
NICU is very useful in aggressive management of very premature, very low-birth weight.
Neonatal Intensive Care Unit
There are many different models of aggressive management of preterm babies using NICU. Two examples of these models are:
Family integrated care (FIC) in neonatal intensive care units.
Regulation of auditory exposure of the preterm babies.
Family integrated care is implemented where parents provide most of the care for the infants with the help of counsel and teachings from nurses (O’Brien et al., 2013).
Regulation of auditory exposure of preterm babies in NICU is aimed at maintaining the acoustic environment of the womb (Panagiotidis & Lahav, 2010).
Neonatal intensive care unit (NICU) is very useful in aggressive management of premature babies. One of the models of NICU use is through family integrated care. The main goal of family integrated care (FIC) is to facilitate a care partnership between care providers and the parents of NICU babies. FIC enables parents to participate in the care of their infants. According to O’Brien et al. (2013), family integrated care is very helpful in aggressive management of premature babies in NICU, especially where the participation of the infants’ parents is required, for example through breastfeeding. Additionally, the participation of parents in the care of infants in NICU helps to reduce the stress of the infants. The neonatal intensive care unit is also used to maintain the acoustic environmental conditions of the womb (Panagiotidis & Lahav, 2010). Panagiotidis & Lahav argue that the NICU environment helps to protect the infant’s brain development, therefore preventing speech, hearing, attention, language and self-regulation problems.
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Medical Care of Premature Babies
Very Premature and very low-birth weight babies are highly susceptible to infections and other health conditions.
Aggressive management of very premature, very low-birth weight babies can cause the babies a lot of stress.
Therefore, sedatives are used to reduce stress and minimize complications
However, sedation of neonates in NICUs using intravenous midazolam infusion raises questions on the safety of the infants (Taddio, Ohlsson & Ng, 2017).
Premature babies undergoing uncomfortable medical procedures should be properly sedated. According to Taddio, Ohlsson & Ng (2017), sedation helps to reduce stress and avoid complications. However, short-acting benzodiazepines such as midazolam have questionable safety standards even though they achieve high levels of sedation. Therefore, the use of such medication in the aggressive management of preterm babies should be carefully monitored.
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Medical Care of Premature Babies
Retinopathy of prematurity (ROP) is a common disorder among very premature babies.
Although ROP usually regresses with time, it can result in irreversible blindness if retinal detachment occurs (Shah, Narendran & Kalpana, 2016).
Aggressive management of ROP among preterm babies can be done using Fundus fluorescein angiography (FFA), which has been used in the treatment of ROP (Shah, Narendran & Kalpana, 2016).
Although retinopathy of prematurity (ROP) regresses with time, aggressive posterior retinopathy of prematurity progresses (APROP) very rapidly and can result in blindness. Fundus fluorescein angiography (FFA) is used to treat APROP. FFA decreases both central and peripheral perfusion, therefore reducing vascularization. This leads to regression of APROP to conventional ROP. However, nurses who are aggressively managing very premature and very low-birth weight babies should avoid using FFA on babies who are using supplemental oxygen. This is because supplemental oxygen in preterm babies causes normal vessel growth to stop and existing vessels to regress, therefore interfering with vascular development (Shah, Narendran & Kalpana, 2016).
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Medical Care of Premature Babies
Another common condition among premature babies is patent ductus arteriosus (PDA).
According to Perez & Laughon (2015), management of PDA in preterm babies is controversial.
Management of PDA is currently done through surgical ligation, use of oral acetaminophen, use of oral ibuprofen and indomethacin, and transcatheter PDA closure (Perez & Laughon, 2015).
It is necessary to aggressively manage preterm babies in order to improve their chances of survival. Conditions like patent ductus arteriosus (PDA) result in numerous morbidities of prematurity (Perez & Laughon, 2015). PDA can be managed through pharmaceutical means using ibuprofen, acetaminophen and indomethacin. Surgical management of PDA is done through cardiac catheterization. Indomethacin is a prostaglandin inhibitor that competes for “arachidonic acid at the site of the prostaglandin synthase enzyme” and therefore causing constriction of the PDA (Perez & Laughon, 2015). Ibuprofen is also a prostaglandin inhibitor, but it acts at the site of thcyclooxygenase enzyme. Acetaminophen inhibits the peroxidase portion of the prostaglandin synthase enzyme, therefore constricting the PDA.
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Medical Care of Premature Babies
Another condition associated with very low-birth weight babies is meconium obstruction.
Meconium obstruction results from a number of intestinal obstructions.
Aggressive management of preterm babies is used in complicated cases of meconium disease (Paradiso, Briganti, Oriolo, Coletta & Calisti, 2011).
Meconium complications range widely in severity. According to Paradiso, Briganti, Oriolo, Coletta & Calisti (2011), meconium disease is the most common meconium abnormality in very premature and very low-birth weight babies. Preterm babies often delay to pass meconium, and this leads to meconium obstruction of the intestines. In very severe cases, surgery can be used to manage meconium obstruction.
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Parental Interventions
Some techniques of aggressive management of premature babies require parental intervention.
Preterm premature rupture of membranes (PPROM) is a high risk factor of both neonatal and maternal morbidity.
Aggressive management of preterm births resulting from PPROM includes prolonging pregnancy through expectant management (Miyazaki, Furuhashi, Yoshida & Ishikawa, 2012).
Premature rupture of membranes occurs when membranes rupture before labor begins. Aggressive management of preterm premature rupture of membranes (PPROM) is done through a number of medical treatments. These treatments include amnioinfusion, cervical cerclage, antibiotics and tocolysis (Miyazaki, Furuhashi, Yoshida & Ishikawa, 2012).
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Parental Interventions
Another parental intervention used in the management of very premature, very low-birth weight babies is family integrated care (FIC).
FIC is often used in neonatal intensive care units (O’Brien et al, 2013).
FIC is implemented with the help of physicians, nurses, an infant’s parents and even the parents whose infants have previously been on neonatal intensive care units.
One of the models of NICU use is through family integrated care. The main goal of family integrated care (FIC) is to facilitate a care partnership between care providers and the parents of NICU babies. FIC enables parents to participate in the care of their infants. According to O’Brien et al. (2013), family integrated care is very helpful in aggressive management of premature babies in NICU, especially where the participation of the infants’ parents is required, for example through breastfeeding. Additionally, the participation of parents in the care of infants in NICU helps to reduce the stress of the infants.
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Nutritional Interventions
Aggressive management of premature and very low-birth weight babies requires strict nutritional adherence.
This is because it is important for the nutrition of the premature babies to result in the same level of growth as the growth of fetuses of a similar gestational age (Hay, 2013).
Aggressive nutrition of preterm babies ensures proper physiological development and reduces postnatal growth failure.
Conclusion
Aggressive management of very premature, very low-birth weight babies involves a broad range of practices and procedures.
These practices/procedures start from delivery of the preterm babies, and include placement in the neonatal intensive care unit (NICU), medical care of the preterm babies, parental intervention and even nutritional intervention.
References
Ali, J., Shivananda, R. P., Bhat, R. G., Sankar, A., Kumar, P., & Rai, L. (2016). Are aggressive deliveries of very preterm babies justified?. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5(5), 1545-1548.
Hay, W. W. (2013). Aggressive nutrition of the preterm infant. Current Pediatrics Reports, 1(4), 229-239.
Miyazaki, K., Furuhashi, M., Yoshida, K., & Ishikawa, K. (2012). Aggressive intervention of previable preterm premature rupture of membranes. Acta obstetricia et gynecologica Scandinavica, 91(8), 923-929.
References
O’Brien, K., Bracht, M., Macdonell, K., McBride, T., Robson, K., O’Leary, L., ... & Lee, S. K. (2013). A pilot cohort analytic study of Family Integrated Care in a Canadian neonatal intensive care unit. BMC Pregnancy and Childbirth, 13(1), S12.
Panagiotidis, J., & Lahav, A. (2010). Simulation of prenatal maternal sounds in NICU incubators: a pilot safety and feasibility study. The Journal of Maternal-Fetal & Neonatal Medicine, 23(3), 106-109.
Paradiso, V. F., Briganti, V., Oriolo, L., Coletta, R., & Calisti, A. (2011). Meconium obstruction in absence of cystic fibrosis in low birth weight infants: an emerging challenge from increasing survival. Italian journal of pediatrics, 37(1), 55.
References
Perez, K. M., & Laughon, M. M. (2015). What is new for patent ductus arteriosus management in premature infants in 2015?. Current Opinion in Pediatrics, 27(2), 158-164.
Shah, P. K., Narendran, V., & Kalpana, N. (2012). Aggressive posterior retinopathy of prematurity in large preterm babies in South India. Archives of Disease in Childhood-Fetal and Neonatal Edition, 97(5), F371-F375.
Taddio, A., Ohlsson, A., & Ng, E. (2017). Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Cochrane Database of Systematic Reviews, (1).
