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[Neonatal care of premature infants]
1Pécsi Orvostudományi Egyetem, Szülészeti és Nögyógyászati Klinika.
Insights
Neonatal intensive care centers manage preterm infants, facing challenges with very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. Advances in preventing and treating conditions like idiopathic respiratory distress syndrome (IRDS) have significantly reduced neonatal mortality.
Area of Science:
- Neonatology
- Perinatology
- Pediatric Intensive Care
Context:
- High rates of preterm deliveries, including very low birth weight (VLBW) and extremely low birth weight (ELBW) infants, present significant challenges in regional perinatal intensive centers.
- Increased incidence of immature infants (<750g) with poor outcomes observed following new preterm delivery regulations.
- Idiopathic respiratory distress syndrome (IRDS) is a primary concern in preterm infants.
Purpose:
- To review current preventive and therapeutic interventions for preterm infants, focusing on improving outcomes in neonatal intensive care.
- To highlight the role of maternal and fetal steroid therapy, surfactant treatment, and cardiopulmonary adaptation monitoring in managing preterm neonates.
- To discuss strategies for addressing common complications such as late hyponatremia, metabolic acidosis, and osteopenia, alongside anemia management.
Summary:
- Maternal steroid treatment and fetal steroid therapy are key for preventing idiopathic respiratory distress syndrome (IRDS), with surfactant products revolutionizing its treatment.
- Cardiopulmonary adaptation in preterm infants is influenced by factors like maternal tocolytic therapy and Cesarean section, monitored via impedance cardiography.
- Careful fluid therapy, planned enteral feeding with gastric emptying assessment, osteopenia prevention through passive exercise, and anemia treatment with erythropoietin are crucial.
- Comprehensive neonatal care includes screening for vision and hearing impairments and neurodevelopmental follow-up.
Impact:
- Significant decrease in neonatal mortality in Hungary over recent decades attributed to the implementation of advanced preventive and therapeutic strategies.
- Improved management protocols for preterm infants, particularly VLBW and ELBW neonates, leading to better survival and long-term health outcomes.
- Established best practices in neonatal intensive care, emphasizing a multidisciplinary approach to preterm infant management.
Abstract:
Perinatal intensive centers deal with preterm infants of the region. Therefore, the rate of preterm deliveries at the Department of Obstetrics and Gynecology, Medical University of Pécs was high in 1997, about the double of the national rate (18.7%). Among prematures the rate of very low birth weight (VLBW) infants (less than 1500 g) was about 40%, moreover, the rate of extremely low birth weight infants (less than 1000 g) was 39% within the latter group. Related to the new regulation concerning preterm delivery the number of immature infants (weighing less than 750 g) with poor outcome increased. The most characteristic disease of preterm infants is the idiopathic respiratory distress syndrome (IRDS). This could be prevented by maternal steroid treatment, a therapy accepted worldwide, however, not so common in Hungary. Direct fetal steroid therapy may be applied also in selected cases. In the treatment of IRDS surfactant products made a breakthrough. Several factors (maternal tocolytic and fluid therapy, Cesarean section) influence the cardiopulmonary adaptation which may be monitored with impedance cardiography. Late hyponatremia and metabolic acidosis may develop in 1/3 of VLBW infants. Besides the fluid therapy the introduction of enteral feeding must be planned carefully and examination of gastric emptying with ultrasound is useful. The development of osteopenia may be prevented by passive exercise of the preterm infant. Anemia is common and human recombinant erythropoietin is available for treatment. Screening of vision, hearing, and neurodevelopmental follow up are integral parts of neonatal care. As a result of the above mentioned preventive and therapeutic interventions neonatal mortality has decreased significantly in Hungary in the past decades.