Advantages And Disadvantages Of Premature Infants

According to the World Health Organization (WHO, 2016), preterm birth are the birth that happened before 37 ended weeks of pregnancy and is one of the number reason of newborn deaths and the second prominent cause of deaths in children below five. The preterm babies have chances of an amplified risk of illness, disability and death. In the first weeks, the complications of premature birth may include: breathing problems, heart problems, brain problems, temperature control problems, gastrointestinal problems, blood problems, metabolism problems, immune system problems. Long-term complications includes cerebral palsy, impaired cognitive skills, vision problem, hearing problems, dental problems, behavioral and psychological problems, chronic health issues.

Another important intervention was to maintain the head of the bed at 30-45 degrees and position L.M.’s left lung into a dependent position to improve ventilation and perfusion. L.M.’s O2 was decreased to 63 and her CO2 was increased to 50. According to the IHI, it is recommended to elevate the bed to 30- 45 degrees to improve ventilation. Patients that lay in the supine position have lower spontaneous tidal volumes on pressure support ventilation compared to those laying at more of an angle (Institute for Healthcare Improvement, 2012). In regards to positioning, when the least damaged portion of the lung is placed in a dependent position it receives preferential blood flow. This redistribution of blood flow helps match ventilation and perfusion, therefore, improving gas exchange (Lough, Stacy & Urden, 2010). Implementing these interventions combined with respiratory therapy, significantly improved the blood gas values for oxygen and carbon dioxide levels.

The new versus classic BPD features have changed over the years. The approaches to care, including surfactant administration, permissive hypercapnia, and noninvasive ventilation have changed. All these has increased the survival of low birth weight infants as before with classic BPD. The classic BPD was before surfactant and more management techniques, and inflammation and alveolar septal fibrosis. All these changes were associated with oxygen toxicity, infection, and barotrauma.

Premature birth has been linked to a vast array of lungs problems, the earlier the birth the greater risk of health complications(Davis R and Mychaliska G, 2013). A majority of the health problems will affect the infant for the rest of their life (Davis R and Mychaliska G, 2013). Infants born between the canalicular and the saccular period (week 25) have lung development that is unsuitable for gas exchange (Davis R and Mychaliska G, 2013). Two major complications that arise with undeveloped lungs is bronchopulmonary dysplasia, and pulmonary arterial hypertension (Mahgoub L. et al. 2017).

The patient population is the preterm babies that are less than 37 weeks’ and weight

According to the World Health Organisation [WHO] (2014) pre-term babies are at increased risk of illness, disability and death. It also states that globally 15 million babies are born pre-term and the figures are rising. In England and Wales during 2012 7.3% of live births were pre-term under 37 weeks nearly 85% of all babies born prematurely will have a very low birth weight (Office for National Statistics, 2012). Pre-term birth is associated with respiratory complications and lung disease, long-tern neurological damage and problems with bowel function (Henderson & Macdonald, 2011). Neonatal services provide care to babies who are born prematurely or are ill and require specialist care. It is seen that sixty per cent of infant deaths occur in the neonatal period (DH,

Now, medical advances make it possible for even the most severe premature babies to survive. Preterm babies as young as 22 to 23 weeks gestation can survive, but the costs associated with them is high (Kornhauser & Schneiderman, 2010). The higher cost is attributed to the extended hospital stay of micro preemies in Level 3 NICU (Bird, 2014). Level 3 NICU offers a wide range of neonatal services that include special imaging techniques, advanced ventilation

ation that I will be discussing is Airway Pressure Release Ventilation (APRV). I have not had an opportunity to use this mode, so I thought I would research it for this assignment. “The degree of ventilator support with APRV is determined by the duration of the two CPAP levels and the mechanically delivered tidal volume. Depends mainly on respiratory compliance and the difference between the CPAP levels. By design, changes in ventilatory demand do not alter the level of mechanical support during APRV. When spontaneous breathing is absent, APRV is not different from conventional pressure-controlled, time-cycled mechanical ventilation”( Putensen, C. )APRV is a form of improved pressure ventilation allowing unrestricted spontaneous breath at an

With a mean gestational age of 29.1 weeks. Because of the failure of the medical treatment,

Ultimately, in 1990, the United States Food and Drug Administration (FDA) approved the use of surfactants in neonates. Since then, surfactant therapy is considered as one of the few treatments that has reduced general mortality in preterm newborns with RDS. On the basis of production, surfactant is divided into two types: natural and synthetic (Roger Soll et al. 2001). The meta-analysis of number of smaller studies comparing synthetic and natural surfactants have shown that synthetic surfactants with their slower response might be supported for prophylaxis use, whereas natural surfactants with their fast response might be more suitable for very sick infants at danger of barotraumas and pulmonary air leaks (Richard A et al,2014). A meta-analysis comparing the effectiveness of prophylactic vs. selective exogenous surfactant administration, carried out by Rojas-Reyes et al., 2012 showed that prophylactic administration reduces the rate of pneumothorax, pneumonic interstitial emphysema, neonatal mortality and death to more marked extent than specific treatment (Rojas-Reyes et al., 2012). Comparing the meta-analysis of six randomized controlled trails (RCTs) on the benefits of early (< 2 hours) and delayed (> 2 hours) surfactant administration, (Richard playka et al., 2002). It has been deduced that early selective surfactant administration to infants with RDS requiring assisted ventilation leads to a reduced risk of acute pulmonary injury and a decreased risk of

As an aspiring neonatologist, I became aware of the work of Dr. Jeffrey Whitsett on respiratory distress in premature infants. I have read some of his research that have been published in the American Academy of Pediatrics as well as the New England Journal of Medicine. Premature infants can rarely breathe normally after birth without administering surfactant and its use allows infants as young as 24 weeks gestation to survive. Having volunteered in a neonatal intensive care unit since my senior year of high school, I have been able to witness physicians administer surfactant to neonates in respiratory distress while either on my volunteer shift or shadowing physicians in the unit. Attending the University Of Cincinnati College Of Medicine

Respiratory distress syndrome (RDS), “is a developmental deficiency in surfactant synthesis accompanied by lung immaturity and hypoperfusion” (Blackburn, 2013, p. 342). Based on the above scenario, there are so many factors that could lead to surfactant deficiency and I would like to discuss on three factors like preterm birth, poorly controlled diabetes, and cesarean section as the reasons for RDS.

| 1. “The presence of coarse crackles during late inspiration indicates fluid in the airway; wheezing indicates a narrowed airway” (Simpson, 2006, p. 487).2. “A normal respiratory rate for an adult without dyspnea is 12-16. With secretions in the airway, the respiratory rate will increase” (Simpson, 2006, p. 486).3. “An oxygen saturation of less than 90% or a partial pressure of oxygen of less than 80 indicates significant oxygenation problems” (Sanford &amp; Jacobs, 2008, p. 125).4. “An upright position allows for maximal lung expansion; lying flat cause abdominal organs to shift toward the chest, which crowds the lungs and makes it more difficult to breathe” (Sanford &amp; Jacobs, 2008, p. 125).5. “This technique can help increase sputum clearance and decrease cough spasms. Controlled coughing was the diaphragmatic muscles, making the cough more forceful and effective” (Sanford &amp; Jacobs, 2008, p. 125).6. “This technique prevents the glottis from closing during the cough and is effective in clearing secretions in the central airways” (Sanford &amp; Jacobs, 2008, p. 126).7. “In

The developmental stage and health needs of the baby were assessed, both her weight and head circumference measurement were at the 25th centile indication no weight loss which gave mother reassurance. This information is vital for babies born with low birth weight such as baby A are more likely to die from Sudden Infant Death Syndrome (Carpneter et al, 2004). Baby was also developing, thriving and feeding well with no concerns. The health visitor also remained mother about immunisation as recommended in Healthy Child (2009), 6 to 8 weeks’ review and avoiding crowded places for the first few weeks due to the risk of infection. Room temperature regulation was discussed which was between 17 and 21 degrees or at times may need to be higher depending on size, gestation and wellbeing of baby (Crawford, 2010).

Respiratory distress syndrome (RDS) is a common lung disorder that mostly affects preterm infants. RDS is caused by insufficient surfactant production and structural immaturity of the lungs leading to alveolar collapse. Clinically, RDS presents soon after birth with tachypnea, nasal flaring, grunting, retractions, hypercapnia, and/or an oxygen need. The usual course is clinical worsening followed by recovery in 3 to 5 days as adequate surfactant production occurs. Research in the prevention and treatment of this disease has led to major improvements in the care of preterm infants with RDS and increased survival. However, RDS remains an important cause of morbidity and mortality especially in the most preterm infants. This chapter reviews the most current evidence-based management of RDS, including prevention, delivery room stabilization, respiratory management, and supportive care.