Anemia of Prematurity - Portal Neonatal

� A premature neonate, therefore, may have a longer risk period for SIDS after hospital
discharge.
� Little data about the comparative risks of SIDS among preterm neonates born at
different postconceptional ages exist. The similarity in postconceptional ages of death
for both term and preterm neonates, however, suggests that a neurodevelopmental
phenomenon may be among the etiologies of this as yet unexplained problem.
• Approaches to AOP and SIDS prevention
o Accumulating evidence from many countries indicates the importance of 2 factors for
SIDS prevention in term infants: placing infants supine for sleeping and preventing infant
exposure to cigarette smoke, both during and after pregnancy. Unless clear
contraindications exist, treat premature neonates in a similar manner. These interventions
appear to reduce the SIDS incidence far more than the use of home monitoring.
Monitoring, however, may be valuable in some clinical situations to treat AOP and to help
families cope with the discharge of a low-birth-weight infant.
o No evidence identifies AOP as an independent risk factor for SIDS, despite the ongoing
controversy surrounding the relationship between apnea and SIDS.
� Prolonged apnea has been reported in infants with near-miss SIDS (ie, infants who
have had an ALTE).
� Short apneic episodes, PB, and mixed and obstructive apnea have been identified in
infants with near-miss SIDS; these observations suggest that a ventilatory control
abnormality may contribute to SIDS.
� These observations prompted the development of polygraphic monitoring to measure
variables such as the heart rate, nasal airflow, chest and abdominal movement, and
transcutaneous oxygen tension or oxygen saturation in an attempt to predict the SIDS
risk in vulnerable infants.
� A number of studies involving large cohorts of infants have failed to demonstrate that
monitoring cardiorespiratory variables can be used to prospectively identify infants at
risk for SIDS.
� The SIDS risk is highest in infants aged 2-4 months, similar to the risk for an ALTE.
Positive family histories for these events are present in both infants who died from
SIDS and patients with apnea. Both have peak incidences during cold weather
months, and both typically occur while the infant is asleep.
� Posturing and cyanosis are often present, as does an increased incidence of
prematurity, low birth weight, and evidence of poor prenatal care.
� Findings from epidemiologic studies suggest that as many as 18% of SIDS cases
occur in infants who were born prematurely.
� Despite all of these common factors, large-scale trials that have been conducted to
verify the relationship between apnea and SIDS have failed to delineate a ventilatory
control abnormality that underlies SIDS.
o A reduction in the postneonatal mortality rate and rate of SIDS has been associated with
sleeping in a supine position rather than a prone position.
� Several groups have documented physiologic benefits for prone positioning versus
supine positioning in preterm neonates, including modest improvement in
transcutaneously measured PO2, more time in quiet sleep, decreased energy
expenditure, less apnea, and greater ventilatory responses to inspired carbon dioxide.
� To decrease the SIDS incidence, the American Academy Of Pediatrics has
recommended placing healthy neonates on their sides or backs and to avoid placing
infants in the prone position for sleeping.
� Oyen et al, in the Nordic Epidemiological SIDS study, concluded that sleeping in both
the prone and side positions increased the risk of SIDS. This risk is increased further
in low-birth-weight infants, infants born before term, and infants aged 13-24 weeks.
� The mechanism by which sleeping in the prone position could lead to SIDS is unclear.
o At the present time, more infants born prematurely are monitored at home than any other
pediatric population. As many as 15-20% of the 400,000 premature babies born annually
are treated with home cardiorespiratory monitoring, primarily to treat apnea but also to
prevent SIDS.