Anemia of Prematurity - Portal Neonatal

Diet: Depending on the degree of neurologic impairment, infants or children may have limitations in
their ability to eat normally. Diet and nutrition must be individualized with the help of the
neurodevelopmental team caring for the patient.
Activity: Some neurologic deficits typically appear during the phase of motor skill acquisition by the
infant. Motor deficits should be identified early, and appropriate intervention should be initiated to
maximize the infant's ability in this critical area.
MEDICATION Section 7 of 11
No medications are available to treat the symptoms of acute or chronic bilirubin encephalopathy.
Pharmacologic intervention is aimed at prevention. Current therapies are indicated as adjuncts to
phototherapy when total bilirubin is approaching exchange level; experimental therapy continues with
the use of bilirubin production inhibitors.
Drug Category: Blood product derivatives -- These methods decrease the amount of free bilirubin
in the intravascular space, thus theoretically reducing the risk of neurotoxicity. Bilirubin is produced via
induction of its enzymatic pathway and by RBC degradation. Inhibition of either of those 2
mechanisms can decrease the amount of bilirubin in the blood.
Albumin (Albuminar, Albunex, Albumisol, Buminate) -- Because bilirubin
bound to albumin is not available to cross the blood-brain barrier,
increasing the amount of serum albumin theoretically increases the
amount of available binding sites and decreases free bilirubin. Efforts to
Drug Name quantify albumin-binding capability or serum levels of bound bilirubin
have not proved to be clinically useful. Therefore, administration of
albumin for the purpose of increasing bilirubin-binding capacity is not a
recommended standard of care. It may be considered in cases of
significant hypoalbuminemia.
Pediatric Dose 0.5-1 g/kg IV of 5% albumin (ie, 5 g/100 mL)
Documented hypersensitivity; pulmonary edema; severe anemia; cardiac
Contraindications
failure
Interactions None reported
Pregnancy C - Safety for use during pregnancy has not been established.
Use 25% albumin with caution in premature neonates because of the
increased risk of intraventricular hemorrhage; caution in renal or hepatic
failure, may cause protein overload; rapid infusion may cause vascular
overload or hypotension; monitor for volume overload; caution in sodium-
Precautions restricted patients; common adverse effects include CHF, hypotension,
tachycardia, fever, chills, and pulmonary edema; do not dilute albumin
25% with sterile water for injection (produces hypotonic solution and, if
administered, may result in life-threatening hemolysis and acute renal
failure)
Immune globulin intravenous (Gamimune, Gammagard, Sandoglobulin) -
- Parenteral administration has been shown in controlled clinical trials to
Drug Name reduce the need for exchange transfusion in both Rh and ABO immunemediated
hemolytic disease. Its mechanism of action is not entirely clear.
0.5-1 g/kg IV; administration must be initiated very slowly and gradually
Pediatric Dose
increased because of the possibility of acute transfusion reaction
Contraindications Documented hypersensitivity; IgA deficiency
Globulin preparation may interfere with immune response to live virus
Interactions
vaccine and reduce efficacy (do not administer within 3 mo of vaccine)
Pregnancy C - Safety for use during pregnancy has not been established.