Anemia of Prematurity - Portal Neonatal

Interactions
suspected necrotizing enterocolitis (NEC)
May interfere with renal excretion of drugs (eg, gentamicin); may
increase serum potassium levels when administered with potassiumsparing
diuretics
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions
Pregnancy category D if used for more than 48 h or after 34 wk of
gestation; fluid and electrolyte imbalance including hyperkalemia;
possible cerebral hypoperfusion and ischemia; alterations in regional
blood flow including gastrointestinal and renal;acute renal failure; oliguria
Drug Category: Carbonic anhydrase inhibitors -- Suppress CSF production.
Drug Name
Pediatric Dose
Contraindications
Acetazolamide (Diamox) -- The suppression of CSF production in slowly
progressive ventricular dilation is controversial. Acetazolamide is a
competitive and reversible inhibitor of carbonic anhydrase.
5 mg/kg/dose PO/IV q6h initially; increase by 25 mg/kg/d; not to exceed
100 mg/kg/d
Patients with hyperchloremic acidosis; decreased serum sodium and/or
potassium
Interactions May increase the excretion of phenobarbital
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions
Hypercalciuria and nephrocalcinosis (especially in combination with
furosemide); possible interference with CNS myelination; metabolic
acidosis; hypokalemia; hepatic dysfunction
FOLLOW-UP Section 8 of 11
Further Inpatient Care: Developmental intervention programs
Further Outpatient Care:
• Neurological follow-up
• Developmental follow-up
Deterrence/Prevention:
• Prevention of PVH-IVH begins with avoidance of conditions that do the following:
o Interfere with autoregulation (eg, hypocarbia, hypercarbia, hypoxia, acidosis
o Overwhelm autoregulatory abilities (eg, hypertension)
o Contribute to rapid fluctuations of cerebral blood flow (eg, ventilatory asynchrony,
rapid volume expansion, noxious stimuli, frequent handling)
• Perform correction of host factors (eg, coagulopathy, acid-base balance, hydration, hypoxiaischemia).
• Pharmacological prophylaxis can be accomplished through the use of indomethacin. Although
the mechanism of action is currently unknown, indomethacin has been shown to reduce the
incidence of PVH-IVH and, specifically, high-grade hemorrhages. Follow-up of patients
enrolled in a multicenter prophylaxis study conducted by Ment is encouraging. Although motor
skills are not different when patients are aged 4.5 years, cognitive and social skills appear
better in patients receiving prophylaxis. However, because of complications, this therapy is
not universally accepted and remains controversial.
• In addition to effects on pulmonary development, prenatal treatment with glucocorticoids has a
protective effect with regard to PVH-IVH.