Anemia of Prematurity - Portal Neonatal

Procedures:
• Sedation, analgesia, or anesthesia whenever feasible
• Arterial puncture, venous puncture, and capillary blood sampling
• Vascular access
o Intravenous line placement
o Umbilical arterial catheterization
o Umbilical artery cut down
o Peripheral artery cannulation
o Umbilical venous catheterization
• Tracheal intubation or tracheostomy
• Bronchoscopy
• Thoracotomy tubes
• Pericardial tubes
• Gastric tubes
• Transfusion of blood, blood products, and exchange transfusion
• Lumbar puncture
• Suprapubic bladder aspiration and bladder catheterization
Histologic Findings: See Pathophysiology and Image 2.
TREATMENT Section 6 of 11
Medical Care:
• Prenatal prevention and prediction of RDS: Obstetricians with experience in fetal medicine
should care for mothers whose infants are at an increased risk for developing RDS,
preferably at a tertiary perinatal center. Strategies to prevent premature birth (eg, bed rest,
tocolytics, appropriate antibiotics) and the prudent use of antenatal steroids to mature fetal
lungs may decrease the incidence and severity of RDS. Fetal lung maturity can be predicted
by estimating the lecithin-to-sphingomyelin ratio and the presence of phosphatidylglycerol in
the amniotic fluid obtained via amniocentesis.
• Delivery and resuscitation: A neonatologist experienced in the resuscitation and care of
premature infants should attend deliveries of fetuses when younger than 28 weeks' gestation.
They are at a high risk of maladaptation, which further inhibits surfactant production.
• Surfactant replacement therapy: The mortality rate of RDS has decreased 50% during the
last decade with the advent of surfactant therapy.
o Infants diagnosed with RDS who require assisted ventilation with more than 0.40 fraction
of inspiratory oxygen (FIO2) should receive intratracheal surfactant as soon as possible,
preferably within 2 hours after birth.
o Because surfactant is protective of delicate lungs, several investigators have
recommended prophylactic use following resuscitation in extremely premature infants
(