Anemia of Prematurity - Portal Neonatal

The postnatal use of surfactant therapy, gentler ventilation, vitamin A, and steroids
reduces the severity of BPD.
o Clinical studies have demonstrated varying incidence of BPD, which has been attributed
to an increase in the survival of smaller and more ill infants with RDS following the
introduction of the above therapies (see Tables 1-6). BPD may also be associated with
Gastroesophageal Reflux or Sudden Infant Death Syndrome; hence, consider these
entities in infants with unexplained apnea prior to discharge from the hospital.
o Retinopathy of prematurity (ROP): Infants with RDS and a PaO2 greater than 100 mm Hg
are at a greater risk of developing ROP; hence, monitor PaO2 closely and maintain at 50-
70 mm Hg. Although used in all premature infants, pulse oximetry is not helpful in
preventing ROP in tiny infants because of the flat portion of the oxygen-hemoglobin
dissociation curve. Eyes of all premature infants are examined at 34 weeks' gestation by
an ophthalmologist and thereafter as indicated. If ROP progresses, laser therapy or
cryotherapy is used to prevent retinal detachment and blindness. Monitor infants with
ROP closely for refractive errors.
o Neurologic impairment: Neurologic impairment occurs in approximately 10-70% of infants
and is related to the infant's gestational age, the extent and type of intracranial
pathology, the presence of hypoxia, and the presence of infections. Hearing and visual
handicaps further may compromise the development of these infants. They may develop
a specific learning disability and aberrant behavior. Therefore, follow up periodically with
these infants to detect those with neurologic impairment, and undertake appropriate
interventions.
o Familial psychopathology: Infants with RDS are at a greater risk of child abuse and
failure to thrive; therefore, obtain home clearance in conjunction with a nurse and social
worker prior to discharge from the hospital. Encourage and document parental visits and
the parent's interaction with the infant. Advise parents to spend time with their infants
with RDS in a separate room prior to discharge, especially parents who are at high social
risk (eg, teenagers) who also have extremely premature infants. Advise parents of infants
who are discharged on oxygen and/or on an apnea monitor, with gastrostomy or
requiring tube feeding, or with a tracheostomy or other special needs to spend time with
their infants with RDS in a separate room prior to discharge. Physicians who are skilled
in recognizing the problems encountered in these infants should be involved with their
ongoing care because of the high risk of morbidity and mortality in infancy.
Prognosis: See Tables 1-6.
Patient Education:
• Because an increased risk of prematurity and RDS exists for subsequent pregnancies,
counsel parents.
• Promptly manage high-risk factors, such as diabetes, hypertension, incompetent cervix, and
chorioamnionitis.
• Educate and counsel parents, caregivers, and families of premature infants regarding the
potential problems infants with RDS may encounter during and after the nursery stay.
Supplement such education with audiovisual aids and handouts.
MISCELLANEOUS Section 9 of 11
Medical/Legal Pitfalls:
• Trained and experienced professionals at a tertiary care facility should treat infants with RDS
whenever possible, because complications of premature births, RDS, and the procedures
performed on infants with RDS are associated with an increase in medicolegal action against
health care professionals and institutions. To minimize such actions, adequately document
the infant's clinical progress, including discussions with the families and/or caregivers. Obtain
written informed consent prior to elective procedures or blood product transfusions.