Anemia of Prematurity - Portal Neonatal

life. Recently, meta-analyses of these trials was presented at the Society for Pediatric
Research.
� Neurodevelopmental follow-up studies of infants treated with dexamethasone suggest
that although this therapy improves short-term pulmonary outcome, long-term
outcome appears significantly worse.
� The routine use of dexamethasone in infants with BPD is not currently recommended
unless severe pulmonary disease exists. A rapid tapering course starting at 0.25
mg/kg/d and lasting for 5-7 days appears to be adequate. If no response is observed
after 3 days, then discontinue dexamethasone. Inhaled glucocorticoid therapy has
been studied in neonates to prevent BPD. In 1999, Cole and colleagues found that
early therapy with beclomethasone did not prevent BPD, but it did decrease the need
for systemic steroids. Further studies and the development of more efficient aerosol
delivery systems are definitely needed.
o Vasodilators: NO is a short-acting inhaled gas that relaxes the pulmonary vasculature. NO
is metabolized rapidly by RBCs, thereby minimizing systemic hypotension. NO in vitro
may have direct effects on the tracheobronchial tree. In 1999, Banks and colleagues
studied the effect of inhaled NO in 16 preterm infants with severe BPD. Eleven of 16
infants had improved oxygenation after 1 hour of inhalation, an effect that persisted in
some infants. Further controlled studies are necessary to define the use of NO in the
prevention and treatment of BPD.
• Because the routine use of surfactant replacement has begun, survival of the most immature
infants has improved. Along with other advances in technology and improved understanding of
neonatal physiology, infants with BPD now appear to have less severe disease. Infants with
severe BPD remain at high risk for pulmonary morbidity and mortality during the first 2 years
of life.
• Fortunately, pulmonary function slowly improves in most survivors with BPD, likely secondary
to continued lung and airway growth and healing. Northway followed the cases of patients with
BPD to adulthood. In 1992, Northway reported that these patients had airway hyperreactivity,
abnormal pulmonary function, and hyperinflation noted on chest radiography.
Rehospitalization for impaired pulmonary function is most common during the first 2 years of
life. In 1990, Hakulinen et al found a gradual decrease in symptom frequency in children aged
6-9 years as compared to the first 2 years of life. Bader in 1987 and Blayney et al in 1991
found persistence of respiratory symptoms and abnormal PFT results in children aged 7 and
10 years. High-resolution chest CT scanning or MRI studies in children and adults with a
history of BPD reveal lung abnormalities that correlate directly with the degree of pulmonary
function abnormality.
Consultations: Infants with BPD have multisystem involvement. Therefore, consultations should be
obtained from various pediatric subspecialists. They include a cardiologist, pulmonologist,
gastroenterologist, developmental pediatrician, ophthalmologist, neurologist, physical therapist, and
nutritionist. They may also assist the pediatrician with the ongoing care of these infants after patients
are discharged from the hospital.
Diet: Infants with BPD have increased energy requirements.
• Early parenteral nutrition is often used to minimize the catabolic state of the preterm infant.
The most immature and unstable preterm infant often has a difficult transition to complete
enteral nutrition. Frequent interruption of feedings secondary to intolerance or patient
instability complicates the management of these patients. Enteral feeding of breast milk may
provide the best nutrition, while possibly preventing feeding complications (eg, sepsis,
necrotizing enterocolitis).
• The energy content of expressed breast milk and formulas can be enhanced to provide
increased energy intake, while minimizing fluid intake. Infants may require 120-150 kcal/kg of
body weight per day to adequately gain weight.
• Diuretics may often be used to prevent or treat fluid overload.
• Early insertion of percutaneous central venous lines may help to improve energy density of
parenteral nutrition. Accomplish progressive increases in protein and fat supplementation to
provide approximately 3-3.5 g/kg of body weight per day and 3 g/kg of body weight per day.
• Rapid and early administration of high concentrations of lipids may worsen hyperbilirubinemia
and BPD through pulmonary vascular lipid deposition and bilirubin displacement from albumin.