Anemia of Prematurity - Portal Neonatal

• Cranial ultrasonography
o Perform cranial sonography if the infant is being considered for extracorporeal
support.
o Ultrasonographic examination should focus on evaluation of intraventricular bleeding
and peripheral areas of hemorrhage or infarct or intracranial anomalies.
Other Tests: Pulse oximetry
Procedures:
o Continuous pulse oximetry is valuable in the diagnosis and management of PPHN.
o Place oximeter probes at preductal (right-hand) and postductal (either foot) sites to
assess for a right-to-left shunt at the level of the ductus arteriosus.
• Intubation and mechanical ventilation
o Endotracheal intubation and mechanical ventilation are required for all infants with
severe CDH who present in the first hours of life.
o Avoid bag-and-mask ventilation in the delivery room because the stomach and
intestines become distended with air and further compromise pulmonary function.
o Avoid high peak inspiratory pressures and overdistension. Consider high-frequency
ventilation if high peak inspiratory pressures are required.
• Arterial catheter placement: Place an indwelling catheter in the umbilical artery or in a
peripheral artery (radial, posterior tibial) for frequent ABG monitoring.
• Central venous catheter placement
o Place a venous catheter via the umbilical or femoral vein to allow for administration of
inotropic agents and hypertonic solutions such as calcium gluconate.
o Frequently, placing an umbilical venous catheter is difficult because of the altered
position of the heart and liver. For the same reason, confirming correct position (in the
low right atrium) can be difficult, and ultrasonography may be needed.
Histologic Findings: Both lungs appear abnormal, although histologic changes are more severe on
the affected side. Bronchi are less numerous, and the overall number of alveoli is reduced. In addition,
the lungs appear to be less mature with fewer mature alveoli. Pulmonary vascular abnormalities occur
in addition to parenchymal abnormalities. These vascular abnormalities are characterized by both a
reduction in the cross-sectional area of the pulmonary vascular bed and an abnormal increase in
muscularization of pulmonary arteries and arterioles.
TREATMENT Section 6 of 10
Medical Care: Because of associated PPHN and pulmonary hypoplasia, medical therapy is directed
toward optimizing oxygenation while avoiding barotrauma.
• If the infant has CDH, or if the diagnosis is suspected in the delivery room, immediately place
a vented orogastric tube and connect it to continuous suction to prevent bowel distension and
further lung compression. For the same reason, avoid mask ventilation and immediately
intubate the trachea. Avoid high peak inspiratory pressures and alert the resuscitation team to
the possibility of early pneumothorax if the infant does not stabilize. Many infants benefit from
exogenous surfactant administration during the first few hours of life.
o Infants with CDH have immature lung development and may be surfactant deficient.
Administration of exogenous surfactant in the delivery room or shortly thereafter may be
useful.