Nutrition and bronchopulmonary dysplasia

Article Abstract:

Very-low-birth-weight (VLBW; very premature) infants are increasingly likely to survive, due to advances in neonatal care. Many of these newborns develop respiratory distress syndrome. However, the availability of surfactant (a substance normally made by the lungs and essential for breathing) has contributed to survival; premature infants often produce inadequate amounts of surfactant. Many of these infants subsequently develop bronchopulmonary dysplasia, abnormal tissue development in the airways and lungs, leading to a prolonged dependence on mechanical ventilation. To evaluate whether low weight and poor nutrition are associated with this problem, 22 babies with bronchopulmonary dysplasia and 22 infants of the same gestational ages but without the disorder were evaluated. Infants with bronchopulmonary dysplasia weighed significantly less at birth, suggestive of poorer prenatal nutrition. After 10 days of age, infants with dysplasia took in significantly fewer calories, and reached full oral feeding (when the full amount of formula needed can be tolerated by the baby) significantly later. VLBW infants have less fatty tissue, which serves as an energy reserve, than normal, full-term infants. The study indicates that VLBW infants with bronchopulmonary dysplasia have even lower energy reserves and feed less well than other VLBW infants after birth, possibly due to medical complications. Further research should indicate whether enhanced nutritional intake (both before and after birth) will improve the outcome of VLBW infants at risk for bronchopulmonary dysplasia. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Risk factors, Food and nutrition, Infants (Premature), Premature infants, Premature birth, Bronchopulmonary dysplasia

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The use of plasma in the neonatal period

Article Abstract:

Plasma and plasma expanders have been commonly used in newborns, but their effectiveness has not been extensively tested. These substances contain protein and can expand blood volume. In addition, fresh plasma contains factors that clot the blood. Some adverse effects of plasma and plasma expanders are circulatory overload (excessive blood volume) and infection. Plasma has been used to treat intraventricular hemorrhage (or bleeding within the brain); asphyxiation or hypotension (low blood pressure) due to fetal hemorrhage; coagulation defects (disorders of blood clotting); and polycythemia (an excess of red blood cells), leading to increased blood viscosity and the risk of blood clot formation. The two major problems with using plasma in newborns are the cost and the risk of transmitting infection. Non-A, non-B hepatitis and cytomegalovirus infection are the principle hazards of transfusion with fresh frozen plasma. The blood protein albumin is used to expand blood volume and to bind bilirubin, the pigment in bile. Albumin can remain in the blood vessels, thereby maintaining or improving blood pressure. Albumin may also be useful in managing infants with respiratory distress syndrome, the severe impairment of breathing in the premature infant. The use of plasma and plasma expanders in infants is an area that requires further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Physiological aspects, Disease transmission, Blood transfusion, Serum albumin, Blood plasma substitutes, editorial

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Evaluation of paediatric intensive care in a regional centre

Article Abstract:

Advances have been made in the intensive care of children within the past 20 years. Guidelines have been developed for the facilities, organization, staffing, and training needed for pediatric intensive care. This service is costly and accounts for 20 percent of hospital costs, yet the effectiveness of pediatric intensive care has not been examined extensively. Hence, pediatric intensive care in a regional center of the United Kingdom was assessed with regard to treatment, degree of illness, age of patients, use of resources, and outcome. Of 162 children admitted to the pediatric intensive care unit, treatment was intended to cure illness in 101 cases and to alleviate symptoms of illness in 30 cases. Five children were admitted for the purpose of using specialized monitoring equipment, and half the children admitted had unstable illness. The age of 102 children was 12 months or younger. About 18 percent of the children admitted died. The rate of death was not influenced by age or purpose of treatment but was related to the degree of illness. The findings help in the comparison of standards of care and outcome between different units. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Practice, Pediatric emergencies, Pediatric intensive care, Critical care medicine

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