Category Archives: Prematurity

Tip 55a: fluid requirements in preterm babies

The insensible losses in preterm babies, from evaporation and respiratory tract, can reach 40-60ml/kg/day, even when nursed in 90% humidity, and can be much larger (up to 140ml/kg/day). Reference:¬†Hartnoll, G., 2003. Basic principles and practical steps in the management of … Continue reading

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Tip 50: surfactant for RDS

Using surfactant early (<2h age vs. late) in preterm infants with RDS requiring ventilation leads to reduced: pneumothorax (RR 0.69) pulmonary interstitial emphysema (RR 0.60) neonatal mortality (RR 0.84) chronic lung disease at 36 weeks’ gestation (RR 0.69). Reference:¬†Bahadue, F.L., … Continue reading

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Tip 49: respiratory distress syndrome (RDS)

“For babies with RDS to have the best outcomes, it is essential that they have optimal supportive care,¬†including: maintenance of normal body temperature proper fluid management good nutritional support appropriate management of the ductus arteriosus support of the circulation to … Continue reading

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Tip 47: PEEP from the first breath

Studies have shown a ~50% reduction in surfactant administration in 25-28 week gestation babies who receive early PEEP during resuscitation/stabilisation. Also, less supplemental oxygen is required. However, the risk of pneumothorax is increased and there is no overall reduction in … Continue reading

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Tip 34a: thrombocytopenia (preterm)

Early-onset thrombocytopenia (<72h, plts <150 x 109/L) in preterm infants is most likely due to placental insufficiency, perinatal asphyxia, perinatal or congenital infection, and should resolve within 14 days. Reference: Chakravorty, S. and Roberts, I., 2012. How I manage neonatal … Continue reading

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Tip 32: specialist preterm milks 2

Nutriprem 2 and SMA Gold Prem 2 contains slightly less Kcal, protein, Ca, PO4 & iron than Nutriprem 1 and SMA Gold Prem 1. Babies on this milk still require vitamin supplementation but not iron. It is generally introduced to … Continue reading

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Tip 28: NEC stages

The modified Bell’s stages for NEC are: 1 (suspected) – general features of sepsis, mild abdo distension, increased NG asp, AXR: normal/mild ileus. 2a (confirmed) – prominent abdo distension, bloody stools, mild abdo tenderness, AXR: thickened bowel wall, focal pneumatosis. … Continue reading

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