ABSTRACT
Although parenteral nutrition has been used widely in the management of sick very low birth weight infants, a smooth transition to the enteral route is most desirable. Trophic feeding is the practice of feeding small volume of enteral feeds in order to stimulate the development of the immature gastrointestinal tract of the preterm infant. This practice has also been termed as minimal enteral nutrition (MEN). MEN improves gastrointestinal enzyme activity, hormone release, blood flow, motility and microbial flora. Clinical benefits include improved milk tolerance, greater postnatal growth, reduced systemic sepsis and shorter hospital stay. There is currently no evidence of any adverse effects following MEN. MEN can be commenced in neonates on ventilation and total parenteral nutrition. A protocol of giving MEN has been presented here.
Subject(s)
Clinical Protocols , Humans , Infant , Infant, Newborn , Infant, Very Low Birth Weight , Monitoring, PhysiologicABSTRACT
Polycythemia is defined as a venous hematocrit of over 65%. The hematocrit in a newborn peaks at 2 hours of age and decreases gradually after that. The etiology of polycythemia is related either to intra-uterine hypoxia or secondary to fetal transfusion. The relationship between hematocrit and viscosity is almost linear till 65% and exponential thereafter. Increased viscosity of blood is associated with symptoms of hypo-perfusion. Clinical features related to polycythemia-hyperviscosity syndrome may affect all organ systems and this entity should be screened for in high-risk infants. Polycythemia may or may not be symptomatic and guidelines for management of both the types based on the current evidence are provided in the protocol.
Subject(s)
Blood Viscosity , Colloids/administration & dosage , Drug Therapy, Combination , Hematocrit , Hemodynamics , Humans , Incidence , India/epidemiology , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Isotonic Solutions/administration & dosage , Polycythemia/diagnosisABSTRACT
Apnea, defined as cessation of breathing resulting in pathological changes in heart rate and oxygen saturation, is a common occurrence especially in preterm neonates. It is due to immaturity of the central nervous system (apnea of prematurity) or secondary to other causes such as metabolic disturbances etc. Secondary causes of apnea should be excluded before a diagnosis of apnea of prematurity is made. Methylxanthines and continuous positive airway pressure form the mainstay of treatment. Mechanical ventilation is reserved for apnea resistant to the above therapy. An approach to the management of apnea in neonates is described.