Neonatal Intensive Care and Premature Babies By: Holley Dobransky, Maria Gosz, and Jennifer Zabinski.

Neonatal Intensive Care and Premature

Babies

By: Holley Dobransky, Maria Gosz, and Jennifer

Zabinski

Prematurity A baby delivered at less than 37 weeks

(more than 3 weeks early) The earlier the baby is born the more

severe the health problems will likely be If the baby needs extra help they will be

admitted to the NICU

Ethical Issues Relating to Age Viability

Before 22 weeks Providing care at this stage is experimental.

Attempts to resuscitate should only take place if the outcome looks promising and if the parents choose.

Between 22 weeks, 0 days and 22 weeks, 6 days Standard practice should be not to resuscitate the

baby. Resuscitation should only be attempted if parents request it and they know the risks and potential outcomes.

Ethical Issues Relating to Age Viability

Between 23 weeks, 0 days and 23 weeks, 6 days It is hard to predict the outcome. Parents should

get the final decision but doctors need to inform the parents of there opinion and recommendation.

Between 24 weeks, 0 days and 24 weeks, 6 days Baby will be offered full invasive intensive care and

support unless the parents and doctors feel that for the babies best interest care should not be given.

At 25 weeks and above Intensive care should be given unless he or she is

known to be affected by a severe abnormality that will significantly affect chance of survival.

Risk Factors for Premature Birth Multiple births (twins, triplets, etc.) Infections during pregnancy Chronic health problems in the mother

(diabetes, high blood pressure, heart disease, and kidney disease)

Previous preterm birth Premature rupture of membranes Smoking, drinking, or drug use during

pregnancy

Babies born prematurely are more likely to have problems with…

Feedings Jaundice Breathing Infections Regulating body temperature Anemia Hypoglycemia (low blood sugar)

Breathing Problems Many premature babies will need help

breathing

Respiratory Support Ventilator CPAP Nasal cannula

Ventilator Mechanical ventilation through an

endotracheal tube A tube is placed in the baby’s mouth into the

trachea Oxygen is blown in and out of the lungs

under pressure This is used when the baby cannot breath on

his/her own The machine does most, if not all, of the

breathing for the baby

Baby on a Ventilator

Respiratory Distress Syndrome (RDS) Occurs in premature babies due to the

lack of surfactant in the lungs Surfactant keeps the airways in the

lungs from collapsing Surfactant Therapy allows the baby’s

lungs to further develop rather than putting more effort into fully breathing

Use either a ventilator or CPAP machine

CPAP CPAP- Continuous positive airway pressure Prongs or a mask are positioned over the

baby's face or nostrils Oxygen is given at a constant pressure This is used when a baby can breath on

his/her own The machine helps keep the lungs open

between breaths 5-6 LPM

Baby on CPAP

Nasal Cannula Small prongs deliver oxygen to the baby

through the nostrils This is used when the baby does not

need CPAP to keep the lungs open, but still needs extra oxygen

1-3 LPM

Baby on Nasal Cannula

ThermoregulationIsolette Warmer

Brain Cooling Program Babies must be at least 36 weeks old Used on babies who had the potential of

asphyxiation in the womb The lack of oxygen can lead to lack of

blood to the brain which later affects the rest of the body

Reduction in the babies core temp to allow it to recover from the lack of oxygen

Hyperbilirubinemia Also called jaundice Refers to a yellowing of the skin and/or eyes Caused by a buildup of bilirubin in the blood Bilirubin is produced by the normal

breakdown of red blood cells Usually the liver breaks down the bilirubin

and passes it through the body When the bilirubin builds up faster than the

liver can break it down, jaundice occurs

Hyperbilirubinemia All babies are born with red blood cells

that they don’t need As their body breaks down the cells, an

orange color (bilirubin) is released into the blood

Phototherapy The baby in undressed as much as

possible to expose the skin The baby’s eyes are covered to protect

them from the bright light

Phototherapy

Bili Blanket

Total Parenteral Nutrition (TPN) TPN is IV nutrition given to babies who

cannot yet handle food Infants who are very premature have

immature digestive systems that cannot handle milk or formula

It is also given to babies who are unable to absorb enough nutrients through regular feedings

TPN

Breast Milk Breast milk has an advantage over formula

because it contains proteins that help fight infection and promote growth

Can be given by bottle or by gavage (tube) feeding

Fortifiers may be added to the milk to give the baby more vitamins and minerals

20 calories per ounce Calories can be added to the milk to make it 22

or 24 calories if the baby needs to grow faster

Formula There are special formulas designed for

premature babies Can be given to the baby by bottle or

gavage feeding

NG Tube Feedings NG- Nasogastric A small tube is placed into the baby’s

stomach through the nose Breast milk or formula is given through

the tube directly into the stomach, giving the baby extra calories

The tube is replaced frequently

Baby with NG Tube

NICU Around the World 800 women die a day from

preventable causes related to pregnancy and childbirth

2.9 million newborns die within the first month, and 2.6 million are still born

Main causes are preventable and treatable, such as complications due to premature birth, complications during delivery and infection.

Equivalent to the population of Minnesota dying every year

Around two-thirds of neonatal deaths occur in just 10 countries, with India accounting for more than a quarter and Nigeria for about a tenth.

Mortality Rates in 1,000 Highest Rates

Afghanistan 117 Mali 104 Somalia 100 Central African

Republic 92 Guinea-Bissau 90 Chad 90 Niger 86 Angola 79

Lowest RatesJapan 2Norway 2.5Singapore 2.5Italy 3.3Canada 4.7United States

6

44% of child deaths under the age of five take place during the neonatal period.

Prevention measureVaccinesGood NutritionBreast feedingAntibioticsZinc Supplements Low-osmolality oral rehydration

Sources http://www.ncbi.nlm.nih.gov/books/NBK11389/ http://nuffieldbioethics.org/wp-content/uploads/2014/07/CCD-Short-Version-FINAL.pdf http://www.tommys.org/prem/hospital/breathing http://www.nlm.nih.gov/medlineplus/ency/article/001562.htm http://www.nlm.nih.gov/medlineplus/ency/article/007302.htm http://www.marchofdimes.org/baby/newborn-jaundice.aspx# http://www.med.umich.edu/1libr/pa/umphototherapy.htm http://kidshealth.org/parent/growth/growing/preemies.htm http://www.healthline.com/health/pregnancy/premature-baby-infections http://

www.mayoclinic.org/diseases-conditions/premature-birth/basics/risk-factors/con-20020050

http://www.mayoclinic.org/diseases-conditions/premature-birth/basics/definition/con-20020050

http://www.gatesfoundation.org/What-We-Do/Global-Development/Maternal-Newborn-and-Child-Health

http://www.who.int/mediacentre/factsheets/fs178/en/ https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html http://

www.childmortality.org/files_v19/download/unicef-2013-child-mortality-report-LR-10_31_14_195.pdf

http://www.gatesfoundation.org/What-We-Do/Global-Development/Maternal-Newborn-and-Child-Health

http://www.saintpetershcs.com/Advanced-Technologies-NICU/ http://www.saintpetershcs.com/Advanced-Technologies-NICU/ http://www.saintpetershcs.com/Advanced-Technologies-NICU/