Preterm mangement

[drprasadrao]

Hello friends,

Greetings from Hyderabad India,I have a preterm baby (28-30 weeks) with resp.distress mother PPROM 3 days born by SVD mother received 2 doses of steroid. how to manage in a level III NICU setup since the parents are poor.

[Padkaer]

Do you have CPAP ?

[Stefan Johansson]

I would also suggest that you work hard to get nasal CPAP working. Unless the baby gets an infections with apneas, CPAP should be enough for respiratory support.

Surfactant - I would not recommend it if the baby is already a few days old and the baby has reached its a descent "platue" when it comes to oxygen need and ventilation is ok. If RDS needs treatment, one dose of surfactant could probably be enough.

Given the PPROM history, antibiotics is adviceable too.

Slow but steady increase of enteral feeding.

Final advice - skin-to-skin care and hands off!

[Padkaer]

Not knowing your set-up and technical possibilities, its a bit hard giving specific advice, but on a general basis i agree with everything Stefan has said.

If you have a working nasal CPAP set-up, i would try very hard to avoid intubation and ventilator treatment. I would accept pH values down to at least 7.2 og pCO2 up to 8.5-9.5 (even higher if the pH is okay and the baby isn`t showing signs of carbondioxid narcosis).

It will be of little avail to a poor child if you save its life, for now, but render it oxygen dependent for a prolonged period secondary to VILI and BPD.

If you do not already have a working nasal CPAP system you could, for future cases, look into the danish Benveniste venturi valve. It has been the first choice in respiratory support of neonates in DK since the late seventies.

http://books.google.dk/books?id=Z5JEcDj3pCEC&pg=PA129&lpg=PA129&dq=beneviste+venturi+valve&source=bl&ots=Du2yZCWeYk&sig=IPpkICE9wv4drWO906bTL9KpQFY&hl=da&ei=8A2XTM-GIIuMOPuusYgJ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBQQ6AEwAA#v=onepage&q&f=false

http://indianpediatrics.net/sep2002/sep-851-855.htm

Its very effective, easy to use and cheap. To my knowledge all patents ran out decades ago and you should be able to manufacture it locally. Jens Kamper, who introduced the valve to clinical use, is still head of the neonatal unit in Odense, if you contact him, there is a chance he will take interest.

Steroids are always a tough call to make, but after 2 weeks i would consider them, if the baby is tied to a ventilator and, depending on the circumstances, even to avoid an intubation.

I would also prioritize to get the baby on enteral feeds as quickly as possible, preferably with the mothers own milk (HIV status ?) and a fortifier.

Kind regards

Jesper

[drakjaleel]

How many days old ? By this time natural resolution might have occured ,simple early nasal CPAP at the delivery room itself will do wonder effect as for HMD is concerned in a set up where ventilation also available .PPROM has to be addressed .Many preterm steroid covered will do well with noninvasive ventilation.