Neonatologist focus attention on micro-preemies

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It’s created happy endings to what were once dire circumstances.

Even some of the sickest and tiniest newborns, those born months too soon and weighing slightly more than two pounds, are able to survive and thrive as a result of advances in neonatal care.

The greatest breakthrough was actually made 30 years ago with the release of the drug Surfactant, which goes directly into the lungs and artificially helps decrease respiratory distress, said Jillian Hanger, nurse manager for the new neonatal intensive care unit at Franciscan St. Anthony Health in Crown Point.

“It is one of the greatest inventions in the last 30 years,” Hanger said.

She said in recent years most of the advances in neonatal care have centered on the micro-preemie, babies weighing less than 1,000 grams (about 2.2 pounds) and before 26 weeks gestation. Although many micro-preemies grow up with no long-term effects of prematurity, others face severe health problems throughout life.

“Infants born between 24 and 25 weeks gestation have a 70 percent survival rate. The biggest problem is with the lungs, but other areas may not be mature either. Most babies that pass away are not developed enough even with all the medical advances,” Hanger said.

She said female preemies do better than males. African-American females do best as preemies and white males do the worst. There is no scientific reason why, Hanger said.

She said to graduate from NICU, babies must maintain their own temperature, gain weight on a consistent basis and be able to breast or bottle feed.

Nutrition is essential

Dr. Cholemari Sridhar, neonatologist at Methodist Hospitals Southlake Campus in Merrillville, said doctors have learned that focusing on nutrition from day one has been instrumental in the preemie’s growth. Intake of proper nutrients through breast milk is strongly recommended by the American Academy of Pediatrics. Nutrients are also fed to the baby through an IV line, said Dr. Sridhar, who helped found the NICU at the hospital’s Northlake campus in Gary more than 20 years ago.

Hanger said they encourage moms with babies born at 32 weeks and under to breast feed or at least pump (breast milk) for the baby even if they weren’t planning to.

“There is a special protective barrier in breast milk, that can’t be recreated in formula, that helps the infant’s digestive system,” Hanger said.

Michelle Cherry, nurse manager of the NICU at Community Hospital in Munster, said the first 24 hours is critical for a micro preemie. The unit has a neonatologist on staff 24 hours day. The neonatologist is at all Caesarean sections, which has been beneficial.

Staying ahead

Recent technical and medical advances in neonatology include:

Ventilators: Dr. Sridhar said new ventilators that breathe for the baby provide respiratory support and help decrease complications with their lungs. Cherry said these ventilators keep lungs expanded and not collapsing.

Z-Flo neonatal liquidized positioners: These fluidized mattresses recreate the womb for several months and keep babies bundled up, yet allow them to stretch their arms and feet, Hanger said. This encourages normal development progression that would take place in the womb.

Frogs: At Community Hospital, preemies are placed in “Frogs,” which are similar to sand bags. Cherry said it’s as if babies are sitting in a nest with boundaries.

Therapy: Occupational therapists work with babies born at less than 27 weeks gestation and their parents to develop an individual plan, Hanger said.

Kangaroo care: Cherry said moms are encouraged to do kangaroo care, which is skin to skin contact. Moms unbutton their shirts, place the babies close, then close their shirts. “Mom’s body temperature helps keep the baby warm,” she said. She said this is done for both regular and preemie births.

Plastic wrap. A sterile piece of plastic wrap is wrapped around the baby to maintain body heat. Cherry said maintaining body heat, along with respiratory issues, are two of the main health problems affecting preemies.

Hanger said there are many reasons why a baby will be born prematurely. Some of these include twins, triplets and other multiples are born early; the mom could have high blood pressure issues making her unable to continue to carry the baby; or her cervix could just start to dilate.

Dr. Sridhar said medications given to the mom during pregnancy can help in the outcome of the baby.

Prenatal care is key

Hanger said prenatal care is still the gold standard for healthy babies. She said as moms become heavier, there are more health problems. Both diabetes and thyroid problems can be hard on a pregnancy. Obstetricians can counsel women about proper diet during the pregnancy and monitor them to see if any problems do occur.