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Spring 2010
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New Technologies Improve Outlook for Preemies

03/31/2010

VS-Spring2010-NewOutlookPreemiesMore than a half-million babies are born preterm — at less than 37 weeks — in the United States each year, placing them at increased risk for serious physical ailments, including breathing and respiratory difficulties, vision and hearing loss, and feeding and digestive problems, as well as learning disabilities and neurological disorders. The good news is that greater awareness and new technologies improve the likelihood that many of these premature babies will survive and lead normal lives.

While the prognosis for the smallest babies — those born from 23 to 25 weeks who weigh less than a kilo — remains grim, the outlook improves for each week that birth can be delayed. The best outcomes occur among late preterm babies, those born between 34 and 37 weeks, says neonatologist Marianne Anderson, M.D., medical director of the Santa Monica- UCLA Medical Center and Orthopaedic Hospital neonatal intensive care unit (NICU).

“No matter what we do, we cannot duplicate the mother’s womb for the smallest of babies,” says Sherin Devaskar, M.D., director of the UCLA Neonatal Research Center and Training Program. “The brains, lungs, eyes and guts of premature babies are not fully developed to the point where they can handle the outside world.” To be able to provide the next best environment to the mother’s womb, “it is critically important to continue to investigate therapies that may change the course for these tiny individuals and their families.”

When it becomes evident a mother will deliver prematurely, she often is treated with antibiotics to control infection and with the steroid betamethasone to help mature the baby’s lungs. Following delivery, preterm babies are admitted to the NICU, where they stay until near their original due date and have reached some key developmental milestones, including being able to maintain their own body temperature and to feed themselves. While in the NICU, techniques to soothe the baby include music therapy and kangaroo care, in which parents hold the baby using skin-to-skin contact.

Most premature babies use a ventilator for a short time before using other therapies to improve lung outcomes. Vapotherm keeps air spaces partially open to make it easier for the babies to breathe on their own. Surfactant replacement therapy makes the air spaces in the lungs easier to open so that mechanical ventilation can be achieved at lower pressures, which reduces VS-Spring2010-Preemiestrauma to premature lungs. Inhaled nitric oxide, a very new therapy, is used selectively for the smallest babies.

Nutrition — critical to recovery — begins with early total parenteral nutrition and tube feedings. Eventually, the babies receive mother’s milk with fortification and/or specialized formulas. Once babies can suck, swallow and breathe, they will be able to feed themselves — usually the last developmental milestone that must be reached before the baby can leave the hospital.

Despite the many benefits of these new technologies, Dr. Anderson says the ultimate goal is to prevent prematurity altogether. “We’re not going to see a significant difference until more babies reach full term,” she notes. To achieve this goal, Dr. Devaskar says, “We need ongoing research that targets the reasons for prematurity.”

For more information, go to:
www.mattel.medsch.ucla.edu/neonatology 





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