Medical
An introduction to Extremely Premature Babies - Dr Doug Derleth PDF (Designed to be given to the parent of a 22 - 24 week premature infant.)
The Need for Better Premature Infant Follow-up Studies - Helen Harrison (An article first published in APEP-Info looking at long term outcomes of premature babies.)
Preemies on Steroids: A New Iatrogenic Disaster? - Helen Harrison (First Published in Birth March 2001, Vol.28, No. 1, pp.57-59.)
Cerebral
White Matter Injury of the Premature Infant -- More Common Than
You Think.
Volpe, JJ - Pediatrics_20003;112;176-180.
This important review of recent brain-imaging studies shows that the majority
(up to 80%) of prematurely-born children suffer brain damage that is visible
by new magnetic resonance imaging techniques. This damage, to the white matter
of the brain, is referred to as PVL or periventricular leukomalacia. PVL,
these new studies reveal, is often undetected in the NICU, and underestimated
by neonatologists.
These new findings of more widespread brain damage in preemies may explain
why children with so-called "normal" NICU ultrasound scans often
exhibit such signs of neurologic damage as seizures disorders; and cognitive,
motor, behavioral, and sensory impairment.
( Available to _Pediatrics_ subscribers, or for a fee, at http://pediatrics.org)
School-Age
Outcomes in Children Who Were Extremely Low Birth Weight From Four
International Population-Based Cohorts.
Oct 2003, Vol. 112 Issue 4, p943, 8p
( Available to _Pediatrics_ subscribers, or for a fee, at http://pediatrics.org)
Developmental
Outcomes of Premature, Low Birth Weight, and Medically Fragile
Infants
Neonatal nurses need to be more aware of the possible developmental outcomes
of premature, low birth weight, and medically fragile infants.
Don't miss this comprehensive literature review. NBIN 3(3) 2003 (http://www.medscape.com/viewarticle/461571?mpid=19027)
Motor
Outcomes in Premature Infants Maureen Connors Lenke,
BS, OTR/L
Abstract and Introduction
Abstract:Motor impairment is frequently associated with prematurity. Many
of the early signs of a significant motor deficit in the premature infant
will be transient and resolve during the first year of life. However, despite
medical advances in the neonatal intensive care unit, the incidence of cerebral
palsy is reported at ***32% ****in infants weighing less than 1,500 grams.
The developmental progression of the premature infant, including early differences
between full-term and preterm infants, that affects motor examination; factors
that predispose premature infants to neuromotor deficits; and the long-term
implications of premature birth from a motoric perspective, will be addressed.(http://www.medscape.com/viewarticle/461577)
Does
My Child Really Need to Wear These Glasses? A Review of Retinopathy
of Prematurity and Long-Term Outcomes
ROP is a common diagnosis in premature infants, which may result in visual
deficits or blindness. It is a disorder that requires vigilant
surveillance and timely intervention. NBIN 3(3) 2003 (http://www.medscape.com/viewarticle/461578?mpid=19027)
Pain and Suffering
Pain control in neonates - William A. Silverman, MD PDF (This document was OCRed and may contain some spelling errors)
Whitfield,
MF and Grunau, RE. Behavior, pain perception, and the extremely
low-birth weight survivor, in _Outcome of the Very Low-Birth Weight
Infant: Clinics in Perinatology_ (ed. B.Vohr), June 2000,
Vol. 27, pp.363-379.
"...There is ample evidence that newborns, even very
immature newborns, mount a hormonal, behavioral, and neural response
to pain, and that pain has adverse effects on outcome...There is
a gathering body of animal and human evidence that suggests that
early pain has long-term consequences on the developing individual
and prior pain experience may explain some of the behavioral characteristics
described in prematures at school age and in neonatal follow-up
studies."
Stevens,
B and Grunau RE. Pain in Vulnerable Infants: Clinics in
Perinatology, September 2002, Volume 29.
(This is a collection of 12 articles on neonatal pain.) From the introduction
to the first article:
"About 300,000 low birth weight neonates are born in the
United States each year and 60,000 of them are classified as very low birth
weight (<1500 grams). An overwhelming majority of these children are
born preterm, at a time when the brain's architecture and vasculature have
not developed completely. The percentage of low birth weight and very low
birth weight babies has increased gradually in the last 20 years, with
a concurrent decline in neonatal and infant mortaility rates. It has been
suggested that this decline in mortality rates could be the result of improved
obstetric and neonatal care.
"Vulnerability
of the Developing Brain: Neuronal Mechanisms" by A.T. Bhutta
and K.J.S. Anand, in _Pain in Vulnerable Infants: Clinics
in Perinatology_ (eds. B. Stevens and RE Grunau) September 2002,
Vol. 29.
Despite impressive acheivements in the increasing survival
of this population, parents and teachers may be dismayed to find
a high prevalence of cognitive deficits, learning difficulties,
and abnormal behaviors...Multiple follow-up studies of ex-preterm
neonates have reported a high prevalence of major neurodevelopmental
deficits, with lifetime needs for special assistance and increasing
burdens on the annual health care budget."
Anand KJS, et al. Randomised trial of fentanyl anesthesia in preterm babies undergoing surgery: Effects on the stress response. Lancet 1987;1:62-66.
Rovner S. Surgery Without Anesthesia: Can Preemies Feel Pain?" The Washington Post (Healthtalk) pp 7-8, August 12, 1986.
Anand KJS, Hickey PR. Pain and its effects in the human fetus and neonate. N Engl J Med 1987;31;31:3121- 1329.
Whitfield, MF and Grunau, RE. Behavior, pain perception, and the extremely low- birth weight survivor.Clinics in Perinatology 2000;27:363-379.
Anand, KJS. Pain, plasticity, and premature birth: a prescription for permanent suffering? Nature Medicine 2000;6:971-973.
Simons S, et al. The Frequency and Painfulness of Daily Procedures at the Neonatal Intensive Care Unit. Pediatric Research April 2002#2112.
Pain
and Pain Management in Newborn Infants: A Survey of Physicians
and Nurses Fran Lang Porter,
Cynthia M. Wolf, Jennifer Gold, David Lotsoff, and J. Philip Miller
- PEDIATRICS Vol. 100 No. 4 October 1997, pp. 626-632
An excerpt from the discussion section of this article:
Results from this study indicate that most neonatal clinicians believe infants
experience pain equal to or greater than that experienced by adults. These
beliefs are generally consistent with current data and confirm a previous
report suggesting that attitudes have recently changed in the area of neonatal
pain. Clinicians also rated the painfulness of most of the listed nursery
procedures as being at least moderately if not very painful. Only tracheal
suctioning, insertion of a gavage tube and insertion of an umbilical catheter
were rated as being less than moderately painful. Together, these findings
indicate that individuals who are at the bedside of newborn infants on a
daily basis generally believe those infants are capable of experiencing pain
and are routinely exposed to painful procedures. Indeed, the higher the clinicians
rated the pain that infants could experience as compared with adults, the
higher they rated the painfulness of the procedures the infants commonly
undergo.
Despite this increased acknowledgment of infant procedural pain, clinicians
generally believed that neither pharmacologic agents nor comfort measures
were being used very often to manage infant pain. Even for those procedures
they rated as most painful, neither pharmacologic (circumcision = 1.0, cutdown
= 1.9, and insertion of chest tube = 1.8) nor comfort (circumcision = 2.1,
cutdown = 1.7, and insertion of chest tube = 1.4) measures were believed
to be used often.
