Micropremie

Although extensive data are available on the impact of nutrient and protein administration on growth, plasma amino acids, and nitrogen balance in the newborn and growing infants, relatively few studies have carefully examined the dynamic aspects of protein metabolism in vivo and particularly in the micropremie or ELBW infant. These studies show that the very preterm infants, either because of immaturity or because of the intercurrent illness, have high rates of protein turnover and protein breakdown. This high rate of proteolysis is not as responsive to nutrient administration...

This article evaluates the current knowledge of the kinetics of glucose homeostasis in the micropremie. Glucose production, glucose use, and glucose oxidation are reviewed in detail. This article also evaluates the developmental regulation of glucose homeostasis relative to some of the fundamental differences known to exist in the neonate compared to the adult.

No abstract text is available yet for this article.

Providing anesthesia for the micropremie involves many considerations beyond what is needed for the full-term neonate. Immaturity of the airway, lungs, cardiovascular system, liver, kidneys, and central nervous system makes the micropremie susceptible to anesthestic complications. Immature respiratory mechanisms and respiratory control increase the risk of apnea, hypoxemia, and hypercapnia intraoperatively as well as postoperatively. Anesthetic drugs depress myocardial contractility and impair baroreflexes in the micropremie to increase the risk of hypotension during anesthesia...

One of the most unsettling experiences for a neonatologist is having an early gestational-age infant for whom resuscitation has been abandoned or not initiated subsequently begin breathing on his own. That was the experience of Gregory Milleville, MD when at 2:30 AM a nurse brought such an infant with a heart rate of 130 and a temperature of 91.2 degrees F to the neonatal intensive care unit (NICU).

During the last years, neonatology has greatly improved. In the last decade, mortality and morbidity have decreased: mortality from respiratory failure of prematurity has decreased from 22% to 12%, mortality of the very low birthweight infants under 1000 g fell from 56% to 35% and mortalities related to asphyxia have diminished from 21% to 12% and to malformations from 33% to 28%. Prematurity is now the first cause of neonatal mortality. During this period, the number of babies under 1000 g has increased 4-fold and the number of multiple births increased more than 2-fold from 3% to 7% of the live births of our hospital...

The viability limit defined by the Japanese Eugenic Protection Act was amended from 24 to 22 completed weeks of gestation in 1991. To testify if the amendment is appropriate, we conducted a survey on the mortality and morbidity rates of infants less than 600 g born in Japan between 1984 to 1993. Questionnaires were mailed to 205 hospitals with neonatal intensive care units (NICUs) and 165 (80%) responded. Of 1655 infants <600 g birth weight and admitted to the NICUs included in this survey, 457 (28%) survived to hospital discharge...

Extreme prematurity (birth weight less than 500 g) with intact survival is very uncommon. This paper describes a preterm infant with birth weight of 354 g who is now 4 years old and developmentally normal. Intervention and management decisions in such a low birth weight group produce an ethical enigma. Survival of newborns with a birth weight less than 400 g is unusual. Decisions regarding intervention and care for extremely low birth weight infants impact on financial, emotional, and medical responsibilities of family members and health care professionals...

This article examines clinical issues regarding gut maturation, gut colonizatiion, gut luminal starvation, a germ-free gut, and the role of enteral intake in the pathogenesis of necrotizing enterocolitis (NEC) in very low birth weight neonates and micropremies. NEC is identified as the final common pathway for a variety of etiologic mechanisms, only one of which is consistent with the enteral-based theory of NEC. The technique of minimal enteral intake ("gut priming") is discussed as a strategy to maintain the normal ontological processes of the developing gut ex utero...

Survival and significant chronic morbidity were determined by retrospective chart review for 107 inborn "micropremies." "Micropremies" are defined as appropriate-for-gestational age neonates of less than 1,001 grams and less than or equal to 28 weeks gestation. The overall survival rate for "micropremies" was 64 percent, ranging from 20 percent at 24 weeks to 83 percent at 27 weeks gestation. Race and sex are important determinants of survival in these infants. The incidence of severe, chronic morbidity in "micropremies" is relatively low...