Previous Page  18 / 20 Next Page
Information
Show Menu
Previous Page 18 / 20 Next Page
Page Background

Page 42

conferenceseries

.com

Volume 4

Neonatal and Pediatric Medicine

Pediatrics Neonatal Care 2018

November 12-13, 2018

November 12-13, 2018 Dubai, UAE

22

nd

World Congress on

Pediatrics, Neonatology & Primary Care

The baby under 500 grams

Richard Mupanemunda

University Hospitals Birmingham, UK

T

he last 25 years have witnesses continued improvement in the survival of extremely low birth weight infants particularly

in the industrialized nations of the world. This has been accompanied by a shift in attitudes to the provision of intensive

care to infants regarded as being at the margins of viability. Intensive care is increasingly offered to such infants with significant

intra- and inter-country variations in outcomes. Infants of birth weight <500 g encapsulate the moral and ethical dilemmas

of perinatal clinicians who struggle to balance the natural parental emotional desire for every effort to be made to save their

premature infants with the clinicians’ uncertainty about the infant’s prospects for survival and/or disability. It is difficult for

perinatal staff to predict the medical prognosis for extremely preterm infants which means some viable infants might die if

not offered aggressive treatment. Detailed outcome data for this group of infants is still limited but reported survival rates vary

from 11% to 68% though concerns remain regarding long term morbidity. Common morbidities included bronchopulmonary

dysplasia BPD, Retinopathy of Prematurity (ROP), Intraventricular Haemorrhage (IVH), Necrotizing Enterocolitis (NEC) and

cerebral palsy. Survival rates increase with increasing birth weight and gestational age, is more likely for small for gestational

age than appropriate for gestational age infants, is greater for female infants and singletons. Despite the increased mortality and

morbidity, up to a third of survivors have been reported free from handicap at age of two years. Current evidence suggests that

a proactive and positive approach to intervention in maternal and newborn care including obstetric interventions, antenatal

steroids, tocolysis and caesarian delivery with a neonatologist present at birth, for ‘a trial of life’ including intubation and

surfactant administration may increase survival without increasing neurological impairment. Providing perinatal teams

with up-to-date outcome data on this group of infants may help further shift attitudes towards a more active and optimistic

approach which may encourage higher expectations of a favorable outcome among obstetricians and neonatologists. The

Japanese experience clearly supports this view as attested by the amendment of their viability limit from 24 to 22 completed

weeks of gestation.

Biography

Richard Mupanemunda has completed his Medical studies graduation from University of Southampton. He teaches Pediatrics and Neonatal Medicine at University

Hospitals Birmingham NHS Foundation Trust. His interests include the use of inhaled nitric oxide in the treatment of hypoxic respiratory failure in newborns, airway

management and the ethics of healthcare provision.

Richard Mupanemunda, Neonat Pediatr Med 2018, Volume 4

DOI: 10.4172/2572-4983-C3-008