Prematurity and Post-Natal Malnutrition

25 Apr

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Few days ago, a colleague of mine from a different region called and referred a preterm baby for transfer to my service. The case is that of a preterm baby who had blood infection but wasn’t apparently improving with anti-microbials. Baby already was given series of strong antibiotics and seemingly isn’t showing signs of improvement. After about 2 weeks being in the hospital, the first attending doctor talked to them and apparently told them that the baby has a nil chance of survival. They were asked to decide whether to keep baby in the hospital costing them unnecessary expenses or bring home the baby and wait till the baby expires at home. Distraught with the options, the parents brought the baby home. One week passed, and with the baby still alive, they brought him to another doctor, my friend. She honestly told them that it is not her expertise to take care of such case, thus she called me up if she could transfer the baby to my care. I gladly obliged. I really got puzzled why the first neonatologist told the parents the baby has no chance of survival when everything hasn’t been explored yet.

The baby arrived and weighed 1.0kg, he weighed 1.2kg at birth. Babies, whether term or preterm, normally lose weight few days after birth but are expected to regain their birthweight by the end of two weeks from birth. In this case, the baby was already 23 days old so he is expected to be 1.3 to 1.4 kgs. He thus have what we call postnatal malnutrition brought about by several factors – infection, inadequate feeding and gastroesophageal reflux disorder. Baby was immediately worked up and treatment started. During the first few days, baby was already showing signs of improvement; he was gaining weight daily. Unfortunately, he would still have occasional arrests in breathing (apnea). This became increasingly frequent until the day his abdomen distended causing prolonged apnea. Aside from anemia, prematurity as plausible causes of the repeated apnea, I considered infection already of the intestine (named as necrotizing enterocolitis). I had to withhold feedings and resume IVF nutrition, switch antibiotics and add antifungal coverage. I also had to correct the anemia as well as minimize or control the esophageal reflux. It took several days before the apnea could be controlled, and for the abdominal infection to resolve. At present, the baby is no longer on antibiotics, he is already feeding through bottle/dropper, but is still malnourished. Baby being stable and with continuous weight gain, I will be sending home on the next day and requested to follow him back quarterly for his developmental surveillance. His regular follow-ups will be done by my friend in their province. He is now 1.5 kgs, but still a far cry from 2.5 kgs which should be his minimum weight at present.

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Posted by on April 25, 2012 in Infection, neonates


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