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Necrotizing enterocolitis: therapeutic hypothermia for preterm infants

Necrotizing enterocolitis: therapeutic hypothermia for preterm infants

In 2021, the Department of Pediatrics at the Ribeirão Preto Medical School implemented a project to improve the quality of necrotizing enterocolitis (NCE) and the results were published in the same year. it is known that Controlled hypothermia Mild treatment of NEC is possible and is associated with reduced indications for surgery, short bowel, and death.

However, the safety aspects of cooling and how to perform therapeutic low-tech hypothermia for preterm infants were not described in this previous article. Thus, this team from Ribeirao has released a new article describing the steps and management for the application of hypothermia in premature infants in settings with few techniques, presenting the safety aspects of the initiative.

Methods

The project to improve the quality of necrotizing enterocolitis was implemented in the intensive care unit of the neonatal referral hospital. For this article, 43 premature neonates (NB) with NEC (modified bell stage II/III) were selected. Of these, 19 are in the control group (2015-2018) and 24 in the hypothermia group (2018-2020). The control group received standard treatment. The hypothermia group received standard treatment and underwent passive cooling (35.5 °C, used 48 h after diagnosis of NEC).

It is described how to perform cooling of preterm infants using the servo control of incubators and the occurrence and treatment of dysentery during cooling, evaluation of blood parameters and gasometry, coagulation disorders, clinical instability and neurological disorders. The incubator was stopped for this procedure and an esophageal probe was used to monitor the temperature every 15 min. If the temperature drops, the incubator is operated at a reheating rate of 0.5 °C per hour.

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consequences

The mean weight was 1186 grams and the mean gestational age was 32 weeks. There were no differences between the indices of blood and serum parameters (sodium, potassium, creatinine, lactate and bicarbonate), pH, pCO2 and pO2/FiO2 between groups during treatment and after rewarming.

Dyslexia, bradycardia, hemodynamic instability, apnea, seizures, hemorrhage, periventricular hemorrhage, or any change in ventilation parameters due to cooling technique were not observed in preterm infants.

This simple technique was implemented relentlessly through rigorous team evaluation, with a target cooling rate of 0.5°C per hour. Target temperature was successfully reached between 2 and 3 hours of age with incubator control in 21 children; Ice bags were used in only three cases. The temperature was maintained at the expected level during the programmed cooling period.

Read also: B. Infantile for very low birth weight infants reduce rates of necrotizing enterocolitis

conclusion

Controlled mild hypothermia in preterm infants with necrotizing enterocolitis is considered safe It is not associated with adverse safety effects during and after refrigeration. Cooling of preterm infants can be done by passive methods, using servo control of incubators to manage temperature. these kids Provide an acceptable temperature change, without hardening, and the target temperature is reached and maintained at an adequate cooling speed. The gently controlled temperature of premature babies does not need an additional cooling device.

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