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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Medical problems associated with prematurity are frequently complex, and a multidisciplinary approach is often required. Some common problems include the following: (1) anemia, which can be reduced by iron supplementation, (2) cerebral palsy or mental retardation as a result of intraventricular hemorrhage or periventricular leukomalacia, (3) respiratory problems, including bronchopulmonary dysplasia and apnea, (4) visual problems, such as those associated with retinopathy of prematurity, (5) gastroesophageal reflux and (6) surgical problems, including inguinal or umbilical hernia and cryptorchidism. Monitoring of growth and development includes recording the infant's head circumference, weight and length on a growth chart for premature infants. Nutritional status should be assessed at each visit, watching for hyperosmolar problems in infants receiving high-calorie formulas. Consultation with other specialists may be required if abnormalities are identified during follow-up care in the office.
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PMID:Office care of the premature infant: Part II. Common medical and surgical problems. 961 10

The diagnosis and treatment of fetal and neonatal diseases requires knowledge of gestational age-dependent reference ranges for most laboratory values. It was the aim of the present study to establish reference values for serum iron, transferrin, ferritin and ceruloplasmin concentrations in premature neonates, thereby paying attention to the possible changes with gestational age. Blood samples were taken from 100 premature neonates within the first hour of life. Total serum iron, transferrin, ferritin and ceruloplasmin concentrations were determined, transferrin saturation was calculated. Newborns who developed a presumed oxygen radical disease of prematurity were excluded from the study (n = 37), because previous investigations could demonstrate significantly lower serum transferrin and ceruloplasmin concentrations in prematures suffering one of these disorders. Related to gestational age, only serum transferrin concentration showed a statistically significant increase and correlation (r = 0.47; p < 0.0001) with rising age. Although statistically not significant, even serum ferritin concentration increased with rising age of the neonates. None of the investigated laboratory values correlated with birth weight. Only ferritin showed a slight, but statistically not significant increase with higher body mass. We conclude that gestational age-dependent changes of serum transferrin levels must be considered in the judgement of fetal and neonatal diseases, whereas total serum iron and ceruloplasmin concentrations remain rather constant at least during the last weeks of gestation.
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PMID:Gestational age-dependent reference values for iron and selected proteins of iron metabolism in serum of premature human neonates. 969 Nov 61

Our objective was to discuss the role of erythropoietin in fetal erythropoiesis and to review its clinical uses in perinatal medicine. All relevant articles compiled through a MEDLINE search (years 1986-1997) were reviewed. Erythropoietin is essential for fetal erythropoiesis and is produced in response to hypoxia and anemia. Cord blood erythropoietin is purely fetal and reflects tissue oxygenation. It has been found to be increased in many complicated pregnancies with underlying fetal hypoxia. Erythropoietin could be used as a marker of fetal hypoxia because its concentration rises rapidly by increased production in response to hypoxia. Its measurement might enable more accurate timing of hypoxic injury. In addition, erythropoietin levels have been well correlated with perinatal brain damage and may facilitate treatment of high risk neonates. Erythropoietin has also been used successfully in anemia of prematurity, decreasing the transfusion requirement. However, studies are still needed to determine the optimal doses of erythropoietin and iron supplementations required for maximizing the red blood cell response. Erythropoietin has been examined as potential maternal therapy in various disorders during pregnancy. These include end-stage renal disease, severe antepartum iron deficiency anemia, and postpartum anemia. Erythropoietin has been found to be effective and well tolerated in these conditions. An additional promising use lies in the optimization of maternal red blood cell mass to allow autologous blood donation. This may be critical in cases where a large amount of bleeding might be anticipated, as with placenta previa. This would also minimize the donor transfusion-related hazards. Erythropoietin with its wide clinical applications could improve maternal and neonatal outcome.
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PMID:Erythropoietin in obstetrics. 970 90

Pregnancy and postpartum anaemia occurs worldwide, particularly in developing countries where it accounts for substantial maternal and infant morbidity and mortality. The main cause is iron deficiency, primarily of dietary origin: 20% of the world population are estimated to have some degree of trace element deficiency. Even in industrialized countries iron deficiency anaemia is common in pregnancy due to the negative iron balance created by the high fetal demand for iron. It is compounded by blood loss during and after delivery, particularly in the absence of adequate prevention and treatment. The main effects of pregnancy and postpartum anaemia (defined by the WHO as hemoglobin values < 110 g/l and < 100 g/l, respectively) present for the mother an increased susceptibility to infection and premature delivery and for the baby intrauterine growth retardation and the consequences of prematurity. Diagnosis and differential diagnosis are thus a major obstetric concern. Iron deficiency can be particularly difficult to diagnose in postpartum anaemia because ferrritin is often falsely elevated due to concurrent infection. Prevention with oral iron + folic acid supplementation has proven effective, as has intravenous iron in more severe cases, while the addition of recombinant erythropoietin augments the effect of iron alone.
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PMID:[Anemia in pregnancy]. 1006 72

Anemia is one of the most frequent complications related to pregnancy. Normal physiologic changes in pregnancy affect the hemoglobin (Hb), and there is a relative or absolute reduction in Hb concentration. The most common true anemias during pregnancy are iron deficiency anemia (approximately 75%) and folate deficiency megaloblastic anemia, which are more common in women who have inadequate diets and who are not receiving prenatal iron and folate supplements. Severe anemia may have adverse effects on the mother and the fetus. Anemia with hemoglobin levels less than 6 gr/dl is associated with poor pregnancy outcome. Prematurity, spontaneous abortions, low birth weight, and fetal deaths are complications of severe maternal anemia. Nevertheless, a mild to moderate iron deficiency does not appear to cause a significant effect on fetal hemoglobin concentration. An Hb level of 11 gr/dl in the late first trimester and also of 10 gr/dl in the second and third trimesters are suggested as lower limits for Hb concentration. In an iron-deficient state, iron supplementation must be given and follow-up is indicated to diagnose iron-unresponsive anemias.
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PMID:Anemia in pregnancy. 1081 99

Neonatal disorders mean disturbance of normal state of body, organs and abnormal function of a newborn. Obstetricians play a major role to minimise the number of neonatal disorders. Prematurity, respiratory dysfunction, birth trauma, congenital malformations, neonatal infection and haemolytic disorders of the newborn are some examples of neonatal disorders commonly encountered. Preventive obstetrics is most important in reducing these disorders. Regular antenatal check-up, balanced diet, iron and folic acid tablet, avoiding repeated pregnancies are some measures which can prevent prematurity. Any factors which cause maternal hypoxia during pregnancy are responsible for foetal hypoxia. Proper antenatal care and avoidance of narcotic drugs in pregnancy are the pillars to combat respiratory dysfunction. Obstetricians play an important part to minimise birth trauma which is single handedly an important example of neonatal disorders. Proper antenatal care to detect any obstetrical anomaly reduces birth trauma to a large scale. In case of congenital anomalies, genetic counselling and early abortion in gross congenital anomaly are important aspects which can be looked after by the obstetricians. Neonatal infections can be minimised by the obstetricians themselves if they take care of any suspicious vaginal discharge in antenatal period. Dirty dressings are to be avoided in delivery time. Proper immunisation to the mother and also counselling of HIV transmission are also important. Haemolytic diseases of the newborn can be confronted by proper Rh and ABO blood groupings in antenatal period and proper intervention at the time of delivery.
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PMID:Neonatal disorders and obstetricians. 1167 12

Many unanswered issues regarding rhEPO therapy in prematurity remain, including which premature infants best respond to rhEPO, what the long-term effect of decreased erythrocyte transfusions is, how nutritional supplementation optimizes the effect of rhEPO, whether or not rhEpo therapy causes iron deficiency later in life, and whether or not it is safe to supplement with parenteral iron. Further study of rhEPO therapy and iron status in prematurity is necessary.
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PMID:Iron status and the treatment of the anemia of prematurity. 1216 42

The purpose of this study was to evaluate the effectiveness of early treatment with erythropoietin (EPO) in two different treatment regimes (high vs. low dose) in comparison to the conventional treatment of packed red blood cell (PRBC) transfusions in the management of anaemia of prematurity in a country with limited resources. An open controlled trial was conducted on 93 preterm infants (7 days postnatal age, 900-1500 g birthweight). Patients were randomly assigned either to a low dose (250 IU/kg), a high dose (400 IU/kg), or a control group. EPO was administered subcutaneously three times a week and all infants received 6 mg/kg iron orally from study entry to endpoint of therapy. Haematological parameters were measured and compared. The success was defined as an absence of transfusions and a haematocrit that did not fall below 30 per cent during the time period that the infants were in the study. The three groups were statistically comparable at study entry with respect to gestational age, birthweight, Apgar scores, and haematological values. Over the period that the infants were in the study, 75 per cent of the low dose group and 71 per cent of the high dose group met the criteria for success compared with 40 per cent in the control group (p < 0.001). However, there was no significant difference in the number of transfusions when the low and high EPO dose groups (9.5 per cent) were combined and compared with the control group (26.7 per cent) p = 0.0587. It was concluded that in stable infants, 900-1500 g, where phlebotomy losses are minimized and stringent transfusion guidelines are adhered to, EPO does not significantly decrease the number of transfusions. A conservative approach in the management of anaemia of prematurity, is a viable alternative in areas with limited resources.
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PMID:A comparison of high versus low dose recombinant human erythropoietin versus blood transfusion in the management of anaemia of prematurity in a developing country. 1220 Sep 85

Observations of nutritional level were made in 2338 lower income whi te women receiving care at the Vanderbilt University obstetric clinic. 73% received no dietary supplement while the remaining 27% received varied supplementation seldom extending through the whole period of gestation. There was a decrease of approximately 200 calories daily in the average intake between the second and third trimesters, partly in response to the physician's request and partly due to the mother's initiative. It is postulated that this reflects lessened activity on the part of the mother. The change in blood constitutents fell into 4 patterns: 1) for total serum protein, serum Vitamin A, and urinary excretion of thiamine and riboflavin there was a decline during Weeks 32-34 of gestation followed by a postpartum rise; 2) for serum carotene, tocopherol, and the urinary excretion of N'-methylnicotinamide there was a progressive increase during pregnancy followed by a postpartum decline ; 3) for serum Vitamin C there was a slight decrease during gestation followed by a sharp decline in lactating mothers; 4) for iron there was a progressive increase in the absorption and utilization as pregnancy advances. Although the group had generally good nutrition some were underweight or overweight, some ate poorly, some excessively, some had low nutrient levels, and some had obstetric and pediatric complications. The underweight women were concentrated in the lower parity groups and had a higher incidence of prematurity but fewer neonatal deaths and congenitally malformed infants. The overweight group had a threefold increase in preeclampsia, more stillborn children, lowered frequency of puerperal morbidity, and more toxemia. The low hemoglobin group had excessive blood loss during the later 1/2 of pregnancy, delivery, or puerperium. Other studies have shown that infants of such women have anemia at 1 year and supplemental infant feeding is indicated. It appears that the recommended standards for calories are too high for the expectant mother of today. A diet that will provide essential nutrients is readily obtainable from food sources and except for specific supplementation in specific cases, the common obstetric routine of broad-spectrum nutrition supplementation is questioned.
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PMID:Vanderbilt cooperative study of maternal and infant nutrition. 1223 89

Dietary deficiency in iron and to a lesser extent folic acid is the principle cause of anemia in the world. Reproductive aged women and growing children are the principle groups at risk of anemia. About half of nonpregnant reproductive aged women in tropical countries have hemoglobin levels lower than 12 g/100 ml, the level used by the World Health Organization to define anemia. Nutritional anemia is even more widespread among pregnant and lactating women because of the increased needs for iron during those periods. Pregnant women need almost 500 mg of iron for their increased red blood cell mass, 220 mg for routine iron loss through the urine, bile, sweat, and other routes; 290 mg for the fetus, and almost 25 mg for the placenta. In all, the pregnant women theoretically requires over 1000 mg of iron through diet or bodily reserves. Healthy, well-nourished women have total iron reserves of 2500 mg, but according to published data almost 2/3 of pregnant women even in favorable circumstances end their pregnancies with no remaining iron reserves. In tropical regions the lack of iron reserves is aggravated by parasites and infections, closely spaced pregnancies that do not allow restoration of reserves, and poor dietary availability of iron. Anemia during pregnancy is associated with elevated risks of maternal morbidity and mortality. Fatigue, dyspnea, palpitations and tachycardia, vertigo, loss of appetite and cravings for soil or other inappropriate substances are frequently observed in anemic women. The risks of prematurity and low weight are increased for infants of anemic women. Fetal malformation may be associated with folic acid deficiency. Nutrition education is needed for pregnant women. Local foods may be enriched with iron, and pregnant women may be given iron and vitamin B12 supplements directly. Iron supplements may rapidly increase iron reserves, but they are poorly tolerated by many women. The supplements should be avoided if possible early in the pregnancy because digestive intolerance is more likely in the 1st months of pregnancy. Parasitic and bacterial infections should be diagnosed and treated as a step in controlling anemia.
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PMID:[Impact of nutritional deficiencies on anemia in pregnant women]. 1228 20


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