Guidelines for treatment in neonate of equals to or lower than 27 weeks gestational weeks

 What are current treatment strategies to save neonate of 26 week of gestational age?

Current treatment strategies for neonates born at 26 weeks of gestation focus on providing intensive supportive care to address their underdeveloped organ systems. Key components include:

1. Respiratory Support:

   • Mechanical Ventilation: Often required due to underdeveloped lungs.
   • Surfactant Therapy: Administered to improve lung function and reduce respiratory distress syndrome (RDS).

2. Thermal Regulation:

   • Use of incubators or radiant warmers to maintain body temperature.

3. Nutritional Support:

   • Parenteral Nutrition: Initially, since the digestive system is immature.
   • Gradual introduction of enteral feeds (mother's milk or formula) as tolerated.

4. Cardiovascular Support:

   • Monitoring and managing blood pressure and heart function.
   • Use of medications or fluids to support cardiovascular stability.

5. Infection Prevention:

   • Strict hygiene protocols.
   • Use of antibiotics if necessary to prevent or treat infections.

6. Neurological Care:

   • Monitoring for intraventricular hemorrhage (IVH) and other neurological issues.

7. Eye Care:

   • Regular screening for retinopathy of prematurity (ROP).

8. Family Support:

   • Psychological and emotional support for parents and family.
   • Involving parents in the care process to the extent possible.

These strategies aim to support the neonate's growth and development while minimizing complications associated with extreme prematurity. Multidisciplinary teams, including neonatologists, nurses, respiratory therapists, and other specialists, collaborate to provide comprehensive care.

What about to prevent bleeding?

Preventing bleeding in neonates born at 26 weeks gestation involves several strategies, primarily focusing on minimizing the risk of intraventricular hemorrhage (IVH) and other bleeding complications:

1. Antenatal Steroids: Administered to the mother before

How?

To prevent bleeding in neonates born at 26 weeks of gestation, several strategies are employed, particularly to reduce the risk of intraventricular hemorrhage (IVH):

1. Antenatal Steroids: Administered to the mother before birth to accelerate

FFP and Vitamin K?

To prevent bleeding in neonates born at 26 weeks gestation, particularly focusing on reducing the risk of intraventricular hemorrhage (IVH), the following strategies are used:

1. Antenatal Steroids: Administered to the mother before birth to enhance fetal lung maturity and reduce the incidence of IVH.

2. Fresh Frozen Plasma (FFP): Used to manage coagulopathy by providing clotting factors.

3. Vitamin K: Administered to all neonates to prevent vitamin K deficiency bleeding, which is critical for normal blood clotting.

Details:

1. Antenatal Steroids: Administered to pregnant women at risk of preterm delivery (before 34 weeks gestation) to enhance fetal lung development and reduce complications like IVH. Common regimens include betamethasone or dexamethasone given as intramuscular injections.

2. Fresh Frozen Plasma (FFP): Used in neonates who show signs of coagulopathy, providing necessary clotting factors to prevent bleeding.

3. Vitamin K: Given routinely to all neonates shortly after birth, usually as an intramuscular injection, to prevent vitamin K deficiency bleeding (VKDB), a condition that can cause severe bleeding due to inadequate clotting.

These measures are part of a comprehensive approach to managing preterm neonates, aimed at reducing the risk of bleeding and other complications.

Can we start FFP and Vitamin K in same day of birth in such neonate prophylactically?

Yes, prophylactic administration of both Fresh Frozen Plasma (FFP) and Vitamin K can be initiated on the same day of birth for neonates born at 26 weeks gestation to prevent bleeding complications:

1. Vitamin K: Administered shortly after birth, typically as an intramuscular injection, to prevent vitamin K deficiency bleeding (VKDB).

2. Fresh Frozen Plasma (FFP): Can be given if there is a clinical indication of coagulopathy or if the neonate is at high risk for bleeding complications, to provide necessary clotting factors.

It is essential to follow specific neonatal care protocols and consult with a neonatologist for individualized treatment plans.

Give link?

Prophylactic administration of Vitamin K and Fresh Frozen Plasma (FFP) can be crucial in preventing bleeding complications in neonates born at 26 weeks gestation.

Vitamin K Prophylaxis

• Vitamin K Administration: Vitamin K is routinely administered intramuscularly (IM) shortly after birth to prevent vitamin K deficiency bleeding (VKDB). The recommended dose is 0.5 to 1.0 mg for term infants, and for preterm infants, a dose of 0.3 to 0.5 mg/kg is suggested. This practice has been endorsed by both the American Academy of Pediatrics (AAP) and the Canadian Paediatric Society, as it significantly reduces the risk of both early and late VKDB​ (AAP Publications)​​ (CanPaedSoc)​.

Fresh Frozen Plasma (FFP)

• FFP Administration: While FFP is commonly used in neonatology to manage coagulopathy by providing clotting factors, its routine prophylactic use is less well defined. The decision to administer FFP is typically based on clinical indications such as significant bleeding, laboratory evidence of coagulopathy, or in preparation for surgical procedures​ (AAP Publications)​.

Administering both Vitamin K and FFP on the same day of birth can be done if clinically indicated, especially in extremely preterm infants who are at high risk for bleeding disorders. However, the routine use of FFP prophylactically is not universally recommended and should be guided by clinical judgment and individual patient needs.

For more detailed guidelines and practices, you can refer to the American Academy of Pediatrics and Canadian Paediatric Society publications on neonatal care​ (AAP Publications)​​ (CanPaedSoc)​.

Can be given 24 hours infusion?

Yes, a 24-hour infusion can be used for certain treatments in neonates, including the administration of FFP or other blood products when continuous support is necessary.

Fresh Frozen Plasma (FFP)

FFP can be administered as a continuous infusion over 24 hours if there is a clinical need to manage ongoing coagulopathy or bleeding. Continuous infusion can help maintain stable levels of clotting factors in the bloodstream, which may be beneficial in critically ill preterm infants.

Considerations for Continuous Infusion

1. Indications: Continuous infusion of FFP might be indicated in cases of severe coagulopathy, ongoing bleeding, or preparation for surgical procedures.
2. Monitoring: Continuous infusion requires close monitoring of the infant's coagulation status, fluid balance, and potential for volume overload.
3. Dosing and Administration: The dosing for continuous infusion should be carefully calculated based on the infant's weight and clinical condition, and administered through a central line if possible.

Evidence and Guidelines

While there are guidelines for the administration of FFP and the use of continuous infusions in neonatal intensive care, the specific practice can vary based on institutional protocols and the clinical judgment of the healthcare team.

For detailed guidelines and evidence, please refer to the following sources:

1. American Academy of Pediatrics (AAP) Publications: Offers guidelines on the administration of blood products in neonates.
2. Canadian Paediatric Society (CPS) Publications: Provides recommendations for the prophylactic use of Vitamin K and considerations for blood product administration in preterm infants​ (AAP Publications)​​ (CanPaedSoc)​.

These sources offer comprehensive guidelines and recommendations for managing bleeding disorders in neonates, including the use of continuous infusion of FFP when necessary.

In FFP all clotting factors are found?

Yes, Fresh Frozen Plasma (FFP) contains all of the coagulation factors, including:

1. Fibrinogen (Factor I)
2. Prothrombin (Factor II)
3. Tissue factor (Factor III)
4. Calcium ions (Factor IV)
5. Proaccelerin (Factor V)
6. Proconvertin (Factor VII)
7. Antihemophilic factor (Factor VIII)
8. Christmas factor (Factor IX)
9. Stuart-Prower factor (Factor X)
10. Plasma thromboplastin antecedent (Factor XI)
11. Hageman factor (Factor XII)
12. Fibrin-stabilizing factor (Factor XIII)

FFP is used in the treatment of various coagulation disorders, providing these clotting factors to patients who may be deficient due to conditions like liver disease, disseminated intravascular coagulation (DIC), or during massive transfusions.

Clinical Uses of FFP

• Management of Bleeding: In patients with active bleeding and known coagulation factor deficiencies.
• Prophylactic Use: In patients undergoing surgery or invasive procedures with a known risk of bleeding.
• Treatment of Coagulopathies: Such as those seen in liver disease or DIC.

Guidelines and Recommendations

FFP is indicated in cases where specific clotting factors are needed and cannot be replaced by other means, such as recombinant factors or other blood products like cryoprecipitate for fibrinogen replacement. The use of FFP should always be guided by coagulation studies and clinical indications.

For further reading on the composition and clinical use of FFP, you can refer to resources from transfusion medicine and hematology guidelines provided by organizations like the American Association of Blood Banks (AABB) and the British Committee for Standards in Haematology (BCSH).

Sources:

• American Red Cross on Blood Types
• National Center for Biotechnology Information (NCBI)

Dose of in extreme premature neonate?

The dose of Fresh Frozen Plasma (FFP) for extremely premature neonates is generally calculated based on the infant's weight. The typical dose is:

• 10-20 mL/kg: This range is often used to ensure adequate levels of clotting factors are provided to manage or prevent coagulopathy in preterm neonates.

Administration

• Frequency: The administration frequency depends on the clinical scenario. FFP may be given as a single dose or repeated as necessary based on ongoing coagulation profiles and clinical assessments.
• Route: FFP is usually administered intravenously.

Considerations

1. Volume Overload: Given the risk of volume overload in preterm neonates, careful monitoring is essential. The volume of FFP should be considered in the context of the neonate's total fluid balance.
2. Clinical Indications: The use of FFP is typically reserved for specific clinical indications such as active bleeding, preparation for invasive procedures, or significant coagulopathy as confirmed by laboratory tests.

Guidelines and Recommendations

• The American Association of Blood Banks (AABB): Provides guidelines for the use of blood products, including FFP, in various clinical scenarios.
• The British Committee for Standards in Haematology (BCSH): Offers detailed recommendations for the administration of blood products in neonates and children.

For detailed clinical guidelines and evidence-based practices, consult resources from the AABB and BCSH, which provide comprehensive recommendations on the use of FFP in neonatal care.