Monday, May 23, 2011

Cerebral Palsy; The Basics

Premature babies are at risk for Cerebral Palsy (CP). It is caused by damage to one or more areas of the brain.

"Cerebral" refers to the brain and "palsy" refers to a physical disorder.

CP falls into one of three main types:

Ataxic CP: (loss of depth perception and balance)caused by damage to the cerebellum, which controls balance; this is the rarest of the three types. Children with this type of CP have difficulty coordinating movements and balance.

Athetoid/Dyskinetic CP: (uncontrolled or involuntary movement)caused by damage to the basal ganglion and causes uncoordinated, involuntary, and uncontrolled muscle movement. Children with this type of CP may be able to walk but often stumble. It is also characterized by twisting of the fingers and wrists.

Spastic CP: (difficult or stiff movement)caused by damage to the cortex which controls movement and sensation. It is the most common type of CP and results in tight muscles in the arms and legs. Children with this type of CP can avoid being placed in a wheelchair if their muscles are exercised properly.

Mixed CP: a combination of two or more of the above,or all three.
 
Aside from Premature birth other risk factors associated with Cerebral Palsy include, but are not limited to, improper oxygen while the infant was developing, bacterial infection in the mother while pregnant, and prolonged oxygen loss during birth. Severe jaundice after birth. Another possible factor can be by the mother being infected with German measles during the beginning of her pregnancy.

Unfortunately, there is no cure for CP due to the fact that brain damage cannot be reversed. However, with training and therapy, muscle function and co-ordination can greatly improve.

Monday, May 9, 2011

Interuterine Growth Retardation (IUGR)

One of the more common conditions of premature birth is Intrauterine Growth Retardation (IUGR).

Intrauterine growth retardation is a condition that is often recognized in babies that are born at or below the tenth percentile for their gestational age. Although approximately 350,000 infants are born weighing below the tenth percentile in the United Stated each year, only about 100,000 are actually diagnosed with IUGR. Many times, low birth weight in infants can be attributed to a low maternal weight or other factors. In these instances, babies normally "catch up" as their age progresses.

IUGR should be evaluated and treated as early as possible, as this condition can raise the risk for more significant health problems. For most babies who suffer from IUGR, however, the prognosis is very good.

What causes intrauterine growth retardation ?

There are various factors that should be considered when evaluating the causes of, and diagnosing and infant suspected of suffering from IUGR. Such factors as the size and weight of the mother, the phenotype of the father, and even higher altitude residency can affect the birth weight of an infant. When these factors are taken into consideration, many children are referred to as "constitutionally small". This term describes children who are of a lower birth weight, but otherwise healthy.

When these factors do not apply, or seem less relevant, or the low birth weight is severe, the child is often said to suffer from Intrauterine growth retardation.

The most common cause of IUGR is poor maternal-fetal circulation resulting in failure to thrive. Other causes include congenital abnormalities and intrauterine infections during pregnancy.

Medical factors that influence IUGR include:
  • Diabetes
  • Early preeclampsia- Preeclampsia causes significant damage to the placenta, resulting in poor blood flow to the infant.
  • Hypertension- Perinatal mortality is three times more likely in infants with hypertensive mothers.
  • Lupus
  • Chronic renal disease
  • Inflammatory bowel disease
  • Severe lung disease
  • Infections account for approximately ten percent of all cases of Intrauterine growth retardation.
Infections that influence the development of IUGR include:
  • Hepatitis B
  • Syphilis
  • HIV
  • Toxoplasmosis
  • Rubella
  • Cytomegalovirus
  • Herpes
Maternal behaviors and characteristics that influence the risk of IUGR include:
  • Smoking
  • Alcohol use
  • Cocaine use
  • Use of Warfarin or Phenytoin
  • Malnutrition
  • Prior pregnancies resulting in infants with IUGR
Prevention techniques include:

While prevention is not always possible, expectant mothers should remove as many risk factors as possible to help prevent their infants from suffering from IUGR. Stopping smoking, alcohol use, and drug use can be an important step in reducing the risk. In addition, expectant mothers should focus on consuming a nutritional diet. Any medications taken during pregnancy should be approved by the attending physician.

Treatments Available:

When IUGR is suspected, many times physicians will recommend an early or preterm delivery of the baby to prevent further development of IUGR. This can be done by inducing preterm labor, or by cesarean delivery.
While most children suffering from IUGR will eventually catch up on their own, much of the prognosis is dependent upon the cause of the growth retardation.

There are many reasons a child won't have catch up growth. About 10% of children born IUGR do not catch up (my son being one of them), however there are also medical conditions such at growth hormones deficiency's, Celiac disease and many more or genetic conditions such as metabolic disorders that will prevent the child from ever fully developing normally.

In some instances, Growth Hormones are recommended to assist the child in reaching average size, and developing properly.

Consult with your endocrinologist for proper testing to determine the cause of inadequate growth.

Wednesday, May 4, 2011

Bronchopulmonary Dysplasia (BPD) / Chronic Lung Disease

I remember the first time I heard “your son has severe bronchopulmonary Dysplasia (BPD)". Time seemed to stop for a moment...

Of course I listened to what the doctors had to say, but it seemed like every time they talked I didn't quite hear WHAT they were saying...not sure why that happens.

Soon, thereafter, I did my own research (its just easier to read it sometimes than actually hear it).
So, in laymans terms here is what I have learned about BPD from my experience with it.

Bronchopulmonary Dysplasia is also known as Chronic Lung disease and it affects babies.

It is one of the most common chronic lung diseases in children and it can range from mild to severe (as in my son’s case).

BPD can start with Respiratory Distress Syndrome (RDS) and RDS occurs in babies whose lungs have not developed completely. It is mainly caused by a lack of a substance called surfactant (a natural lubricant that improves lung function).

Symptoms:
  • Blue Color of Skin (Cyanosis)
  • Apnea (a brief stop in breathing)
  • Nasal flaring
  • Rapid, shallow breathing
  • Shortness of breath and grunting sounds
  • Retractions (pulling at rib cage) while breathing
If symptoms of RDS continue after a about month or so, then the condition will be considered to be BPD.
BPD is defined by inflammation and scarring in the lungs, most commonly found in premature and low birth weight infants.

It can also be caused by other conditions other than premature birth such as pneumonia's or RSV (respiratory syncytial virus). So, BPD can even happen in a healthy full-term baby and sometimes (but rare) in older children.

White (Caucasian), boy babies seem to be at greater risk for developing Bronchopulmonary Dysplasia, for reasons that are unknown, and most babies will outgrow the more severe symptoms of BPD.


How is BPD Diagnosed and Treated?

In my son’s case he was; premature, had RDS, became septic (infection), exposed to high oxygen, and of course he was ventilator dependent (so, he required a tracheostomy). His Chest X-ray’s and CT scans showed scarring of lung tissue. All indicating factors of Bronchopulmonary Dysplasia.

There is no cure BPD. Just time. Babies diagnosed receive intensive support in the hospital, until they are stable enough to be transferred to a rehab hospital or (as in our case) home.


Medications

If the baby is born and has RDS, doctors may be give, a dose of surfactant (in my sons case two doses), this may decrease the chance for BPD to develop.

The medications used to treat my son's BPD were; Albuterol,a bronchodilator, (helps keep small airway sacs open). Lasix (furosemide), a diuretic that helps decrease fluid build up in the lungs. Flovent, (an inhaled steroid). He remains on this even today for maintenance of his asthma. He was also on course of prednisolone (a strong anti-inflammatory) for an extended period of time,, spironolactone (a.k.a., Aldactone),which also removes excess fluid from body, and a K supplement(potassium).
BPD babies are also at high risk of developing infections so antibiotics are sometimes needed.


Nutrition

Nutrition is also extremely important. BPD babies may need high-calorie formulas through a nasal gastric tube (NG tube) or a gastrointestinal tube (G-tube), which is surgically placed.

Why an NG tube or G-tube? BPD babies have a difficult time eating by mouth, they tend to burn alot of calories just trying to breath, when they eat they burn even more calories, resulting in poor weight gain. The tubes are a way to get the calories into the baby without effort on the babies part.

Result? More growth. Which means? More new and healthy lung tissue.

New lung tissue that forms may ultimately take over much of the work of breathing for diseased lung tissue. Babies continue to grow new lung tissue for 5-7 years.

Babies with BPD are slow to improve(mine sure was). After coming through the more severe stages of BPD, some may have longer-term complications (my son has asthma).

How to care for your Child who has BPD once s/he comes home?

We, as parents have a critical role in the care of our children when they leave the hospital.

One essential safety measure for us was to reduce Collin’s exposure to infections.

I limited visits from people who were sick, even eliminated them. When he got a little stronger I limited play dates to 1-2 children and also delayed him from starting school for a year. (some may tell you I was a little over the top, but I don’t think so!)

Also, it is very important that babies receive all the recommended vaccinations to prevent further illness.
Continue the high-calorie formula if you were asked to do so. Children with BPD sometimes can grow slower and are slower gain weight due to breathing problems.

Try to remember, each case of Broncopulmonary Dysplasia is different and every child is different.
Thankfully, new studies are always being done and new treatments become available.


So, as always please consult with your NICU team for further information on the treatments available for Bronchopulmonary Dysplasia.

For more information on  how infant massage reduces stress in preemies check out this article: click here.