Many parents of preemies leave the NICU so happy about their miracle that they often do not consider issues that could have major implications. One of these relate to teeth. A preemie can have delayed tooth eruption by as much as 6 months. When you consider that most term babies are starting to eat regular foods around the age of 6 months you realize the potential implications that a preemie faces if they haven't even gotten their first tooth by age 1 year. The following article provides great information on topics from the production of enamel, palatal groove formation which is seen in babies who are intubated for long periods and the timing of primary teeth eruption.
Dental Outcomes of Preterm Infants
Saturday, June 13, 2015
Wednesday, June 10, 2015
6/10/15
Many of you know that my wife and I had a 26 weeker over 1 year ago. We have been very blessed and he has been doing great. I will start to focus a lot of attention on giving back by using my knowledge and experience to help others through this blog. If there are particular topics you would like to see please let me know.
Tuesday, August 19, 2014
Brain bleeding in Prematurity
Intraventricular hemorrhage (IVH) occurs in approximately 45% of infants born weighing 500-750 grams. The overall incidence of IVH in newborns weighing <1500 grams is about 20%. To better describe the anatomy involved in this condition I have included a representation of the brain.
Typically in pre-mature babies an Ultrasound is performed 7 days after birth to evaluate for a bleed. If one is found it is graded on a 1-4 scale. A 1 or 2 grade bleed is a small amount of bleeding that typically does not require intervention and does not have any long-term consequence. A grade 3-4 bleed however have a higher amount of blood which can place pressure on the brain potentially causing damage or blocking the normal flow of spinal fluid. If this happens a condition called hydrocephalus can occur in which there is an accumulation of fluid in the brain. This may require surgical intervention with the use a drain called a shunt to direct the extra fluid from the brain to an area where it can be reabsorbed by the body naturally.
Here are some resources that can be of more help in learning about this condition.
Sunday, June 15, 2014
Happy Father's Day
Sunday, 6/15/14
Happy Father's Day to all of those who are celebrating their 1st Father's Day and those that are celebrating another year of being a Dad. For me this day is more special than I could have ever imagined. As a preemie parent we go through a lot to watch our little one's fight to survive then face challenges and obstacles we could never imagine as an adult. For me, my son Carter has taught me so much and I have yet had the opportunity to teach him anything. I am eager to have the opportunities to constantly teach him every day. To all of those Dads out there enjoy your babies, toddlers, infants, adolescent, tween, teen, and adult not only today but everyday. Always be grateful, proud and patient.
Thursday, June 12, 2014
Retinopathy of Prematurity
Retinopathy of Prematurity (ROP)
Like most terms that parents will hear in the NICU your first reaction to this term is what is that and what does it mean for my baby. Simply put ROP has to do with the vascularization, or blood supply to the retina in the eye. The retina is the light sensitive layer of tissue in the back of the eye that provides the message to our brain so that we can process what we are seeing. It is very important that the retina is supplied with blood so that it develops properly however in ROP too many vessels grow which can cause damage to the retina. Prior to 16 weeks gestation there is no blood supply to the retina. This vascularization begins to occur between 15 and 18 weeks gestation and continues to progress through the 40th week of gestation. In some cases the development of the blood supply to the retina is delayed all the way out to 48 or 52 weeks post-menstrual age. The cause of this condition is not well known however it is believed that certain factors such as a lack of oxygen, too much oxygen, and low blood pressure injures newly developing vessels or the formation of new vessels that will bring blood to the retina. All of the following factors may also play a role in ROP; low birth weight, low gestational age, assisted ventilation for longer than one week, surfactant therapy, high blood transfusion volume, cumulative illness severity, hyperglycemia, and insulin therapy.
One of the most confusing things I found during the report after an eye exam was the staging for ROP. You may hear the ophthalmologist spout off something like ROP stage II zone 3. The zone is the location of the retinopathy (see image below).
Image from Up To Date, http://www.uptodate.com/contents/retinopathy-of-prematurity?source=search_result&search=retinopathy+of+prematurity&selectedTitle=1%7E51
The stage indicates the severity of the disease with a stage 1 being an early stage and stage 5 being the most severe stage. In some situations the term Plus Disease will be used and this is typically an ominous sign for retinal detachment which can lead to blindness.
ROP will occur in approximately 68% of babies born that weigh less than 1251g or 2.78 pounds. In addition, gestational age at birth plays a role. Babies born earlier have a higher incidence of ROP.
The good news is that in the majority of cases ROP will totally resolve on its own. The ophthalmologist will perform serial exams about 2 weeks apart as long as there is nothing to warrant a weekly exam to monitor the progress of the disease. Here is a general rule of when follow-ups occur based on the severity of the disease.
Follow-up within one week is recommended for infants with
●Immature vascularization in zone I, without ROP
●Immature retina that extends into posterior zone II, near the boundary of zone I
●Stage 1 or 2 ROP in zone I
●Stage 3 ROP in zone II
●Suspected aggressive posterior ROP
Follow-up within one to two weeks is recommended for infants with:
●Immature vascularization in posterior zone II
●Stage 2 ROP in zone II
●Regressing ROP in zone I
Follow-up within two weeks is recommended for infants with:
●Stage 1 ROP in zone II
●Immature vascularization in zone II, without ROP
●Regressing ROP in zone II
Follow-up within two to three weeks is recommended for infants with:
●Stage 1 or 2 ROP in zone III
●Regressing ROP in zone III
If treatment becomes necessary it can be done with a procedure called photocoagulation in which a laser is used to destroy the extra vessels that have developed causing the condition. In some cases these extra blood vessels will strain the retina causing it to detach. For these cases a surgical procedure can be done.
No matter what degree of ROP your baby has it can and will be a scary time. It is always important to have a good communication with the nurses, doctors and practitioners so that you have a good understanding of what the diagnosis means for your baby. Never be shy to ask questions. Remember that understanding what your baby is going through is imperative to making the right choices for them.
Like most terms that parents will hear in the NICU your first reaction to this term is what is that and what does it mean for my baby. Simply put ROP has to do with the vascularization, or blood supply to the retina in the eye. The retina is the light sensitive layer of tissue in the back of the eye that provides the message to our brain so that we can process what we are seeing. It is very important that the retina is supplied with blood so that it develops properly however in ROP too many vessels grow which can cause damage to the retina. Prior to 16 weeks gestation there is no blood supply to the retina. This vascularization begins to occur between 15 and 18 weeks gestation and continues to progress through the 40th week of gestation. In some cases the development of the blood supply to the retina is delayed all the way out to 48 or 52 weeks post-menstrual age. The cause of this condition is not well known however it is believed that certain factors such as a lack of oxygen, too much oxygen, and low blood pressure injures newly developing vessels or the formation of new vessels that will bring blood to the retina. All of the following factors may also play a role in ROP; low birth weight, low gestational age, assisted ventilation for longer than one week, surfactant therapy, high blood transfusion volume, cumulative illness severity, hyperglycemia, and insulin therapy.
One of the most confusing things I found during the report after an eye exam was the staging for ROP. You may hear the ophthalmologist spout off something like ROP stage II zone 3. The zone is the location of the retinopathy (see image below).
Image from Up To Date, http://www.uptodate.com/contents/retinopathy-of-prematurity?source=search_result&search=retinopathy+of+prematurity&selectedTitle=1%7E51
The stage indicates the severity of the disease with a stage 1 being an early stage and stage 5 being the most severe stage. In some situations the term Plus Disease will be used and this is typically an ominous sign for retinal detachment which can lead to blindness.
ROP will occur in approximately 68% of babies born that weigh less than 1251g or 2.78 pounds. In addition, gestational age at birth plays a role. Babies born earlier have a higher incidence of ROP.
The good news is that in the majority of cases ROP will totally resolve on its own. The ophthalmologist will perform serial exams about 2 weeks apart as long as there is nothing to warrant a weekly exam to monitor the progress of the disease. Here is a general rule of when follow-ups occur based on the severity of the disease.
Follow-up within one week is recommended for infants with
●Immature vascularization in zone I, without ROP
●Immature retina that extends into posterior zone II, near the boundary of zone I
●Stage 1 or 2 ROP in zone I
●Stage 3 ROP in zone II
●Suspected aggressive posterior ROP
Follow-up within one to two weeks is recommended for infants with:
●Immature vascularization in posterior zone II
●Stage 2 ROP in zone II
●Regressing ROP in zone I
Follow-up within two weeks is recommended for infants with:
●Stage 1 ROP in zone II
●Immature vascularization in zone II, without ROP
●Regressing ROP in zone II
Follow-up within two to three weeks is recommended for infants with:
●Stage 1 or 2 ROP in zone III
●Regressing ROP in zone III
If treatment becomes necessary it can be done with a procedure called photocoagulation in which a laser is used to destroy the extra vessels that have developed causing the condition. In some cases these extra blood vessels will strain the retina causing it to detach. For these cases a surgical procedure can be done.
No matter what degree of ROP your baby has it can and will be a scary time. It is always important to have a good communication with the nurses, doctors and practitioners so that you have a good understanding of what the diagnosis means for your baby. Never be shy to ask questions. Remember that understanding what your baby is going through is imperative to making the right choices for them.
Thursday, May 29, 2014
New research on placenta
This is a very interesting article that discusses how the placenta can play a role in premature birth. Just a snip-it of the potential causes yet to be revealed.
http://www.parents.com/blogs/parents-news-now/2014/05/22/pregnancy/placenta-found-to-have-significant-impact-on-newborns-health/?socsrc=pmmfb1405276
http://www.parents.com/blogs/parents-news-now/2014/05/22/pregnancy/placenta-found-to-have-significant-impact-on-newborns-health/?socsrc=pmmfb1405276
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