Nursing Management of Premature Baby with Bpd

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SECTION 1
1.1introduction
A new born baby in the family is very much awaited by all parents, but when the baby was born premature, many complications to be borne with the baby. Bronchopulmonary Dysplasia is one of the complications faced by the premature baby. Singer.L et al(1997),mentioned in United States Bronchopulmonary Dysplasia is one of the leading cause of lung disease in low very birth weight infants(VLBW). Infants with BPD had higher rates of mental retardation, associated with greater neurologic and social risk. Baraldi.E,Filippone.M(2007), mentioned that Northway et al(1967) described firstly that Brochopulmonary Dysplasia is a new chronic respiratory disease developed in premature infants exposed to mechanical ventilation and oxygen supplement. They also suggesting that lifelong consequences may be experienced by those babies affected with lung injuries. According to May.C et al (2006), they mentioned that common adverse outcome of very premature birth is Bronchopulmonary Dysplasia and it will results in a chronic respiratory morbidity. Adams.J.M(2011), mentioned that “Despite important advances in perinatal care and a steady decline in mortality rates among very low birth weight (VLBW) infants (1 month), emphysematous alveoli are seen. Chronic lung damage eventually causes Pulmonary hypertension (caused by thickening of the inner-most lining of pulmonary arterioles), and results in cor pulmonale. Fibrosis, atelectasis, a cobblestone appearance due to uneven lung aeration, and pleural pseudofissures are often seen. Marked hypertrophy of peribronchiolar smooth muscle is present, (E-Medicine, 2009). Mentioned in Open Physio.com(2009), according to FreeMd (2008) and Medline plus (2005) the following are the most noted signs in an infant with BPD. The most Common signs of BPD are: * Shortness of breath

* Cough
* Wheezing

If BPD worsens, the infant will present with:
* Severely difficult breathing with grunting
* The chest and abdomen move in opposite directions with every breath * Rib retractions: ribs are visible during each breath
* Nasal flaring: nostrils open wide during each breath
* Use of accessory muscles: neck muscles are prominent during each breath * Rapid breathing rate

The outcomes involved in BPD babies according to Verklan.M.T, Walden.M(2004) were : 1) Mortality rate was approximately 10% to 15% by 1 year of age(Davis and Rosenfeld,1999). It may vary with the increased use of surfactant therapy and decrease use of steroid such as dexamethasone. After discharge , the mortality rate is less than 10%, and usually caused by respiratory failure and infections.

2) Discharged home with oxygen supplement to some of the infants.

3) Recurrent pulmonary infections and growth restriction are seen commonly among survivors.

4) Pulmonary function will improved little before 6 months of age. According to Adams and Cooper, 2003) by three years of age, pulmonary compliance is near normal, however, airway resistance may be 30% higher than that of controls.

5) Neurologic and developmental sequelae :
* cerebral palsy – most common. Prolonged treatment with dexamethasone decreases the risk of CLD, but infants are noted to have a higher incident of cerebral palsy and poorer neuro developmental outcome(Stark et al.,2001) * sensorineural hearing loss- involved in 0.7% to 2% in very low birth weight baby. Retinopathy of prematurity is reported at 23% to 57% with myopia common(Dusik,1997) Mentioned by Lissauer.T,. Fanaroff.A.A,(2006) the strategies for preventions include : * Antenatal corticosteroids

* Surfactant therapy
* possibly synchronized/high-frequency oscillatory ventilation * avoidance of fluid overload
* closure of patent ductus arteriosus(PDA)
* vitamin A (given in some centers)

SECTION 2
PRESENTATION OF CASE

2.1Demographic data
This case study is of a three months old Chinese baby. She...
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