Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-1678-3755
Respiratory and Gastrointestinal Management of an Infant with a Birth Weight of 258 Grams
![](https://www.thieme-connect.de/media/ajpr/202201/lookinside/thumbnails/10-1055-a-1678-3755_210029-1.jpg)
Abstract
Today, more infants weighing less than or equal to 300 g are born, and they survive because of the improvements in neonatal care and treatment. However, their detailed clinical course and neonatal intensive care unit management remain unknown due to their low survival rate and dearth of reports. A male infant was born at 24 weeks and 5 days of gestation and weighed 258 g. The infant received 72 days of invasive and 92 days of noninvasive respiratory support, including high-frequency oscillatory ventilation with volume guarantee and noninvasive neurally adjusted ventilatory assist. Meconium-related ileus was safely treated using diatrizoate. Although the infant was diagnosed with severe bronchopulmonary dysplasia and retinopathy of prematurity requiring laser photocoagulation, he had no other severe complications. He was discharged 201 days postdelivery (3 months of corrected age) with a weight of 3.396 kg. Although managing infants weighing less than or equal to 300 g is difficult, our experience shows that it is possible by combining traditional and modern management methods. The management of such infants requires an understanding of the expected difficulties and adaptation of existing methods to their management. The management techniques described here should help improve their survival and long-term prognosis.
Keywords
tiny infant - extremely low birth weight - small for gestational age - high-frequency oscillatory ventilation with volume guarantee - noninvasive neurally adjusted ventilatory assist - meconium-related ileus - transpyloric tube feeding - cow milk–based fortifier - medium-chain triglyceride oilPublication History
Received: 20 September 2021
Accepted: 20 October 2021
Accepted Manuscript online:
25 October 2021
Article published online:
09 February 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Lau C, Ambalavanan N, Chakraborty H, Wingate MS, Carlo WA. Extremely low birth weight and infant mortality rates in the United States. Pediatrics 2013; 131 (05) 855-860
- 2 Itabashi K, Horiuchi T, Kusuda S. et al. Mortality rates for extremely low birth weight infants born in Japan in 2005. Pediatrics 2009; 123 (02) 445-450
- 3 Inoue H, Ochiai M, Yasuoka K. et al; Neonatal Research Network of Japan (NRNJ). Early mortality and morbidity in infants with birth weight of 500 grams or less in Japan. J Pediatr 2017; 190: 112-117.e3
- 4 Griffin IJ, Lee HC, Profit J, Tancedi DJ. The smallest of the small: short-term outcomes of profoundly growth restricted and profoundly low birth weight preterm infants. J Perinatol 2015; 35 (07) 503-510
- 5 Salihu HM, Emusu D, Aliyu ZY, Kirby RS, Alexander GR. Survival of “pre-viable” infants in the United States. Wien Klin Wochenschr 2005; 117 (9–10): 324-332
- 6 Sauve RS, Robertson C, Etches P, Byrne PJ, Dayer-Zamora V. Before viability: a geographically based outcome study of infants weighing 500 grams or less at birth. Pediatrics 1998; 101 (3, Pt 1): 438-445
- 7 Gillone J, Banait N, Miller N, Ward Platt M, Harigopal S. Outcomes of infants with a birthweight less than or equal to 500 g in Northern England: 15 years experience. Acta Paediatr 2018; 107 (02) 223-226
- 8 Brumbaugh JE, Hansen NI, Bell EF. et al; National Institute of Child Health and Human Development Neonatal Research Network. Outcomes of extremely preterm infants with birth weight less than 400 g. JAMA Pediatr 2019; 173 (05) 434-445
- 9 The University of Iowa. The Tiniest Babies. Accessed 9 October 2021 at: https://webapps1.healthcare.uiowa.edu/TiniestBabies/index.aspx
- 10 Inoue H, Ochiai M, Sakai Y. et al; Neonatal Research Network of Japan. Neurodevelopmental outcomes in infants with birth weight ≤500 g at 3 years of age. Pediatrics 2018; 142 (06) e20174286
- 11 Muraskas JK, Rau BJ, Castillo PR, Gianopoulos J, Boyd LAC. Long-term follow-up of 2 newborns with a combined birth weight of 540 grams. Pediatrics 2012; 129 (01) e174-e178
- 12 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
- 13 Muraskas JK, Myers TF, Lambert GH, Anderson CL. Intact survival of a 280-g infant: an extreme case of growth retardation with normal cognitive development at two years of age. Acta Paediatr Suppl 1992; 382: 16-20
- 14 Hokuto I, Ikeda K, Tokieda K, Mori K, Sueoka K. An ultra premature baby of 290 g birth weight needed more than 500 mg/kg of calcium and phosphorus daily. Eur J Pediatr 2001; 160 (07) 450-451
- 15 Kohelet D, Arbel E, Shochat R, Tavori I. Survival of a 300-g infant ventilated by high-frequency oscillatory ventilation for respiratory distress syndrome. Crit Care Med 2002; 30 (05) 1152-1155
- 16 Arimitsu T, Wakabayashi D, Tamaoka S, Takahashi M, Hida M, Takahashi T. Case report: intact survival of a marginally viable male infant born weighing 268 grams at 24 weeks gestation. Front Pediatr 2021; 8: 628362
- 17 Rehan VK, Fong J, Lee R. et al. Mechanism of reduced lung injury by high-frequency nasal ventilation in a preterm lamb model of neonatal chronic lung disease. Pediatr Res 2011; 70 (05) 462-466
- 18 Zivanovic S, Peacock J, Alcazar-Paris M. et al. Late outcomes of a randomized trial of high-frequency oscillation in neonates. N Engl J Med 2014; 370 (12) 1121-1130
- 19 Cools F, Offringa M, Askie LM, Askie LM. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev 2015; 19 (03) CD000104
- 20 Iscan B, Duman N, Tuzun F, Kumral A, Ozkan H. Impact of volume guarantee on high-frequency oscillatory ventilation in preterm infants: a randomized crossover clinical trial. Neonatology 2015; 108 (04) 277-282
- 21 Enomoto M, Keszler M, Sakuma M. et al. Effect of volume guarantee in preterm infants on high-frequency oscillatory ventilation: a pilot study. Am J Perinatol 2017; 34 (01) 26-30
- 22 Belteki G, Morley CJ. High-frequency oscillatory ventilation with volume guarantee: a single-centre experience. Arch Dis Child Fetal Neonatal Ed 2019; 104 (04) F384-F389
- 23 Tuzun F, Deliloglu B, Cengiz MM, Iscan B, Duman N, Ozkan H. Volume guarantee high-frequency oscillatory ventilation in preterm infants with RDS: tidal volume and DCO2 levels for optimal ventilation using open-lung strategies. Front Pediatr 2020; 8: 105
- 24 Lee BK, Shin SH, Jung YH, Kim EK, Kim HS. Comparison of NIV-NAVA and NCPAP in facilitating extubation for very preterm infants. BMC Pediatr 2019; 19 (01) 298
- 25 Yagui AC, Gonçalves PA, Murakami SH, Santos AZ, Zacharias RSB, Rebello CM. Is noninvasive neurally adjusted ventilatory assistance (NIV-NAVA) an alternative to NCPAP in preventing extubation failure in preterm infants?. J Matern Fetal Neonatal Med 2021; 34 (22) 3756-3760
- 26 Kallio M, Mahlman M, Koskela U. et al. NIV NAVA versus nasal CPAP in premature infants: a randomized clinical trial. Neonatology 2019; 116 (04) 380-384
- 27 Krasna IH, Rosenfeld D, Salerno P. Is it necrotizing enterocolitis, microcolon of prematurity, or delayed meconium plug? A dilemma in the tiny premature infant. J Pediatr Surg 1996; 31 (06) 855-858
- 28 Dimmitt RA, Moss RL. Meconium diseases in infants with very low birth weight. Semin Pediatr Surg 2000; 9 (02) 79-83
- 29 Emil S, Nguyen T, Sills J, Padilla G. Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management. J Pediatr Surg 2004; 39 (05) 731-737
- 30 Shinohara T, Tsuda M, Koyama N. Management of meconium-related ileus in very low-birthweight infants. Pediatr Int 2007; 49 (05) 641-644
- 31 Ein SH, Shandling B, Reilly BJ, Stephens CA. Bowel perforation with nonoperative treatment of meconium ileus. J Pediatr Surg 1987; 22 (02) 146-147
- 32 Michikata K, Kodama Y, Kaneko M. et al. Oral diatrizoate acid for meconium-related ileus in extremely preterm infants. Pediatr Int (Roma) 2018; 60 (08) 714-718
- 33 Farhath S, He Z, Nakhla T. et al. Pepsin, a marker of gastric contents, is increased in tracheal aspirates from preterm infants who develop bronchopulmonary dysplasia. Pediatrics 2008; 121 (02) e253-e259
- 34 Misra S, Macwan K, Albert V. Transpyloric feeding in gastroesophageal-reflux-associated apnea in premature infants. Acta Paediatr 2007; 96 (10) 1426-1429
- 35 Malcolm WF, Smith PB, Mears S, Goldberg RN, Cotten CM. Transpyloric tube feeding in very low birthweight infants with suspected gastroesophageal reflux: impact on apnea and bradycardia. J Perinatol 2009; 29 (05) 372-375
- 36 Watson J, McGuire W. Transpyloric versus gastric tube feeding for preterm infants. Cochrane Database Syst Rev 2013; 2013 (02) CD003487
- 37 Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006; 117 (04) 1253-1261
- 38 Franz AR, Pohlandt F, Bode H. et al. Intrauterine, early neonatal, and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support. Pediatrics 2009; 123 (01) e101-e109
- 39 Belfort MB, Rifas-Shiman SL, Sullivan T. et al. Infant growth before and after term: effects on neurodevelopment in preterm infants. Pediatrics 2011; 128 (04) e899-e906
- 40 Zozaya C, Díaz C, Saenz de Pipaón M. How should we define postnatal growth restriction in preterm infants?. Neonatology 2018; 114 (02) 177-180
- 41 Arslanoglu S, Boquien CY, King C. et al. Fortification of human milk for preterm infants: Update and recommendations of the European milk bank association (EMBA) working group on human milk fortification. Front Pediatr 2019; 7: 76
- 42 Vaidya UV, Hegde VM, Bhave SA, Pandit AN. Vegetable oil fortified feeds in the nutrition of very low birthweight babies. Indian Pediatr 1992; 29 (12) 1519-1527
- 43 Kwon S-J, Park H-K, Kim M-S. Nutritional management for intolerance to human milk fortifier in a preterm small-for-gestational-age infant: a case report. Clin Nutr Res 2020; 9 (03) 235-240