Pre Mature Babies
Pre-term Labour
Pre -term birth is defined when baby born before complete 37 weeks gestation.Now i'm going to explain how to take care of those babies.In rural side of the world,most are reluctant of this method .So talk with your doctor in-case if you'r baby is pre mature baby.
Treatment:
the risks to mother and fetus of delivering prematurely need to be weighed against the risks of trying to prolong the pregnancy.Treatment options include steroids ,tocolytics and antibiotics.
Steroids
steroids uses encourages fetal lung maturation and reduces the risk of intraventricular haemorrhage ,necrotizing enterocolitis and neonatal daeth,e.g betamethasone (12mg IM x 2 doses 24h apart) administered from 24-36 completed weeks of gestation. even dexamethasone can be use for this function..
Tocolytics
Tocolytics prolong preganacy in the short term,however there is no evidence that this improves neonatal morbidity or mortality .Therefore ,they cannot be recommenced routinely .However ,they do have a role in prolonging the pregnancy for 48th,to allow sufficient time for the steroids to have an effect or for in utero transfer.They should not be used after this period.
Commonly used to tocolytics include atosiban ,nifedipine ,ritodrine and indometacin.Atosiban IV( is an inhibitor of the hormones oxytocin and vasopressin) is recommended as first line treatment due to its preferential side -effect profile.
Antibiotics
Infection remains one of the leading causes of pre term birth.Antibiotics therapy prolongs pregnancy and improve fetal outcome if mother 's membrane have rupture.If not,they should not be given.A common regime is erythromycin 250mg 6 hours) for 10 days..
Before i end up here,i would like to share some interesting treatment of betamethasone here..
Before i start ,let me tell you what is phimosis..
Phimosis
Causes:
Pathological phimosis (as opposed to the natural non-retractability of the foreskin in childhood) is rare and the causes are varied. Some cases may arise from balanitis (inflammation of the glans penis), perhaps due in turn to inappropriate efforts to retract an infant's foreskin. Other cases of non-retractile foreskin may be caused by preputial stenosis or narrowness that prevents retraction, by fusion of the foreskin with the glans penis in children, or by frenulum breve, which prevents retraction. In some cases a cause may not be clear, or it may be difficult to distinguish physiological phimosis from pathological if an infant appears to be in pain with urination or has obvious ballooning of the foreskin with urination or apparent discomfort. However, ballooning does not indicate urinary obstruction.
Phimosis in older children and adults can vary in severity, with some men able to retract their foreskin partially ('relative phimosis'), and some completely unable to retract their foreskin even in the flaccid state ('full phimosis').When phimosis develops in an adult who was previously able to retract his foreskin, it is nearly always due to a pathological cause, and is far more likely to cause problems for the man.
Beaugé noted that unusual masturbation practices, such as lying face down on a bed and rubbing the penis against the mattress, may cause phimosis. Patients are advised to stop exacerbating masturbation techniques and are encouraged to masturbate by moving the foreskin up and down so as to mimic more closely the action of sexual intercourse. After giving this advice Beaugé noted not once did he have to recommend circumcision.
One cause of acquired, pathological phimosis is chronic balanitis xerotica obliterans (BXO), a skin condition of unknown origin that causes a whitish ring of indurated tissue (a cicatrix) to form near the tip of the prepuce. This inelastic tissue prevents retraction. Infectious, inflammatory, and hormonal factors have all been implicated or proposed as contributing factors.
Phimosis may occur after other types of chronic inflammation (such as balanoposthitis), repeated catheterization, or forcible foreskin retraction.
Phimosis may also arise in untreated diabetics due to the presence of glucose in their urine giving rise to infection in the foreskin.
Management:
-Circumcision
-Stretching of the foreskin can be accomplished manually, with balloon or with other tools. Skin that is under tension expands by growing additional cells. A permanent increase in size occurs by gentle stretching over a period of time. The treatment is non-traumatic and non-destructive. Manual stretching may be carried out without the aid of a medical doctor. The tissue expansion promotes the growth of new skin cells to permanently expand the narrow preputial ring that prevents retraction. Beaugé treated several hundred adolescents by advising them to change their masturbation habits to closing their hand over their penis and moving it back and forth. Retraction of the foreskin was generally achieved after four weeks and he stated that he never had to refer one for surgery
-Application of topical steroid cream, such as betamethasone, for 4–6 weeks to the narrow part of the foreskin is relatively simple, less expensive than surgical treatments and highly effective.It has replaced circumcision as the preferred treatment method for some physicians in the British National Health Service
Recently, a trial of treatment with betamethasone dipropionate (0.05%) for 2 weeks is advocated in all children with phimosis before undertaking surgery. This steroid therapy demonstrated a success rate of 77%
Betamethasone is a potent glucocorticoid steroid with anti-inflammatory and immunosuppressive properties. Unlike other drugs with these effects, betamethasone does not cause water retention. It is applied as a topical cream, ointment, foam, lotion or gel to treat itching. Betamethasone sodium phosphate is sometimes prescribed as an intramuscular injection (I.M) for itching from various ailments, including allergic reactions to poison ivy and similar plants.It also as a trial used for the treatment of phimosis..(see above)
by Lakdhes
