It's all about the lungs . . .

Hi all.  I have been silent on my blog for quite awhile.  I got busy with life (and kids), plus I did not think anyone was really reading.  From looking at statistics, I may not have regular followers, but I have had quite a few more blog visits since I stopped writing, so maybe it's time to try and pick it up again.  :-)

Some changes in where I work and what population I care for have happened in the last few years.  I moved from California to the mid-west and from a Children's hospital to a local large hospital system.  This means less chance to encounter congenital malformations, cardiac, and/or surgical conditions first hand.  However, I still can write about my knowledge and experiences with these different encounters, I will most likely focus on prematurity and it's complications.

The main issue in my line of work is respiratory issues, hence the title.  The lungs are one of the last organs to develop in the infant, and continue to develop into our 30s!  That is one of the reasons that top marathoners tend to be in the late 20s, early 30s.  The human body continually amazes me.

The earliest babies that can be saved when born are in the 23-25 week gestation age.  This is about 6 months into pregnancy (which is really 10 lunar months, which is close to 9 calendar months, but not exactly).  This means that these babies are born 3-4 months before they are supposed to be.  At this point the air sacs where oxygen exchange takes place are still barely formed and not optimal for gas exchange.  Amazingly, some infants at this age are still able to survive and develop usually with the help of artificial ventilation.  Very occasionally, I have seen some infants close to 25 weeks who are able to breathe with the help of CPAP rather than a ventilator.  Amazingly strong little babies.

I will go further into ventilation and CPAP on a further blog post, but for now just know the lungs are usually the body system that give us the most difficulty early in life.

NEC

NEC stands for necrotizing enterocolitis which basically is death of intestinal tissue. It is a very scary and unpredictable preemie problem. One of the scary things with NEC is that we do not know exactly what causes it or how to prevent it in preemies. It appears to be related to feedings and ischemic injury (lack of blood flow to an area).

While in the NICU, we try to give preemies feedings as early as possible once they are fairly stable to help the gut begin to work as it should. Normally in development there will be no food entering the digestive system, although now that they are outside the womb, preemies must continue development in a different environment and there will be a whole host of other problems if we delay feedings too long unnecessarily.

Often preemies breath sporadically and have small pauses in their breathing. This can cause a drop in the oxygen concentration of their blood for a short time. If the pause is too long - there is a chance for injury to happen to different body tissues due to lack of oxygenation. Neonatologists feel that this may be part of the cause of NEC.

There are different types of NEC and different ways of treating it depending on the type and seevarity. Medical NEC is often treated with antibiotics and resting the gut i.e. holding regular feedings. There is also NEC that needs to be treated surgically to remove the dead tissue and attempt to save the tissue that remains alive within the infant.

Amazingly many preemies who develop NEC can go from normal to very sick within a few hours and sometimes they die within a few hours of developing intestinal issues. Usually we are able to provide some treatment and can help to save much of the intestines. Thankfully many of the babies that now develop NEC do improve and eventually go home.

Still, it remains to be a major problem for our patients and we continue to try and do our best to first prevent and then treat NEC.