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Hospital work experience: neonatal ward part 2

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As it is very rare to find medicines specifically made forneonates there is often a lot of wastage. The pharmacist I was with remarkedthat if someone set up a company specialising in neonatal medicines they wouldmake a fortune! Another issue when administering medicines to neonates is thetaste and texture of oral formulations because if a medicine tastes unpleasantthey simply will not swallow it. Volume is also an important factor toconsider. Since the babies are so small if the volume of oral medicineadministered is too great the baby will not be able to swallow it at all. In anattempt to overcome this concentrated forms of the medicine are sometimes giveninstead. However, this often means that the taste becomes unpleasant.Furthermore, there is a higher risk of error when administering highlyconcentrated medicines. The risk of error has to be weighed up against howimportant it is that the baby actually takes the medicine.

The stomach pH of premature babies is often just veryslightly acidic and this is an issue when nasogastric tubes are inserted. Thereis a risk that the tube can enter the lungs instead of the stomach and to testfor this some fluid is normally withdrawn and its pH tested. However, inpremature babies this is not very useful so chest x-rays are given instead toensure the correct positioning of the tube.

Another issue affecting premature babies is that they have alarge surface area to volume ratio which means they find it hard to maintaintheir core temperature. This is why incubators are used. Incubators are alsocapable of creating a humid environment which helps to prevent the baby’s skinfrom drying out.

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