Newborn infants
Endotrachael suctioning is often used during intubation in newborn infants to reduce the risk of a blocked tube due to secretions, a collapsed lung, and to reduce pain. Suctioning is sometimes used at specifically scheduled intervals, "as needed", and less frequently. Further research is necessary to determine the most effective suctioning schedule or frequency of suctioning in intubated infants.In newborns free flow oxygen used to be recommended during intubation however as there is no evidence of benefit the 2011 NRP guidelines no longer do. Predicting difficulty
Tracheal intubation is not a simple procedure and the consequences of failure are grave. Therefore, the patient is carefully evaluated for potential difficulty or complications beforehand. This involves taking the medical history of the patient and performing a physical examination, the results of which can be scored against one of several classification systems. The proposed surgical procedure (e.g., surgery involving the head and neck, or bariatric surgery) may lead one to anticipate difficulties with intubation. Many individuals have unusual airway anatomy, such as those who have limited movement of their neck or jaw, or those who have tumors, deep swelling due to injury or to allergy, developmental abnormalities of the jaw, or excess fatty tissue of the face and neck. Using conventional laryngoscopic techniques, intubation of the trachea can be difficult or even impossible in such patients. This is why all persons performing tracheal intubation must be familiar with alternative techniques of securing the airway.
Care of systemic disease
Sickle cell disease is a systemic disease that affects several organs in the body. Management of the underlying disease can therefore prevent the development of retinopathy and slow its progression. Fetal haemoglobin transfusion - Fetal haemoglobin (HbF) is a form of haemoglobin that is found in children up to 6 months after birth. This type of haemoglobin is beneficial in sickle cell patients as it resists modification to the sickled shape. As a result, transfusion of HbF in younger populations can prevent and slow the progression of sickle cell retinopathy. Hydroxyurea administration - Hydroxyurea is a drug that can be used as an alternative method of increasing fetal haemoglobin levels in the blood of a patient with sickle cell disease. Hydroxyurea also provides the benefit of reducing inflammation. Haematopoetic stem cell transplantation - This process is more commonly known as a bone marrow transplant. It is useful in the management of sickle cell disease. However, access to this method is limited due to cost and the need for a donor that is biologically compatible with the person requiring the transplant. Anti-inflammatory and anti-adhesive drugs reduce the likelihood of occlusions in the small blood vessels of the retina therefore preventing the development of sickle cell retinopathy. There drugs include anti adhesive antibodies, anti-integrin antibodies, anti-Willebrand factor, sulfasalazine and statins. Gene therapy has also been proven beneficial in the prevention of sickle cell retinopathy. Treatment
Medical
Vascular endothelial growth factor (VEGF) is known to be associated with sea fan lesions which are types of neovascularization.