Immediate care of the preterm infant

Introduction

Preparing appropriately for the delivery and immediate care of the preterm infant is essential when time permits and may impact on the eventual outcome for the infant. This article describes the skills and equipment needed for the care and possible resuscitation of these vulnerable babies. The support and advice needed by parents and families at this time is also explored.

Preparation for preterm delivery

When preterm delivery can be anticipated there may be an opportunity for paediatric staff to discuss intrapartum and postnatal care with prospective parents and colleagues from midwifery and obstetrics. Even if detailed discussion is not possible, relevant historical details should be taken to anticipate problems and prepare appropriately for the arrival of the preterm infant.

Broadly, the level of resuscitation that may be needed is inversely related to the gestation of the preterm infant. Usually, the approach taken in resuscitating preterm infants of > 32 completed weeks' gestation is the same as that taken for term infants. Most need only basic measures such as drying and stimulation. Infants of gestation < 32 weeks (or birth weight < 1500 g) require more active support. For infants of < 28 weeks' gestation, this support will probably include endotracheal intubation and assisted ventilation.

Ideally, two members of staff who are experienced in the early care of preterm infants should be present at the delivery of each anticipated infant. A senior paediatrician with extensive experience in dealing with preterm babies should be at the delivery of infants of < 28 weeks' gestation. Before delivery, the attending staff should recheck essential equipment for resuscitation.

Assessment and resuscitation

Preterm infants get cold quickly because of their relatively large surface area. Resulting hypothermia reduces surfactant production, may hasten …