Intended for healthcare professionals

Clinical Review ABC of preterm birth

Care in the early newborn period

BMJ 2004; 329 doi: (Published 04 November 2004) Cite this as: BMJ 2004;329:1087
  1. William McGuire,
  2. Peter McEwan,
  3. Peter Fowlie


    The first week after birth is a time of major metabolic and physiological adaptation for newborn infants. Preterm infants have to cope with additional stresses because most of their organ systems are immature or because of associated illnesses, such as congenital infection. Very preterm infants (< 32 weeks' gestation) or ill infants often need intensive monitoring and support during this critical period of postnatal adaptation.

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    Clothes, covers, and hat help to maintain body temperature of newborns when they are nursed in an open cot

    Temperature control and fluid balance

    Preterm infants are susceptible to heat and fluid loss, especially immediately after delivery and in the first few days after birth. Hypothermia is associated with increased morbidity and mortality. Trials in the 1950s showed that reducing heat loss improves survival for preterm and low birthweight infants. Measures to prevent cold stress should start immediately after delivery—for example, resuscitating newborns under radiant heaters, drying them, and wrapping them in warmed towels straight away. A randomised controlled trial showed that wrapping the infant in polyethylene immediately (without drying) is at least as effective in reducing evaporative heat loss in extremely preterm infants (< 28 weeks' gestation).

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    Heat and fluid loss

    Maintaining the neutral thermal environment

    After admission to the neonatal unit unnecessary oxygen and energy consumption must be minimised. Several options are available for nursing preterm infants in a neutral thermal environment. Bigger and more mature infants (weighing > 1800 g) can usually maintain their body temperatures in open cots with clothing (including a hat), covers, and possibly a heated mattress. Smaller and less mature infants, particularly very preterm infants, are usually cared for in air heated perspex incubators or in open cots, where they are placed under clear polyethylene blankets and there are overhead radiant heaters. The air temperature of the incubator or the power of the overhead heater can be set …

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