ABC of preterm birth : Care in the early newborn period
BMJ 2005; 331 doi: https://doi.org/10.1136/sbmj.0509320 (Published 01 September 2005) Cite this as: BMJ 2005;331:0509320- William McGuire, senior lecturer in neonatal medicine1,
- Peter Fowlie, consultant paediatrician2,
- Peter McEwan, specialist registrar3
- 1Tayside Institute of Child Health, Ninewells Hospital and Medical School, University of Dundee
- 2Perth Royal Infirmary and Ninewells Hospital and Medical School, Dundee
- 3Ninewells Hospital and Medical School, Dundee
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.
Preterm infants are susceptible to heat and fluid loss because
High surface area to volume ratio
Thin non-keratinised skin
Lack of insulating subcutaneous fat
Lack of thermogenic brown fat
Inability to shiver
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).
Risk factors for respiratory distress syndrome
Potential adverse consequences of hypothermia
High oxygen consumption can lead to hypoxia
High use of glucose can lead to hypoglycaemia
High energy expenditure can cause reduced rate of growth
Low surfactant production can cause respiratory distress
Vasoconstriction may cause poor perfusion or metabolic acidosis
Delayed adjustment from fetal to newborn circulation
Heat and fluid loss
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 …
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