ABC of preterm birth: Immediate care of the preterm infant

• Published in: BMJ (Online) 2005-06, Vol.330 (Suppl S6), p.506230
• Main Authors: Fowlie, Peter W, McGuire, William
• Format: Article
• Language: English
• Subjects: Babies; Catheters; Drugs; Families & family life; Heart rate; Intensive care; Intubation; Lungs; Management decisions; Masks; Medical prognosis; Mortality; Newborn babies; Palliative care; Parents & parenting; Premature birth; Respiration; Respiratory distress syndrome; Respiratory therapy; Surfactants; Ventilation
• ISSN: 1756-1833; 0966-6494; 1756-1833; 1752-069X
• DOI: 10.1136/sbmj.0506230

Stopping intensive resuscitation efforts If the heart rate does not improve despite 15-20 minutes of appropriate efforts, then it may be appropriate to stop resuscitation and to provide palliative care.\n The parents can spend time with their baby, and should be aware that their baby may show signs of life, such as occasional gasps, after birth. Perinatal management at the threshold of viability Antenatal counselling should be provided by senior neonatologists, obstetricians, and midwives Management decisions should depend on what the parents and their medical advisers think is in the child's best interests Parents should have accurate information on likely outcomes for their infant - including their chances of survival and the risk of longer term disability Information on outcomes provided to parents should cite data from large cohort studies that reported the outcome of all pregnancies for each week of gestation (not just for infants admitted to intensive care units) Perinatal management plans should consider the mode of delivery, use of intrapartum monitoring, and immediate care of the newborn Decisions not to provide active resuscitation or intensive care should not be binding, particularly if the newborn seems more mature than anticipated It may be appropriate to provide full resuscitation and intensive care to infants at birth until the clinical progress becomes clearer and further discussions with the family have been possible Parents should be supported throughout and encouraged to seek advice and further support from others, such as family members and religious advisers Infants who are not actively resuscitated or in whom active resuscitation is withdrawn should receive palliative care Drugs used in acute resuscitation of the preterm infant Adrenaline (epinephrine) (1:10 000): 0.1 ml/kg endotracheal route or via umbilical venous catheter Sodium bicarbonate (4.2%): 2-4 ml/kg via umbilical venous catheter Dextrose (10%): 2.5ml/kg via umbilical venous catheter Intravenous volume replacement: saline (0.9%), plasma, blood: 10-20 ml/kg via umbilical venous catheter Further reading Joint Working Party of Royal College of Paediatrics and Child Health and Royal College of Obstetricians and Gynaecologists.