Table of contents
Preterm infant
What's new
Updated 2024 NTN guidelines for red blood cell transfusion thresholds in very preterm infants.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of preterm infant are prepared by our editorial team based on guidelines from the International Collaboration for Transfusion Medicine Guidelines (ICTMG 2024), the Neonatal Transfusion Network (NTN 2024), the American Society for Parenteral and Enteral Nutrition (ASPEN 2023), the European Consensus Group on Respiratory Distress Syndrome (ECG-RDS 2023), the European Society ...
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Diagnostic investigations
Respiratory support
Noninvasive positive pressure ventilation: as per ILCOR 2022 guidelines, insufficient evidence to recommend for or against the routine use of CPAP in spontaneously breathing late preterm infants with respiratory distress in the delivery room.
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Supplemental oxygen
Medical management
Surfactant therapy, prophylactic administration: as per CPS 2021 guidelines, do not administer prophylactic surfactant therapy in neonatal care settings where CPAP is routinely used to stabilize preterm infants and when the rate of antenatal corticosteroid administration is high (> 50%).
D
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Surfactant therapy (indications for respiratory distress syndrome)
Surfactant therapy (choice of preparation)
Surfactant therapy (mode of administration)
Surfactant therapy (repeat doses)
Inhaled nitric oxide
Intravenous albumin
Caffeine
Probiotics
Emollients
Nonpharmacologic interventions
Kangaroo mother care
As per WHO 2022 guidelines:
Implement Kangaroo mother care as routine care in all preterm or low-birth-weight infants and initiate as soon as possible after birth.
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Consider initiating Kangaroo mother care in the healthcare facility or at home and provide for 8-24 hours/day (as many hours as possible).
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Temperature management
Feeding
Vitamin and microelement supplementation
Parenteral nutrition
Therapeutic procedures
Umbilical cord clamping: as per SOGC 2022 guidelines, delay cord clamping for 60-120 seconds in both preterm (< 37 weeks) and extremely preterm (< 28 weeks) singletons because it decreases newborn mortality and morbidity and improves hematological outcomes after the neonatal period. Delay cord clamping for at least 30 seconds over clamping immediately when cord clamping cannot be deferred for a full 60-120 seconds. Delay cord clamping with the infant at or below the level of the introitus or at the level of the Cesarean incision.
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RBC transfusion