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Preterm infant

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Updated 2023 ASPEN guidelines for parenteral nutrition in 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 American Society for Parenteral and Enteral Nutrition (ASPEN 2023), the European Consensus Group on Respiratory Distress Syndrome (ECG-RDS 2023), the European Society for Paediatric Gastroenterology Hepatology and Nutrition...
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Diagnostic investigations

HR assessment
As per AHA 2020 guidelines:
Consider obtaining an ECG for the rapid and accurate measurement of the HR during resuscitation of preterm infants.
C
Consider obtaining an ECG for the rapid and accurate assessment of the HR during chest compressions.
B
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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.
A
Consider initiating Kangaroo mother care in the healthcare facility or at home and provide for 8-24 hours/day (as many hours as possible).
B

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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.
A
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Patient education

Family involvement: as per WHO 2022 guidelines, Involve family in the routine care of preterm or low-birth-weight infants in healthcare facilities.
B
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Preventative measures

Vitamin K prophylaxis
As per CPS 2018 guidelines:
Administer IM vitamin K prophylaxis in all preterm infants.
E
Insufficient evidence to support the routine use of IV vitamin K administration in preterm infants.
I