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Preterm infant

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 European Consensus Group on Respiratory Distress Syndrome (ECG-RDS 2023), the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN 2023), the World Health Organization (WHO 2022; 2015), the International Liaison Committee on Resuscitation (ILCOR 2022), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2022), the Canadian Paediatric Society (CPS 2021; 2018), the American Heart Association (AHA 2020), the American Gastroenterological Association (AGA 2020), the American College of Obstetricians and Gynecologists (ACOG 2020), and the American Academy of Pediatrics (AAP 2014).
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Guidelines

1.Diagnostic investigations

Heart rate assessment
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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2.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

3.Medical management

Surfactant therapy, prophylactic administration, CPS: 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

  • Caffeine

  • Probiotics

  • Emollients

4.Nonpharmacologic interventions

Kangaroo mother care
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

5.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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6.Patient education

Family involvement: involve family in the routine care of preterm or low-birth-weight infants in healthcare facilities.
B
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7.Preventative measures

Vitamin K prophylaxis
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