Definition

• Very low birth weight (VLBW) infants (birth weight <1500 g) and extremely low birth weight (ELBW) infants (birth weight <1000 g) constitute approximately 1.2% and 0.4% of all newborn babies in industrialized countries, respectively

• Induction of fetal lung maturation by betamethasone and prenatal transfer to a perinatal level III center prior to delivery of any such tiny infant is of paramount importance. This way, the most experienced doctors and nurses available perform or supervise the initial care of very immature infants. If prenatal transport is not possible due to rapid birth progression, call the Neonatal Emergency Transport Service (NETS) at the earliest available opportunity.

• Many details of the initial care of very preterm infants are controversial. Health care providers, while striving for the best evidence available, may follow locally established guidelines to benefit from the experience in a particular environment and to ensure a team approach

Questions prior to delivery

• Prenatal transfer allows the health care team to discuss treatment options with expectant parents before delivery in cases of borderline viability (see Chapter “Ethics in neonatal intensive care,” pp. 184–90).

• Is there a reliable estimate of gestational age?

• What is the estimated birth weight?

• Has fetal lung maturation been induced (e.g., betamethasone: how many doses and how many hours prior to delivery)?

• Are there signs of fetal distress? for example, fetal tachycardia or bradycardia

• Are there signs of perinatal infection (maternal fever, CRP, GBS status, etc.)?

Preparations in the delivery room

Temperature

• Increase room temperature to 25–30°C if possible

• Turn on radiant heaters

• Keep doors closed

• Have prewarmed cotton towels or food-grade, heat-resistant plastic wrapping or bags ready