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  • Print publication year: 2005
  • Online publication date: August 2009

11 - Management of the preterm neonate

Summary

Immediate resuscitation of the preterm neonate

Introduction

The importance of a planned and coordinated approach to the initial resuscitation, stabilisation and subsequent management of babies born between 27 and 28 completed weeks' gestation was emphasised in the Confidential Enquiries of Stillbirths and Deaths in Infancy (CESDI) Project 27/28 Enquiry (Mackintosh 2003). This chapter covers many of the aspects of care that the report highlighted as contributing to optimising the care of the premature infant. More than 90% of the babies studied for the CESDI report required resuscitation. Having a resuscitation system based on the needs of infants is the recommended approach. The resuscitation guidelines used by the neonatal life support course have been formalised for the term neonate based on combined evidence from the limited pool of resuscitation trials, consensus views on best practice and experimental animal models (Kattwinkel et al. 1999; Niermeyer et al. 2000). The basic approach to resuscitating a preterm neonate is similar to that of the term neonate with emphasis on maintaining body heat and possible earlier progression to advanced manoeuvres to stabilise the airway and administer exogenous surfactant.

Anticipation

Communication forms a cornerstone of the management of imminent preterm deliveries. Liaison between the delivery suite and the Neonatal Intensive Care Unit (NICU) is thus essential to ensure that potential problems are anticipated and that appropriate cot spaces are available.

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