This document summarizes key aspects of caring for extremely preterm infants addressed by various speakers. It discusses specific topics like organization of care, resuscitation, stabilization, early intervention, ventilation, ethics, neuroprotection, anemia, bronchopulmonary dysplasia, jaundice, nutrition, and the ductus arteriosus. It then addresses in more detail thermal care to prevent hypothermia, intracranial hemorrhage, apnea of prematurity, infection, necrotizing enterocolitis, and retinopathy of prematurity. It emphasizes prevention strategies and treatment approaches for these conditions, and notes that survival of extremely preterm infants will lead to increased management of related complications.

1. Care of the Extremely
Preterm Baby
Edward F. Bell
University of Iowa
Kyiv, 5 March 2013

2. Kyiv 2003

5. Specific Aspects of Preterm Care
Addressed by Other Speakers
 Organization of care
 Schunko, Stark, Stranak, Ognean, Sydorov,
Tkachenko, Chernov
 Resuscitation and stabilization
 Stranak, Dobryanskiy
 Early intervention
 Curteanu

6. Specific Aspects of Preterm Care
Addressed by Other Speakers
 Noninvasive and high-frequency ventilation
 Marozsynska
 Ethical issues
 Opitz
 Neuroprotection
 Baud
 Anemia and transfusion
 Bell

7. Specific Aspects of Preterm Care
Addressed by Other Speakers
 Bronchopulmonary dysplasia
 Rubenstein
 Jaundice
 Stark
 Nutrition
 Ziegler
 Ductus arteriosus
 Schirtz

8. Other Specific Aspects of Care of the
Extremely Preterm Infant
 Thermal care
 Intracranial hemorrhage
 Apnea of prematurity
 Infection
 Necrotizing enterocolitis
 Retinopathy of prematurity

9. Definitions
 Full-term: > 37 weeks 87.9%
 Preterm: < 37 weeks 12.1%
 Very Preterm: < 32 weeks 2.0%
 Extremely Preterm: < 28 weeks 0.7%
Approximately 3500 per year in Ukraine

10. Hypothermia

11. The Influence of the Thermal Environment upon
the Survival of Newly Born Premature Infants
W. A. Silverman, J. W. Fertig, A. P. Berger
Survival rate
Birth weight range (g) 28 oC 32 oC
< 1000 14% 50%
1001-1500 77% 86%
1501-2500 79% 93%
PEDIATRICS, November 1958

12. Preventing Hypothermia

13. Kangaroo Care

14. Intracranial Hemorrhage and
Periventricular Leukomalacia
Periventricular
Intraventricular IVH at postmortem
leukomalacia
hemorrhage (IVH)
on ultrasound

15. Intracranial Hemorrhage
 Prevention
 Prevent preterm birth
 Antenatal corticosteroids to mother
 Vitamin E at birth
 Avoid blood pressure fluctuations, pneumothorax,
high and low PCO2
 Correct coagulation disorder
 Treatment
 Nothing for hemorrhage itself, but posthemorrhagic
hydrocephalus can be treated

16. Apnea of Prematurity
 Prevention
 Prevent preterm birth
 Treatment
 First, rule out underlying cause, such as atelectasis or
infection, and treat cause
 If it is true apnea, what is the predominant type of
apnea – central or obstructive?
 If central, treat with caffeine, theophylline, or aminophylline
 If obstructive, consider CPAP

17. Infection
 Prevention
 Mother should be immunized against hepatitis,
tetanus, rubella, and possibly tuberculosis
 Careful infection control practices, including meticulous
hand hygiene (will be discussed by Dr. Schlösser)
 Limit use of foreign bodies that enter the body, such as
intravenous cannulae and endotracheal tubes, and
remove these when they are no longer needed
 Treatment
 Appropriate, focused antibiotics

18. Necrotizing Enterocolitis

19. Necrotizing Enterocolitis
 Prevention
 Prevent preterm birth
 Antenatal corticosteroids to mother
 Breast milk, not formula
 Probiotics
 Treatment
 Stop enteral feedings, give intravenous nutritional
support
 Gastric suction
 Antibiotics

20. Retinopathy of Prematurity

21. Retinopathy of Prematurity
 Prevention
 Prevent preterm birth
 Antenatal corticosteroids to mother
 Careful monitoring of oxygen therapy
 Before 32 weeks postmenstrual age, keep oxygen saturation
90-95%
 Retinal examinations by qualified ophthalmologist
 Treatment
 After 32 weeks postmenstrual age, if infant has ROP,
keep oxygen saturation in the mid to high 90s
 Laser ablation

22. Laser Treatment of Retinopathy of Prematurity

23. Success Brings New Challenges
 As you experience more success in reducing
mortality of extremely preterm infants, you will
see more patients with these complications
 Hypothermia
 Intracranial hemorrhage
 Apnea of prematurity
 Infection
 Necrotizing enterocolitis
 Retinopathy of prematurity

24. Jeff Hackbarth, 24 weeks gestation, 690 grams,
university graduate