Preterm Newborns

Simulation Manikins. Far left (full term baby), middle (28-week gestation baby), right (22-week gestation baby)

Preterm (32-37 Weeks)

Preterm newborns are managed in the same way as term newborns with appropriately sized equipment in each case.

Extreme Preterm 22-32 Weeks: Survival Focused Care

In cases where the gestation is unknown or unclear but may be 22 weeks or more, anticipate survival-focussed care for the baby.

Optimise ambient temperature: warm the room/ ambulance and keep the heating on.
Deferred cord clamping is recommended. Unless there is significant maternal haemorrhage and/or the mother requires urgent medical attention, do not clamp the umbilical cord until 60 seconds have elapsed since birth. Use this time to focus on placing the baby into the polythene bag up to the neck, applying a hat and wrapping with a warm towel/blanket.
Minimally dry the baby – using a soft patting approach so as not to damage delicate skin
Place the baby feet-first into the maternity polythene bag up to the newborn’s neck.
Swaddle the baby in warm, dry blankets/ towel and use a thermal mattress to provide warmth.
Do not unwrap the baby to examine; auscultation of heart rate over the polythene bag and under the blanket is sufficient.
Apply a hat to the baby.
Keep mother and baby together, where possible.

If required: Follow the NLS algorithm to provide airway, inflation breaths and ventilation.

Where there is absent heart rate despite airway support continue ventilation breaths until arrival to the receiving unit.
CPR is not required below 22 weeks gestation.
DO NOT apply ECG electrodes (to prevent tissue damage).