Temperature regime and microclimate
Prevention of chilling begins from the very first seconds of life in the delivery room. The newborn is received exclusively in sterile warmed blankets and immediately placed on a resuscitation table with a radiant warmer, the surfaces of which have also been pre-warmed. The transfer of extremely preterm patients to the intensive care unit is permitted only in a specialized transport incubator.
The most immature infants and critically ill children are transferred to incubators. The main goal of incubator care is the prevention of hypoxia and metabolic acidosis, which rapidly develop upon the slightest cooling.
Basic incubator parameters:
- Temperature: 30–35 °C (adjusted individually depending on maturity).
- Humidity: up to 90% on the first day of life, decreasing to 40–60% on subsequent days.
- Oxygen: concentration of about 30% with mandatory warming of the delivered mixture.
The duration of stay in the incubator depends on body weight: low birth weight (LBW) infants stay there for 2–4 days, whereas very low birth weight (VLBW) and extremely low birth weight (ELBW) infants stay from a week to several months. As soon as their condition permits, the infant is transferred to a heated crib, as prolonged stays in an incubator increase the risk of infection. The optimal room temperature in such a ward is about 25 °C.
The concept of "gentle nursing"
The survival and subsequent neurological status of VLBW and ELBW infants directly depend on environmental aggressiveness. Preterm infants exhibit an extremely low pain threshold.
The protective regimen implies the minimization of any stress factors:
- Maximum restriction of traumatic medical procedures.
- Protection from bright light.
- Isolation from loud sounds.
Any pain stimulus triggers a prolonged pathophysiological response. Disturbances in systemic blood pressure and cerebral blood supply can persist for up to a day after stress, which is critically dangerous for immature vessels.
Nutritional support
Nutritional management is a highly complex task due to the functional immaturity of the gastrointestinal tract (GIT), enzyme deficiencies, and enormous energy demands. Attempting to immediately initiate full enteral feeding drastically increases the risk of complications.
Parenteral nutrition (PN) Prescribed for extremely preterm infants at risk of aspiration or necrotizing enterocolitis. Initiated no later than 1 hour after birth:
- First 24 hours: only fluids and carbohydrates (dextrose) are administered.
- From days 2–3: amino acids and lipids are added.
However, the complete absence of food in the intestine leads to atrophy of the gastrointestinal mucosa, a decrease in secretory IgA, cholestasis, and colonization of the intestine with pathogenic flora.
Minimal enteral nutrition (MEN) To support the GIT, "trophic feeding" is initiated 12–48 hours after birth. It is administered via continuous tube infusion (naso- or orogastric tube): 3 hours of infusion, 1 hour of break, plus a 5-hour pause at night. Early MEN reliably reduces the risk of neonatal sepsis.
Calorie calculation (step-by-step adaptation):
- Days 1–2: 30 kcal/kg;
- Day 3: 35 kcal/kg;
- Day 4: 40 kcal/kg;
- Days 5–10: increase by 10 kcal/kg daily;
- By day 14: 120 kcal/kg;
- From day 21: 140 kcal/kg.
Feeding methods and discharge
Native breast milk fully covers the needs only of those infants whose birth weight exceeds 1800–2000 g. For infants with lower weight, milk must be fortified with special fortifiers (protein, Ca, P, vitamins), otherwise a deficiency of macro- and micronutrients will develop. For artificial feeding, specialized formulas are used; switching to standard formulas is possible only upon reaching a weight of 2500–3000 g.
Feeding delivery methods:
- Via gastric tube: for gestational age less than 28 weeks, respiratory distress syndrome, and weak sucking.
- From a bottle: with a good sucking reflex and satisfactory condition.
- Breastfeeding: from the first days for weight >1800–2000 g; for children <1500 g, latching is postponed until the 3rd week of life.
Discharge home is possible directly from the maternity hospital if the infant is somatically healthy and has reached a weight of 1800–2000 g. The rest are transferred to the second stage of nursing in perinatal centers.
Long-term outcomes
With proper nursing care, 70–75% of children will demonstrate normal school performance in the future. Although modern resuscitation technologies have doubled the survival rate of ELBW infants (less than 800 g), the incidence of severe pathology among them does not decrease.
Congenital malformations occur 10–12 times more frequently. Gross neuropsychiatric defects develop in 13–27%: cerebral palsy, cognitive deficits, hearing and vision impairments, and epilepsy. A high risk of ADHD, school maladaptation, and chronic lung and gastrointestinal diseases is also typical. Girls born with ELBW have a high future risk of menstrual cycle disorders, infertility, and miscarriage.
Class and exam questions
When body temperature drops below 32 °C, an immature infant develops "cold injury" with 100% mortality. The incubator provides not only a stable temperature (30–35 °C) but also critically important high humidity (up to 90%), as well as warmed oxygen for the prevention of hypoxia and acidosis.
When body temperature drops below 32 °C, an immature infant develops "cold injury" with 100% mortality. The incubator provides not only a stable temperature (30–35 °C) but also critically important high humidity (up to 90%), as well as warmed oxygen for the prevention of hypoxia and acidosis.
Due to the extreme immaturity of digestive enzymes, enteral load in the first hours will lead to complications (aspiration, necrotizing enterocolitis). Therefore, fluids and carbohydrates are given intravenously within the first hour of life, while tube feeding (MEN) is added later and in minimal doses.
Due to the extreme immaturity of digestive enzymes, enteral load in the first hours will lead to complications (aspiration, necrotizing enterocolitis). Therefore, fluids and carbohydrates are given intravenously within the first hour of life, while tube feeding (MEN) is added later and in minimal doses.
If the infant is somatically healthy, discharge is possible upon reaching a body weight of 1800–2000 g. Infants with lower weight or pathologies are transferred to the second stage of nursing.
If the infant is somatically healthy, discharge is possible upon reaching a body weight of 1800–2000 g. Infants with lower weight or pathologies are transferred to the second stage of nursing.
What else to study on this topic
- Pathogenesis of necrotizing enterocolitis in preterm infants
- Breast milk fortifiers: composition and preparation guidelines
- Features of bronchopulmonary dysplasia development during oxygen therapy
- Stages of nursing: structure and equipment of newborn pathology departments
- Neurological monitoring of ELBW infants during the first year of life
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