Neobook — clinical reference

ICD-10 code: P07.3

Neonate born before 37 completed weeks of pregnancy.

Admit unwell/unstable infants to a neonatal high/intensive care facility.
Temperature control:
- Kangaroo mother care: Initiate if baby is well and vital signs are stable.
- Provide a neutral thermal environment (incubator or infant crib with overhead heater) and keep ambient temperature at 26–28°C.
- Keep infant’s temperature, axilla or skin of anterior abdominal wall, at 36.5–37.5°C.

Table for neutral thermal environment for age and body mass

Neutral Thermal Environment
Age	Temperature for body mass range
Age	< 1200 g ± 0.5°C	≥ 1200– 1500 g ± 0.5°C	≥ 1500– 2500 g ± 1°C	≥ 2500 g ± 1.5°C
0–12 hours	35.0	34.0	33.3	32.8
12–24 hours	34.5	33.8	32.8	32.4
2–4 days	34.5	33.5	32.3	32.0
4–14 days	33.5	32.1	32.0
2–3 weeks	33.1	31.7	30.0
3–4 weeks	32.6	31.4
4–5 weeks	32.0	30.9
5–6 weeks	31.4	30.4

Monitor:
- respiratory rate,
- haematocrit,
- blood pressure,
- bilirubin,
- blood gas,
- blood glucose,
- acid-base status,
- electrolytes,
- calcium, magnesium,
- hydration status, and
- growth parameters.
Nutritional support:
- Give oro/nasogastric tube feedings to infants with audible bowel sounds and no complications of prematurity.
- Preferably use own mother’s expressed breast milk, pasteurised donor breast milk or preterm formula. Give small frequent bolus feeds, 3 hourly or continuous oro/nasogastric tube feeds (alternatives: cup, dropper, spoon, syringe). Refer, if there is intolerance.
- Monitor gastric emptying by aspirating the stomach before each feed.
- Consider stopping enteral feeding if:
  - vomiting,
  - abdominal distension,
  - diarrhoea,
  - haematochezia, or
  - ileus.
- IV alimentation if enteral feeds are contraindicated or not tolerated.
IV fluids to ensure adequate hydration, electrolyte and mineral intake, and normoglycaemia (blood glucose ≥ 2.6 mmol/L) until enteral (tube or oral) intake is satisfactory.
- Discontinue IV fluids gradually to avoid reactive hypoglycaemia.
- Discontinue the infusion when several oral feedings have been retained.
- If renal function is compromised, use potassium-free solution.

Fluid requirements for a healthy preterm infant
Day of life	mL/kg/24 hours
1	70
2	90
3	110
4	130
5 and onwards	150

Some infants may require fluid volumes up to 180 mL/kg/24 hours after day 6.

Hospital discharge if:
- clinically well,
- able to breastfeed or formula feed,
- able to maintain body temperature, and
- usually > 1.8 kg.
Follow-up visits to assess growth parameters, neurodevelopment, hearing and vision.

If anaemia is present according to thresholds in figure 1

Packed red cells, IV, 10 mL/kg over 3 – 4 hours in haemodynamically stable patients. More rapid transfusions may be appropriate in bleeding and haemodynamically unstable patients.

To maintain oxygen tension in the blood at 60–80 mmHg:

Oxygen, humidified via nasal cannula.
- Oxygen therapy should be utilised to maintain oxygen saturation of haemoglobin at of 90–95%; use a pulse oximeter.

At birth

Prophylaxis

Iron (elemental), oral, 2–4 mg/kg/24/hours.
- Ferrous lactate 1 mL = 25 mg elemental iron.
- Multivitamin, oral, providing at least vitamin D, 400–800 IU and vitamin A, 1250–5000 IU per 24 hours.

Continue with iron and vitamin supplementation until the infant is on a balanced diet

Presence of one or more of the following complications that cannot be managed at the facility:

Respiratory distress and/or apnoea attacks requiring ventilatory support.
PDA with cardiac failure not responding to medical management.
Necrotising enterocolitis requiring surgical intervention.
Jaundice with serum unconjugated bilirubin level in the exchange transfusion zone.
Septicaemic infants or infants with infections not responding to therapy.
Pulmonary and/or intraventricular haemorrhage.
Feeding difficulties where the underlying cause is unclear.
Infants requiring hyperalimentation if parenteral nutrition is not available at the hospital.
Convulsions not responding to treatment.
Congenital abnormalities requiring surgical intervention.
Hypoglycaemia not responding to treatment.
For eye examination/hearing screening:
- infants < 1.5 kg,
- infants < 32 weeks gestation,
- infants who received prolonged respiratory support/oxygen,
- infants with recurrent apnoea, and
- infants with an unstable clinical course.

Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 19: Prematurity And Neonatal Conditions, 19.3 Prematurity/preterm Neonate

Click here for 19.3.4 Apnoea, Neonatal

Prematurity/Preterm Neonate