Pertinent considerations in preterm infant management

Urgent demands made on the ill-equipped developing organ-systems of the preterm newborn to adapt to an extrauterine independent existence lead to the specific clinical problems seen. The degree and severity of these adaptive adjustment changes may be influenced by obstetric and environmental factors which could either precipitate or aggravate some of these problems. The management of the preterm newborn soon after delivery can thus be competently achieved by an anticipatory team approach involving the obstetrician, pediatrician (neonatologist) and nursing personnel. A predelivery decision-making process would involve the issue of when and how to deliver, the assessment of pulmonary maturity and use of steroids to accelerate pulmonary maturation. Immediate management at birth centers on cardio-pulmonary resuscitstion and prophylaxis against cooling. Following this, respiratory, hematalogic, renal cardiovascular, gastrointestinal and metabolic adaptative disorders must be anticipitated and overcome. Continuing care demands continuous electronic monitoring of vital signs, clinical monitoring and vigilance to provide adequate fluids and nutrients along with a consideration to allow considerate patient-infant bonding. Aversion of measures which are believed to contribute to sequelae such as bronchopulmonary dysplasia, retrolental fibroplasia and neurologic and intellectual impairment are also crucial issues. Follow-up is thus mandatory. The costs of all these in skilled manpower and economic terms are expectedly high. These challenges have proven to be exciting and the results rewarding.