It's the little things. A framework and guidance for programs to care for infants 22-23 weeks' gestational age

Area of Science:

• Neonatology
• Perinatology
• Pediatric Critical Care

Background:

• Infants born before 24 weeks gestation, termed "tiny babies," present unique challenges due to immature organ systems.
• Existing evidence for the care of these extremely premature infants is limited, necessitating structured approaches.
• Centers of Excellence (CoEs) have developed integrated care models for tiny babies, acknowledging inter-system physiological impacts.

Purpose of the Study:

• To propose a framework for developing "tiny baby programs" in neonatal intensive care units (NICUs).
• To guide NICUs in establishing clinical approaches for infants born before 24 weeks' gestation.
• To summarize key operational and physiological principles for the care of extremely premature infants.

Main Methods:

• Review of integrated care approaches from Centers of Excellence (CoEs).
• Identification of operational principles for program development.
• Summary of physiological principles crucial for managing extremely premature infants.

Main Results:

• A proposed framework for establishing tiny baby programs.
• Emphasis on the interconnectedness of physiological systems in tiny babies.
• Cautionary advice for NICUs adapting practices from CoEs to local contexts.

Conclusions:

• Developing tiny baby programs requires a structured, evidence-informed approach.
• Integrated care considering all physiological systems is paramount for infants born before 24 weeks.
• NICUs should cautiously adapt best practices, prioritizing patient safety and individual needs.