21  VLBW/ELGAN/ELBW Infants

Rouding Sheet

[Download the Rouding Sheet here]

21.1 Thermoregulation and Heat Loss Prevention

Labor & Delivery / OR

  • Maintain L&D/OR temperature at 70-74℉
  • Preheat the radiant warmer before birth and set on servo-control mode
  • Use prewarmed blanket to dry the newborn during delayed cord clamping
  • use prewarmed blanket to receive the newborn and dry under the warmer
  • Place temperature probe as soon as baby is under the warmer
  • Monitor temperature frequently (every 5-10 minutes) prior to transfer to the NICU
  • Maintain axillary temperature between 36.5℃ - 37.5℃
  • Place a thermal mattress under the blanket on the radiant warmer
  • Wrap the baby in a polyethylene plastic bag or wrap (<28 weeks and/or < 1,000 grams)
  • Place a prewarmed hat on the baby’s head (as soon as possible)
  • Keep the newborn fully covered during resuscitation and stabilization


NeoDrape Wrapping During Delayed Cord Clamping

Vaginal delivery

Cesarean delivery


Transport

  • Prewarm transport incubator
  • Use warming measures such as thermal mattress during transport


NICU

  • Prewarm the incubator before the infant arrives in the NICU
  • Keep incubator humidity at 80% (<30 weeks and/or < 1,000 grams)
  • Prewarm linens and other items
  • Use thermal mattress if temperature is below 36.5℃
  • Monitor temperature closely throughout procedures
  • prewarm IV fluids
  • Ensure ventilator heaters are set at a warm temperature before use



21.2 ELGAN/ELBW Respiratory Protocol

Refer to ELGAN/ELBW Respiratory Support Protocol for the First 72 Hrs page


BPD bundle

Refer to No-BPD Prevention Bundle page



21.3 ELGAN/ELBW Gut Health Protocol

Probiotics (Evivo) use

Refer to Probiotics (Evivo) page

Important

Probiotic use is temporarily suspended until further notice.

Glycerin use

Administer 0.5 mL/kg every 12 hours until meconium is fully passed and stool transitions.



21.4 Screening


Sepsis screening and empiric antibiotic use

GA < 32 weeks and BW < 1,500g

  • Blood culture
    • 1 blood culture if no central line
    • 2 blood cultures if central line is in place
  • Empiric antibiotics
    • Ampicillin and gentamicin if no other nephrotoxic medication or no signs of AKI
    • Ampicillin and ceftazidime/cefotaxime if presence of other nephrotoxic medication or has/has had AKI

GA ≥ 32 weeks or BW ≥ 1,500g

  • Blood culture: obtain 2 from different sites
  • Empiric antibiotics
    • Ampicillin and gentamicin if no other nephrotoxic medication or no signs of AKI
    • Ampicillin and ceftazidime/cefotaxime if presence of AKI


Thyroid screening

Indication

  • BW ≤ 1,500g
  • Same-sex if chorionic status not known

Timing

  • 2, 4, 6 weeks of life

Labs

  • TSH only


Head Ultrasound

Pediatrics (2020) 146 (5): e2020029082. https://doi.org/10.1542/peds.2020-029082

Indication

  • GA < 31 weeks or BW < 1,500 grams

Timing

  • DOL7 & 30


Retinopathy of prematurity

Pediatrics (2013) 131 (1): 189–195. https://doi.org/10.1542/peds.2012-2996

Indication

  • GA < 31 weeks or BW ≤ 1,500 grams
  • GA ≥ 31 weeks or BW > 1,500 grams with risk factors

Timing

Gestational Age at Birth, wk Age at Initial Examination, wk
Postmenstrual Chronologic
22 (a) 31
23 (a) 31
24 31
25 31
26 31
27 31
28 32
29 33
30 34
Older gestational age, high-risk factors (b)
Shown is a schedule for detecting prethreshold ROP with 99% confidence, usually before any required treatment.
Note
  1. This guideline should be considered tentative rather than evidence-based for infants with a gestational age of 22 to 23 wk because of the small number of survivors in these postmenstrual-age categories.
  2. Consider timing based on severity of comorbidities.


21.5 Blood transfusion

For all ELGAN and ELBW infants

  • Obtain Type & Screen with confirmation ON ADMISSION
    • one specimen from cord blood
    • one speciment from umbilical line during line placement
  • Obtain blood transfusion consent ON ADMISSION

Ordering blood product

  1. Use the BPAM orderset

  1. Select the blood product type

  1. Enter the volume and the duration



21.6 Prophylaxis


Systemic fungal infection

Fluconazole 3mg/kg/dose twice weekly for 6 weeks (42 days) or until central line removed, whichever comes first.



21.7 Neuroprotective Care


First 72 hrs of life

4 to 7 days of life