Care of the Extremely Low Birth Weight Neonate

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When a baby is born prematurely, the mother, family, and healthcare team are focused on the initial care and long-term wellbeing of the newborn. Extremely low birth weight (ELBW) neonates are among the most premature of these infants, and require expert professional attention during their initial days and weeks. Management of these neonates in highly-specialized care units is paramount to providing the best outcomes for the patient, and requires the expertise of a multi-disciplinary team.

ELBW infants are typically born before the 28th gestational age. Most survive when proactively managed in specialized units and appropriately treated. With proper management, outcomes improve exponentially. Improved outcomes are linked to early detection of problems that ELBW neonates are prone to, and special, proactive initatives designed to keep the infant healthy and safe.

1. Early Detection and Nutritional Support of ELBW Neonates

Early detection is an important part of care for ELBW neonates, and providers must remain vigilant in monitoring the baby’s health. ELBW neonates are prone to health complications such as brain hemorrhage, neonatal infections, retinopathy of prematurity, and cardiomyopathy.

Nutrition is an essential factor in the care of ELBW neonates. ELBW neonates have high energy and nutrient requirements, and need special formula specifically-crafted for their age and weight range. Nutritional requirements generally increase during the first three weeks after their birth, and piercing of the baby’s small intestine should be done within 24 to 48 hours of birth to gain proper nourishment via a parenteral route.

2. Oxygenation and Respiratory Care

When born prematurely, a baby’s lungs are less developed and may be unable to provide sufficient oxygen for the body to function properly. Premature babies are put on an oxygen ventilator support system to help them maintain adequate oxygen levels. To ensure the likelihood of a successful transfer out of the neonatal intensive care unit, ELBW infants undergo a process called surfactant replacement therapy (SRT) where surfactant protein is used to stabilize the baby’s alveoli. This helps premature respiratory problems such as infant respiratory distress syndrome (IRDS).

3. Pharmacological Strategies to Promote Growth and Development

Growth following birth is a vital factor in the success of an ELBW neonate’s growth. ELBW infants are prone to growth restriction as their immature gastrointestinal system makes it harder to absorb essential nutrients. Prophylactic loading of calories, protein, fats, and minerals such as iron and calcium is necessary for the sustained growth and development of these infants.

ELBW neonates are also susceptible to hypoglycemia, which is a dangerously low sugar level in the body. As a preventative measure, ELBW infants are generally given high total caloric intakes and high carbohydrate components such as human milk fortifier and dextrose gel.

4. Care of the ELBW Neonate at Home

When the ELBW neonate is released from the intensive care unit, there will be a number of follow-up appointments and homecare routines that must be followed to prevent future health problems. Parents should be instructed in proper monitoring of oxygen saturation and respiratory rate, as well as the importance of remaining vigilant in monitoring the infant?s growth. The infant will also need regular checkups with their pediatrician to ensure that their developmental progress is on track.

In addition to regular checkups, parents should be taught the correct method for holding and feeding their baby. ELBW neonates will need to be in upright positions, and skin-to-skin contact will also encourage their growth. Parents should also be aware of the importance of providing a safe sleep environment for their baby, as premature infants are at higher risk of sudden infant death syndrome (SIDS).

Final considerations

Extremely low birth weight neonates require careful monitoring and special supportive care in the form of early detection, nutrition, oxygenation, and pharmacologic strategies. ELBW neonates are at risk for a variety of complications, both physical and developmental, but with the right care and therapies, they can have strong prognoses and reach their developmental milestones to have successful outcomes in life. It is essential that the family and healthcare team provide comprehensive care to these infants and follow-up with the necessary precautions at home for successful medical management of ELBW neonates.

Topics:

ELBW neonates,

nutrition support,

oxygenation

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