Synopsis
Recognise the gestation-dependent physiology of preterm birth, anticipate early and later complications, deliver protective neonatal care, and organise surveillance using corrected age and the baby's individual risk profile.
- Preterm birth is before 37 completed weeks; risk and immaturity rise steeply at lower gestation, so use exact gestational and postmenstrual age rather than the label premature alone.
- Immature lungs have reduced surfactant and compliant chest walls, immature respiratory drive and vulnerability to oxygen and ventilation injury.
- Maintain a neutral thermal environment, minimise evaporative heat loss and monitor glucose because small glycogen and fat stores make hypothermia and hypoglycaemia common.
- Use breast milk, lactation support and unit-specific fortification; advance enteral feeds carefully while providing parenteral nutrition when full intake is not yet possible.
- Apnoea of prematurity is a diagnosis of exclusion. Caffeine citrate is routine in babies born at or before 30 weeks and is used for clinically significant recurrent apnoea.
- Necrotising enterocolitis presents with feed intolerance, distension, blood in stool and systemic illness; stop feeds, decompress, investigate, treat sepsis and involve surgery early.
- Intraventricular haemorrhage can be silent. Follow gestation- and risk-based cranial ultrasound schedules and trend head circumference and neurological state.
- Retinopathy screening includes babies born before 31 weeks or weighing below 1501 g; consider screening at 31+0 to 31+6 weeks according to the national guideline.
- After stabilisation, NICE recommends a preterm oxygen-saturation target of 91–95%; both hypoxia and excess oxygen cause harm.
- Assess development using corrected age until 2 years. Babies below 28 weeks also receive a face-to-face developmental assessment at 4 years uncorrected age.
- Plan immunisation by chronological age unless a specific programme says otherwise, and give eligible seasonal respiratory-virus prevention according to the current national programme.
- Discharge requires physiological stability, safe feeding and growth, family training, medication and equipment plans, screening completion and coordinated neonatal/community follow-up.
Key red flags
Recurrent apnoea with bradycardia or desaturation is not automatically apnoea of prematurity; exclude sepsis, respiratory deterioration, anaemia, metabolic disturbance and seizures.
Abdominal distension, bilious or bloody aspirate, blood in stool, tenderness, discoloration or systemic instability raises necrotising enterocolitis and requires feeds to stop immediately.
A bulging fontanelle, seizures, sudden anaemia, hypotonia or unexplained cardiorespiratory deterioration raises intraventricular haemorrhage or evolving post-haemorrhagic ventricular dilatation.
Increasing oxygen or ventilatory requirement may reflect respiratory distress syndrome, air leak, infection, patent ductus arteriosus or evolving bronchopulmonary dysplasia.
Absent red reflex, abnormal visual behaviour or failure to complete retinopathy screening risks preventable visual loss.
Poor growth, persistent feeding difficulty, abnormal tone, asymmetry, loss of skills or parental developmental concern needs assessment rather than reassurance based only on corrected age.
Investigation priorities
Detect hypoxaemia, apnoea, bradycardia, temperature disturbance and haemodynamic change in babies requiring neonatal care.
Management branches
Preterm birth is expected or has occurred.
- Arrange appropriately skilled neonatal attendance and antenatal counselling.
- Prevent heat loss, support lung aeration gently and titrate oxygen by preductal saturation.
- Admit to the appropriate level of neonatal care and establish nutrition, monitoring and family contact.
The infant is stable enough for planned neonatal care.
- Use human milk, careful nutrition, infection prevention and developmentally supportive handling.
- Follow respiratory, cranial ultrasound, hearing, blood-spot and ROP pathways.
- Minimise painful procedures, unnecessary oxygen, ventilation, transfusion and antimicrobial exposure while treating genuine disease promptly.