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.
Key red flags
Recurrent apnoea with bradycardia or desaturation is not automatically apnoea of prematurity; exclude sepsis, respiratory deterioration, anaemia, metabolic disturbance and seizures.
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.
The infant is stable enough for planned neonatal care.
Key medicines
Caffeine citrateLoading dose 20 mg/kg caffeine citrate intravenously over 30 minutes once. Start maintenance 24 hours later at 5 mg/kg once daily IV or enterally; NICE permits specialist increase up to 20 mg/kg daily according to response and local neonatal protocol.