Changes to management and care of the extremely premature infant

There are significant changes to the care regime for babies born 21 weeks & 6 days [21+6] and earlier, and those born between 22+0 – 23+6 weeks gestation.

The British Institute of Perinatal Medicine [BAPM] has issued guidance on the management of the extremely premature infant born in the pre-hospital environment, which has been adopted within JRCALC Clinical Practice Guidelines.

≤21+6 weeks gestation, Babies born with signs of life up to and including 21+6 weeks gestation, no active resuscitation is advocated and instead opt for comfort-based care.

“Where gestation is certain, attempted resuscitation of the baby before 22 completed weeks’ gestation is not appropriate and should not be undertaken.”

≥22+0 to 23+6 weeks gestation should receive survival focussed care with respiratory support only. Chest compressions are not likely to be effective and thus are not recommended.

“From 22+0 weeks’ gestation, or if gestation is not known, simple interventions focussed on maintaining body temperature and supporting the airway and breathing should be undertaken. This is a time-critical emergency for the baby.”

The full clinical instruction can be found below and a video has also been produced to talk through the changes.

if you have any questions or require any support please contact:

Daimon Wheddon – EEAST Clinical lead for Maternity damon.wheddon@eastamb.nhs.uk

Kerrie Wykes – Midwife and Paramedic at EEAST

Monday 17th October 2022