Premature newborn care

Last reviewed: 2 Sep 2022
Last updated: 15 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • maternal last menstrual period (LMP)
  • distance from the maternal superior pubis to the uterine fundus
  • infant physical maturity score
  • infant neuromuscular maturity score
  • combined physical/neuromuscular score <10: gestational age <28 weeks
  • combined physical/neuromuscular score 11 to 19: gestational age 29 to 31 weeks
  • combined physical/neuromuscular score 20 to 24: gestational age 32 to 33 weeks
  • combined physical/neuromuscular score 25 to 33: gestational age 34 to 36 weeks
More key diagnostic factors

Other diagnostic factors

  • infant birth weight (appropriate for gestational age infants)
Other diagnostic factors

Risk factors

  • intrauterine infection
  • preterm premature rupture of membranes (PPROM)
  • pre-eclampsia/pregnancy-induced hypertension
  • placental abruption/antepartum hemorrhage
  • abnormal amniotic fluid volume
  • severe bacterial vaginosis
  • multiple gestation
  • previous preterm birth
  • fetal abnormality
  • cervical incompetence/uterine abnormality
  • gestational diabetes
  • maternal surgery during pregnancy
  • chronic maternal illness
  • short interpregnancy time interval
  • drug use (tobacco, cocaine, heroin)
  • maternal pregnancy body mass index <19 or >35
  • stress/depression
  • nonwhite race
More risk factors

Diagnostic investigations

1st investigations to order

  • fetal biometry during prenatal period
More 1st investigations to order

Investigations to consider

  • fundoscopy
More investigations to consider

Treatment algorithm

ACUTE

gestational age <28 weeks

gestational age 28 to 31 weeks

gestational age 32 to 33 weeks

gestational age 34 to 36 weeks

Contributors

Authors

Mohan Pammi, MD, PhD

Professor of Pediatrics

Section of Neonatology and Department of Pediatrics

Baylor College of Medicine

Houston

TX

Disclosures

MP declares that he has no competing interests.

Acknowledgements

Dr Mohan Pammi would like to gratefully acknowledge Dr Stephen Welty and Dr James L. Wynn, previous contributors to this topic.

Disclosures

SW and JLW declare that they have no competing interests.

Peer reviewers

Isaac Babarinsa, MSc, MRCOG

Consultant Obstetrician and Gynaecologist

Gloucestershire Royal Hospital

Gloucester

UK

Disclosures

IB declares that he has no competing interests.

  • Differentials

    • Small for gestational age (SGA)
    • Intrauterine growth restriction (IUGR)
    More Differentials
  • Guidelines

    • Guidance for surfactant therapy in neonates
    • Neonatal infection: antibiotics for prevention and treatment
    More Guidelines
  • Patient leaflets

    Premature labor

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer