Care for Premature and Small for Gestational Age Infants

Initial Management

The American Academy of Pediatrics recommends deferring cord clamping for at least 60 seconds in preterm infants <37 weeks who do not require immediate resuscitation, as this intervention reduces mortality with a number needed to treat of 18 1, 2, 3
For infants 28+0 to 36+6 weeks who cannot receive delayed cord clamping, umbilical cord milking is a reasonable alternative to improve hematologic outcomes 1, 2, 3
The American Heart Association recommends avoiding intact cord milking in infants <28 weeks' gestation due to safety concerns 1, 2, 3
If immediate resuscitation is required, the American Academy of Pediatrics recommends proceeding directly to resuscitation without delayed cord clamping 1, 2, 3

The American Academy of Pediatrics recommends placing the infant under a radiant warmer immediately or in a servo-controlled incubator to maintain normothermia (36.5-37.5°C) 4, 7
The American Academy of Pediatrics recommends covering the infant's head with a cap and using prewarmed blankets to prevent heat loss 4
The American Academy of Pediatrics recommends monitoring temperature continuously or every 15-30 minutes to prevent both hypothermia and iatrogenic hyperthermia (>38.0°C), which increases mortality risk 7

The American Academy of Pediatrics recommends assessing respiratory effort, heart rate, and oxygen saturation immediately after birth 6, 1
The American Academy of Pediatrics recommends considering CPAP immediately after birth even without respiratory distress to reduce need for mechanical ventilation in infants <32 weeks' gestation 6, 1
The American Academy of Pediatrics recommends providing advanced respiratory support including conventional and/or high-frequency ventilation as needed based on clinical status 6

The American Academy of Pediatrics recommends that Level I facilities can stabilize preterm infants 35-37 weeks who are physiologically stable 6
The American Academy of Pediatrics recommends that Level II facilities are appropriate for moderately ill newborns ≥32 weeks' gestation or ≥1500g with problems expected to resolve rapidly 6
The American Academy of Pediatrics recommends that Level III facilities are required for all infants <32 weeks' gestation, <1500g, or with medical/surgical conditions regardless of gestational age 6

The American Academy of Pediatrics recommends scheduling examination by a qualified healthcare professional within 3-5 days (72-120 hours) after hospital discharge 8
The American Academy of Pediatrics recommends earlier or more frequent follow-up for infants with gestational age 35-38 weeks, jaundice in first 24 hours, blood group incompatibility, exclusive breastfeeding with intake concerns, or discharge before 48 hours 8

The American Heart Association recommends never delaying cord clamping assessment—make the decision about immediate resuscitation need within seconds of delivery 1, 2
The American Academy of Pediatrics recommends not relying on visual assessment alone for jaundice—always measure total serum or transcutaneous bilirubin if any doubt exists 8
The American Academy of Pediatrics recommends avoiding excessively high warmer settings that increase hyperthermia risk 7
The American Heart Association recommends not assuming gestational age alone determines prognosis—consider birth weight, appropriateness for gestational age, maternal steroid use, and other factors 9
The American Academy of Pediatrics recommends never leaving mothers unsupervised during skin-to-skin care in the first 2 hours when sudden collapse risk is highest 4