Care of ELBW Babies

Care of Extremely Low Birth Weight (ELBW) Babies

Definition & Characteristics

Birth weight < 1000 grams
Usually born at < 28 weeks gestation
Highest risk category among premature infants
Survival rates:
- 23 weeks: 30-40%
- 24 weeks: 50-60%
- 25 weeks: 70-80%
- 26-27 weeks: 80-90%

Essential Infrastructure Requirements

Level III/IV NICU facilities
Specialized equipment:
- Advanced incubators
- High-frequency ventilators
- Nitric oxide delivery systems
- Advanced monitoring systems
24/7 availability of:
- Neonatologists
- Specialized nursing staff
- Respiratory therapists
- Support services

Delivery Room Management (Golden Hour)

Pre-delivery Preparation

Team briefing and role assignment
Equipment check:
- Resuscitation equipment
- Temperature management supplies
- Monitoring devices
- Intubation equipment
Room temperature set to 25-26°C
Pre-warmed resuscitation bed

Immediate Actions

Thermal Management:
- Immediate plastic wrapping without drying
- Pre-warmed hat application
- Chemical mattress activation
- Target temperature: 36.5-37.5°C
Respiratory Support:
- Gentle ventilation strategies
- Early CPAP consideration
- Selective surfactant administration
- Oxygen titration (Starting FiO2: 30%)

NICU Management Protocols

First 24 Hours

Environmental Control:
- Double-walled incubator use
- Humidity 60-80%
- Minimal handling protocol
Respiratory Management:
- Volume-targeted ventilation
- Lung-protective strategies
- Regular blood gas monitoring
- SpO2 targets: 90-95%
Cardiovascular Support:
- Blood pressure monitoring
- Early recognition of PDA
- Fluid management protocols

Infection Prevention

Strict hand hygiene protocols
Sterile procedures for all interventions
Bundle care approach
Antibiotic stewardship

Systemic Care Considerations

Neurological Care

Brain-protective strategies:
- Minimal handling protocols
- Pain management guidelines
- Regular neurological assessment
Monitoring:
- Daily head circumference
- Serial cranial ultrasounds
- Amplitude-integrated EEG when indicated

Cardiovascular Management

Hemodynamic monitoring:
- Continuous BP monitoring
- Perfusion assessment
- Echo evaluation when indicated
PDA management protocol
Fluid balance optimization

Gastrointestinal Care

Feeding protocols:
- Early minimal enteral nutrition
- Human milk prioritization
- Standardized advancement schedules
NEC prevention strategies
GI monitoring protocols

Advanced Monitoring Requirements

Continuous Monitoring

Vital Parameters:
- Heart rate variability
- Respiratory rate patterns
- Blood pressure trends
- Temperature stability
Oxygenation:
- Pre/post-ductal saturation
- Tissue oxygenation when available
- Target oxygen saturation ranges

Laboratory Monitoring

Regular assessments:
- Blood gases (q6-8h initially)
- Electrolytes (q12-24h)
- Blood glucose (q3-6h initially)
- CBC with differentials
Special investigations:
- Cranial ultrasound protocols
- Echo screening
- ROP screening schedule

Special Considerations & Complications

Common Complications

Respiratory:
- Severe RDS (>90% incidence)
- BPD (40-60% risk)
- Pulmonary hemorrhage
- Air leak syndromes
Neurological:
- IVH (30-40% risk)
- PVL (5-10% risk)
- Seizures
Other Systems:
- NEC (5-10% risk)
- ROP (40-60% risk)
- Late-onset sepsis (40% risk)
- PDA (30-40% incidence)

Prevention Strategies

Bundle approaches for:
- VAP prevention
- CLABSI prevention
- NEC prevention
Standardized care protocols
Quality improvement initiatives

Outcomes & Follow-up Care

Short-term Outcomes

Expected hospital course: 3-4 months
Common morbidities:
- Growth failure
- BPD
- Neurodevelopmental concerns

Long-term Follow-up

Multidisciplinary approach:
- Neonatology
- Neurodevelopmental
- Respiratory
- Ophthalmology
- Physical/Occupational Therapy
Growth monitoring
Development assessment
Family support services

Further Reading

Additional Resources