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Pre-term Infant Care Pathway Overview

Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. There are sub-categories of preterm birth, based on gestational age:

  • extremely preterm (before 28 weeks)
  • very preterm (28 to 32 weeks)
  • moderate to late preterm (32 to 37 weeks).

Breastfeeding should be prompted, encouraged and supported whenever possible.

Please click the relevant flowchart box to be taken directly to textual information.

                                                  

Red Flags
Guidelines for Jaundice in Term and Preterm Babies - Gloucestershire Health and Care Services (GHC)

This guideline is for any medical or nursing/midwifery practitioner caring for neonates. To provide a framework for the diagnosis and management of jaundice occurring in the  first 2 weeks of life and of prolonged jaundice in babies of all gestations up to 28 days of life. The management of conjugated hyperbilirubinaemia and the indications and method for dilutional and exchange transfusion are also covered.

Please follow the resource link below to view.

Initial Management

Breastfed babies

Mothers/carers feeding pre-term babies may need additional support. If you have concerns please follow the Countywide Infant Feeding pathway. Breastfeeding should be promoted, encouraged and supported whenever possible.

If baby is less than 28 days old with exceptional or ongoing feeding problems contact Specialist Infant Feeding Midwife on 07799341200 (please do not give this number to the patient).

Unresolved feeding concerns for babies more than 28 days old can be discussed with Health Visiting Infant Feeding Lead on 07798534298.

Pre-term formula

Infants (who are not breast-fed) will have had their pre-term formula commenced on discharge from the neonatal unit. It is started for babies born before 34 weeks gestation, weighing less than 2kg at birth.

Product

Presentation

Price

Cost/100g

Cost/100kcals

SMA Gold Prem 2

400g

£5.03

£1.26

£0.24

Nutriprem 2

900g

£11.24

£1.25

£0.25

These formulae should not be used in primary care to promote weight gain in patients other than babies born prematurely. 

When to Refer

Breastfed babies

If baby is less than 28 days old with exceptional or ongoing feeding problems contact Specialist Infant Feeding Midwife on 07799341200 (please do not give this number to the patient).

If there are unresolved feeding concerns for babies more than 28 days old, these can be discussed with the Health Visiting Infant Feeding Lead on 07798534298.

If there are concerns regarding growth whilst the infant is on preterm formulae, refer to the Paediatric Dietitian.

If there are concerns regarding growth at 6 months corrected age or at review one month after these formulae are stopped, refer to the Paediatric Dietitian

Ongoing Care

Secondary Care

Pre-term infants should be under regular review by the Paediatricians.

Health Visitor

The Health Visitor should monitor growth (weight, length and head circumference) while the baby is on preterm formulae.

Primary Care

Preterm formula should be discontinued by 6 months corrected age.

Not all babies need these formulae for the full 26 weeks from expected date of delivery (EDD).

If there is excessive weight gain at any stage up to 6 months corrected age, stop the formula. 

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