From the Guidelines
The recommended treatment for a premature infant weighing 800g involves comprehensive intensive care in a neonatal intensive care unit (NICU) with a focus on reducing morbidity and mortality, and improving quality of life, as supported by the most recent evidence from 1 and 1.
Key Components of Care
- Immediate respiratory support with continuous positive airway pressure (CPAP) or mechanical ventilation if needed, along with surfactant administration to prevent respiratory distress syndrome, as suggested by 1.
- Temperature regulation using an incubator set at 36.5-37.5°C.
- Nutritional support starting with parenteral nutrition providing 80-100 kcal/kg/day, gradually transitioning to enteral feeding with breast milk or specialized preterm formula when tolerated.
- Infection prevention with empiric antibiotics, such as ampicillin and gentamicin, pending culture results.
- Cardiovascular support with volume expansion or inotropes like dopamine if hypotension occurs.
- Regular monitoring of vital signs, blood gases, electrolytes, glucose, and bilirubin levels.
Rationale
The care for a premature infant weighing 800g is critical due to the high risk of complications including respiratory failure, infection, intraventricular hemorrhage, and necrotizing enterocolitis. The interventions outlined are based on the best available evidence to reduce morbidity and mortality, and improve quality of life. Vitamin A supplementation, as discussed in 1, may also be beneficial in reducing the incidence of chronic lung disease and retinopathy of prematurity, although the optimal dosage and delivery method require further study.
Level of Care
According to the definitions of levels of neonatal care from 1, a premature infant weighing 800g would require care at a Level III or IV neonatal intensive care unit (NICU), which provides comprehensive care for critically ill infants, including sustained life support and access to pediatric medical and surgical subspecialists.
Monitoring and Follow-Up
Regular monitoring and follow-up are crucial to promptly identify and manage any complications that may arise. This includes close surveillance of vital signs, laboratory results, and clinical status, as well as timely interventions to address any issues that may impact morbidity, mortality, and quality of life, as emphasized by the need for evidence-based practice in 1.
From the Research
Morbidity Rate of Premature Infants Weighing 800g
- The morbidity rate of premature infants weighing 800g is a critical concern, with various studies indicating a range of outcomes 2, 3.
- A study from 1984 reported that out of 147 premature infants weighing 800g or less, 65 (44%) survived, with 43% of the survivors being normal, 22% having mild developmental delays, and 35% being impaired 2.
- Another study from 1983 found that among 16 survivors of infants weighing less than 800g, 13 (81%) were without major CNS handicaps and were developing appropriately at 6 months to 3 years of age 3.
Recommended Treatment for Premature Infants Weighing 800g
- The recommended treatment for premature infants weighing 800g includes surfactant replacement therapy, which has been shown to improve survival rates and reduce the incidence of serious complications such as bronchopulmonary dysplasia 4, 5, 6.
- Prophylactic surfactant administration within the first 15 minutes of life appears to be more efficacious than later treatment for very preterm babies 4.
- Other treatments, such as assisted ventilation, corticosteroids, and inhaled nitric oxide, may also be beneficial in reducing pulmonary inflammation and improving outcomes 4, 5.