Guideline

WHO recommendations for care of the preterm or low-birth-weight infant.

Year of Publication

2022

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

26 included recommendations

Kangaroo mother care (KMC) is recommended as routine care for all preterm or low-birth-weight infants. KMC can be initiated in the health-care facility or at home and should be given for 8–24 hours per day (as many hours as possible).

Status

Updated

Recommended in favor

Strong

Certainty of evidence

High

Kangaroo mother care (KMC) for preterm or low-birth-weight infants should be started as soon as possible after birth

Status

Updated

Recommended in favor

Strong

Certainty of evidence

High

Mother’s own milk is recommended for feeding of preterm or low-birth-weight (LBW) infants, including very preterm (< 32 weeks’ gestation) or very LBW (< 1.5 kg) infants

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Low

When mother’s own milk is not available, donor human milk may be considered for feeding of preterm or low-birth-weight (LBW) infants, including very preterm (< 32 weeks’ gestation) or very LBW (< 1.5 kg) infants.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Moderate

Multicomponent fortification of human milk is not routinely recommended for all preterm or low-birth-weight (LBW) infants but may be considered for very preterm (< 32 weeks’ gestation) or very LBW (< 1.5 kg) infants who are fed mother’s own milk or donor human milk

Status

Updated

Recommended against

Conditional

Certainty of evidence

Low

When mother’s own milk and donor human milk are not available, nutrient-enriched preterm formula may be considered for very preterm (< 32 weeks’ gestation) or very low-birth-weight (< 1.5 kg) infants.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Early initiation of enteral feeding. Preterm and low-birth-weight (LBW) infants, including very preterm (< 32 weeks’ gestation) and very LBW (< 1.5 kg) infants, should be fed as early as possible from the first day after birth. Infants who are able to breastfeed should be put to the breast as soon as possible after birth. Infants who are unable to breastfeed should be given expressed mother’s own milk as soon as it becomes available. If mother’s own milk is not available, donor human milk should be given wherever possible.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

In health-care facilities, scheduled feeding may be considered rather than responsive feeding for preterm infants born before 34 weeks’ gestation, until the infant is discharged

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

In preterm or low-birth-weight (LBW) infants, including very preterm (< 32 weeks’ gestation) or very LBW (< 1.5 kg) infants, who need to be fed by an alternative feeding method to breastfeeding (e.g. gastric tube feeding or cup feeding), feed volumes can be increased by up to 30 ml/kg per day

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Moderate

Preterm or low-birth-weight infants should be exclusively breastfed until 6 months of age

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Very low

Enteral iron supplementation is recommended for human milkfed preterm or low-birth-weight infants who are not receiving iron from another source

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Enteral zinc supplementation may be considered for human milk-fed preterm or low-birth-weight infants who are not receiving zinc from another source

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Enteral vitamin D supplementation may be considered for human milk-fed preterm or low-birth-weight infants who are not receiving vitamin D from another source.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Enteral vitamin A supplementation may be considered for human milk-fed very preterm (< 32 weeks’ gestation) or very low-birth-weight (< 1.5 kg) infants who are not receiving vitamin A from another source

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Probiotics may be considered for human-milk-fed very preterm infants (< 32 weeks’ gestation).

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Moderate

Application of topical oil to the body of preterm or low-birthweight infants may be considered

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Continuous positive airway pressure (CPAP) therapy is recommended in preterm infants with clinical signs of respiratory distress syndrome

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Continuous positive airway pressure (CPAP) therapy may be considered immediately after birth for very preterm infants (< 32 weeks’ gestation), with or without respiratory distress

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

For preterm infants who need continuous positive airway pressure (CPAP) therapy, bubble CPAP may be considered rather than other pressure sources (e.g. ventilator CPAP).

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Caffeine is recommended for the treatment of apnoea in preterm infants

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Caffeine is recommended for the extubation of preterm infants born before 34 weeks’ gestation

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Caffeine may be considered for the prevention of apnoea in preterm infants born before 34 weeks’ gestation.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Family involvement in the routine care of preterm or low-birthweight infants in health-care facilities is recommended

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Low

Families of preterm or low-birth-weight infants should be given extra support to care for their infants, starting in health-care facilities from birth and continued during follow-up postdischarge. The support may include education, counselling and discharge preparation from health workers, and peer support

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Very low

Home visits by trained health workers are recommended to support families to care for their preterm or low-birth-weight infant

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Care of the preterm (< 37 weeks’ gestation) or low-birth weight (< 2.5 kg) infant. The guideline development group decided not to make a recommendation on calcium or phosphorous supplementation as there was little evidence of benefits or harms on any critical outcome

Status

Updated

Certainty of evidence

Very low