[Care of the premature infant].

The Labor Room It is accepted that the umbilical cord should be clamped early in known and suspected cases of erythroblastosis. When isoimmunization is not a factor, some advocate late clamping to effect a physiologic transfusion. Others say this produces excessive blood volume, which may be a causative factor in the respiratory-distress syndrome. Studies by umbilical-vein catheterization thus far have failed to show an association between high venous pressure and increased mortality. Aspiration of the stomach is being performed routinely in many centers. No convincing controlled studies are available to show that this procedure has lowered mortality or morbidity. Resuscitation of the newborn continues to be a problem. The trend is toward more vigorous measures more promptly applied, to produce and maintain an airway, and thus facilitate initial expansion of the lungs. Nasopharyngeal suction is adequate in most instances. Infants who do not breathe spontaneously may benefit from direct haryngoscopy, clearance of the airway and artificial respiration. Morphine antagonists may be given if narcosis is evident following use of narcotics during delivery. Initial heat loss is greater in prematures than in full-term newborns. The rate of fail of body temperature is maximal during the first hour of life when the infant is cxposed to labor-room temperatures while being resuscitated. Swaddling, effective against heat loss, has the disadvantage of interfering with direct observation of the infant. The answer to this problem may be infra-red heat lamps built into one corner of the labor room. The use of glucose has been mentioned but not enough information is available. There is a growing trend toward the omission of silver nitrate for prophybaxis in the eyes in newborns. In some centers local instillation of antibiotics is used; others have abandoned prophylaxis completely. There is no evidence concerning the apphication of these methods to premature infants. Some believe that the chemical conjunctivitis produced by silver nitrate may help the premature conjunctiva to ward off other bacterial invaders as well as the gonococcus.