The challenges that the very low birth-weight (VLBW) infant presents to clinicians in
todays Neonatal Intensive Care units vary widely throughout the world, based on
resources and definition. It is first necessary to come to a consensus as to the definition
of that patient population so as to have a common framework in which to work. It is
the intention in this lecture to address those infants born less than 1000gms. While the
achievements in both technologic advances and new modalities of therapy such as
Liquid Ventilation are exciting, concurrently we are forced to focus our attention on the
quality of outcomes in the survivors of our care. Since the follow-up management of a
new patient population has created a new responsibility.
Survival in these patients is possible with diligent monitoring by well educated clinical
staff, careful attention to the basics of thermal management, fluid delivery and a back to
basics approach to the environment, most conductive to enhance developmental
outcomes. For example humidification once banned in most Neonatal units is being
reintroduced with a new respect for the advantages gained over the apparent
disadvantage seen with infection, Family centered care and the inclusion of parental
participation specifically with Kangaroo care is gaining rapid acceptance as a method to
improve care, along with a new energy to look again at the environmental factors that
these patients are subjected to, Furthermore a recent study just beginning to look at
twins being nursed in the same incubator will challenge us as we progress forward in
our care of these VLBW infants.
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