Neonatal emergency management in a 25-day-old infant with prematurity, extremely low birth weight, and respiratory distress syndrome

Abstract

Neonatal mortality remains a significant challenge worldwide, with prematurity, extremely low birth weight (ELBW), and respiratory distress syndrome (RDS) as major contributors. These conditions often coexist and create a complex pathological cycle that threatens neonatal survival. This study aimed to present a case report of a premature neonate with ELBW and RDS, focusing on the comprehensive midwifery and neonatal management provided in an Indonesian referral hospital. A case study design was applied. Data were collected through direct clinical observation, documentation of the infant’s medical record, and review of relevant literature. The midwifery management process followed Varney’s 7-step framework, including assessment, diagnosis, identification of potential complications, immediate interventions, care planning, implementation, and evaluation. The case involved a male infant born at 28 weeks of gestation, weighing 950 g. Clinical manifestations included tachypnea, intercostal retractions, nasal flaring, cyanosis, and a Downes score of 7, confirming severe RDS. The management included thermal regulation using an incubator, nutritional support via orogastric feeding with expressed breast milk, continuous positive airway pressure (CPAP), administration of exogenous surfactant, intravenous antibiotics, and close monitoring of vital signs. Parental education on kangaroo mother care (KMC) was also provided. After 12 days of NICU care, the infant demonstrated improved oxygen saturation (95% on CPAP), weight gain (1,120 g), and stabilization of vital signs, and was discharged with scheduled follow-up. Comprehensive neonatal care that integrates respiratory support, thermal regulation, nutritional management, infection prevention, and family-centered approaches is essential to reduce mortality and improve outcomes in premature neonates with ELBW and RDS.