Cold, under-supported preterm lungs do badly. In the first minutes the priorities are warmth, gentle breathing support, and calling for help early.
Call early - registrar / consultant and NETS (1300 36 2500). Even a few minutes of preparation helps.
Prepare
Even with minutes
Move to the procedure room / warmer.
Gather a small kit: small masks, ETT 2.5 / 3.0, polyethylene bag + hat, sats probe, T-piece with PEEP, surfactant, UVC kit, glucose.
Allocate roles before the baby arrives.
Thermoregulation
The biggest quick win
<32 weeks - do not dry. Place straight into a polyethylene bag / wrap with a hat, under a radiant warmer.
Aim for normothermia 36.5-37.5 C.
Cold significantly worsens outcomes.
Breathing support
Gentle
If breathing, support with PEEP / CPAP.
If PPV is needed, use a T-piece with PEEP and lower pressures.
Start oxygen at 30% and titrate to SpO2 targets - avoid hyperoxia.
Avoid routine sustained inflations.
The rest of the golden hour
Delayed cord clamping if the baby is stable.
Check and support glucose.
Consider early antibiotics if infection risk.
Surfactant per local threshold.
Discuss level of care / retrieval early.
Extreme prematurity / periviability: decisions about active management are gestation-dependent and senior-led - involve the consultant and family early. See Antenatal for counselling tools.
Educational summary - follow your local guideline and ANZCOR, and call NETS early.