The specialized care that very-low-birthweight (VLBW) infants (< 1500 g or < 3 lb, 5 oz) need at birth is facilitated best by prior maternal transfer to a tertiary center. However, we cannot always anticipate preterm births soon enough to allow for safe transfer. Accordingly, attending pediatricians should be prepared to evaluate and stabilize such infants prior to transfer to a neonatal intensive care unit. Evaluation starts with the maternal history and the Apgar scores and continues until transfer is accomplished. It consists of frequent assessment of cardiorespiratory function, glucose homeostasis, and the infant's potential for serious infection. Stabilization includes controlling the infant's temperature, supporting cardio-respiratory functions as needed, supplementing glucose, and initially managing potentially life-threatening infections, when applicable. Other problems, such as central nervous system depression or serious malformations, also may require attention.
The clinical evaluation of the VLBW infant differs from that of the term infant in several ways. For instance, the Apgar score generally has a range narrower than 0 to 10. Because of neurologic immaturity, Apgar scores greater than 6 in VLBW infants are unusual. This difference is due primarily to decreased tone and reactivity compared with that of term infants, but skin color also is less uniform and respiratory effort more variable in this group.