Navigating technical challenges in the care of infants born at the limits of viability

Abstract The resuscitation, intensive care and survival of peri-viable extremely premature infants (PVEPT) have been increasing in recent years. The initial care of these infants requires precision when performing a number of procedures after delivery. The multi-disciplinary team within the neonatal intensive care unit requires significant training with graduated autonomy to successfully perform procedures in this population. Preparation, performance and complications of endotracheal intubation, umbilical catheterization, percutaneously inserted central catheter placement, and orogastric tube placement in PVEPTs are reviewed. Experiential approaches are provided to bolster the discussion of these procedures when literature is limited. A review of PVEPT skin physiology is presented, and techniques to secure lines and tubes to minimize skin trauma within environments that do and do not utilize humidity are discussed. Impact The care of peri-viable extremely premature infants requires many precise technical skills from a multidisciplinary team immediately following delivery. Careful preparation, supervised technique, and an understanding of common pitfalls are paramount to procedural success in this population. Careful attention must be paid to the fragile neonatal skin to avoid pain and injury in this patient population.