Careful adjustment and continuous assessment of ventilation pressures and oxygen in order to optimize gas exchange without damaging fragile underdeveloped lung tissue is the primary goal of respiratory management during transport. Exogenous surfactant may be given before or during transport to increase lung compliance. ELBW infants have difficulty regulating their temperature for several reasons. Thermal insulation is poor as body fat does not appear until 26 to 29 weeks. A lack of epithelial keratin causes evaporative losses alone to be greater than heat production capabilities.
Hypothalamic regulation is poor and unreliable.
Therefore, these infants are vulnerable to environmental temperature stresses. Fluid boluses and medications should be administered over 20 minutes with the smallest necessary volume utilized. Hemodynamic lability may be treated with a Dopamine drip once hypovolemia has been treated. Grouping treatments and keeping the head of the isolette level with the infant's body also avoids cerebral blood flow and pressure fluctuations. Protecting Fragile Skin Fragile neonatal skin burns, tears and bruises very easily due to a lack of significant keratin and the presence of very few epithelial layers.