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Delivery room strategies and outcomes in preterm infants with gestational age 24-28 weeks
Enrico Zecca1, Daniele de Luca, Simonetta Costa
1Division of Neonatology, Neonatal Intensive Care Unit, Catholic University of the Sacred Heart, Rome, Italy. enrizecca@rm.unicatt.it
Insights
Changing delivery room strategies to reduce mechanical ventilation for extremely premature infants improved survival rates, especially for those 27-28 weeks gestation. This approach also lowered the need for retinopathy of prematurity surgery and hospital stays.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Pediatric Critical Care
Background:
- Delivery room management significantly impacts outcomes for extremely premature infants.
- Historically, elective intubation was standard for infants born at the limit of viability.
- Evolving strategies aim to minimize invasive interventions in the delivery room.
Purpose of the Study:
- To compare the effects of two distinct delivery room management strategies on extremely premature infants.
- To assess impacts on survival, short-term morbidity, and key neonatal outcomes.
- To identify which gestational age groups benefit most from changes in delivery room protocols.
Main Methods:
- Retrospective cohort study of preterm infants (24-28 weeks gestation) across two periods (1992-1997 and 1998-2003).
- Period A: elective intubation. Period B: nasal continuous positive airway pressure (nCPAP) if spontaneous breathing present.
- Comparison of survival rates, intubation rates, morbidity, retinopathy of prematurity (ROP) surgery, and length of stay.
Main Results:
- Period B showed significantly increased survival rates and a higher proportion of never-intubated infants compared to Period A.
- No significant differences in short-term morbidity were observed between the two periods.
- Infants in Period B had a significantly lower need for ROP surgery and shorter hospital stays.
- Subgroup analysis revealed significant improvements in the 27-28 weeks gestation group, including increased survival and reduced ROP surgery rates.
Conclusions:
- Delivery room strategies that reduce mechanical ventilation benefit extremely premature infants, particularly those 27-28 weeks gestation.
- The observed benefits include improved survival and reduced need for ROP surgery.
- Further research is needed to determine if these benefits extend to infants at the very limit of viability.
Objective:
To investigate the effect of different delivery room strategies on survival, short term morbidity, and outcomes in extremely premature infants.
Methods:
This retrospective cohort study included all preterm infants with a gestational age between 24 and 28 weeks who were born in 1992-1997 (period A; n = 161) and in 1998-2003 (period B; n = 163). In period A, elective intubation was performed. In period B, if spontaneous breathing was present, nasal continuous positive airway pressure (nCPAP) was applied.
Results:
Survival rate and the number of never-intubated infants significantly increased in period B. No differences were found concerning short-term morbidity. Among major outcomes, the need for retinopathy of prematurity (ROP) surgery and the length of stay were significantly lower in period B. Subgroup analysis showed no significant differences from period A to period B in infants with gestational age 24-26 weeks. In the 27-28 weeks subgroup, the never-intubated infants rate increased from 2.8% to 21.3% and survival rate increased from 63% to 79%. A reduced need for ROP surgery and a shorter hospital stay were also observed.
Conclusions:
Changes in delivery room strategy tending to reduce mechanical ventilation in extremely premature infants are likely to benefit essentially infants of 27-28 weeks of gestation. Extension of such benefits to premature infants at the limit of viability requires further research.
