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Updated: Jun 6, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
[Delivery room intensive care unit]
1UO di Neonatologia e Terapia Intensiva Neonatale, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano.
Insights
Survival rates for extremely preterm infants have not improved in a decade. Implementing neonatal intensive care unit principles in the delivery room may enhance outcomes for these vulnerable newborns.
Area of Science:
- Neonatal medicine
- Perinatal care
- Pediatric critical care
Context:
- Survival and morbidity rates for extremely-low-gestational-age-neonates (ELGANs, ≤28 weeks' gestation) have plateaued over the last decade.
- Major morbidities like bronchopulmonary dysplasia (BPD) may be influenced by immediate postnatal management.
- Current delivery room care for ELGANs lacks specialized protocols, advanced equipment, and objective monitoring.
Purpose:
- To highlight the need for improved delivery room management for extremely preterm infants.
- To advocate for the integration of neonatal intensive care unit principles into the delivery room setting.
- To emphasize the necessity of evidence-based resuscitation strategies for ELGANs.
Summary:
- No significant improvements in survival or morbidity for preterm infants (ELGANs) in the past 10 years.
- Delivery room management, particularly in the first minutes of life, may impact short- and long-term outcomes.
- Current delivery room practices for ELGANs are suboptimal, necessitating a shift towards intensive care principles.
Impact:
- Potential to improve survival rates and reduce morbidity in extremely preterm infants.
- Encourages the development and implementation of standardized, evidence-based resuscitation protocols for ELGANs.
- Promotes further research into gentle resuscitation parameters for vulnerable newborns.
Abstract:
Over the most recent 10 years there have been no significant further improvements in survival or morbidity rates of preterm infants, mostly the extremely-low-gestational-age-neonates (ELGANs, defined as less than or equal to 28 weeks' gestation).The incidence of some of the major morbidities associated with extreme prematurity, such as BPD, could potentially be affected by management in the first minutes of life; it may be necessary to apply the principles of care that occur in the neonatal intensive care unit in the delivery room to achieve a further improvements in short and long-term outcome of these neonates. Up to now, the care of the smallest preterm infants in the delivery room has received little attention: few resuscitation protocols addressed to these newborns, not advanced equipment used and subjective monitoring based on clinical examination. Therefore, it may be useful to incorporate an intensive care environment into the delivery room to enhance survival rates and reduce morbidity of the extremely preterm infants. New approaches in the first minutes of life using more gentle parameters of intervention are being studied but further evidence is needed to improve resuscitation procedures in these newborns.
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