Improving delivery room management for very preterm infants.

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Evidence-Based Medicine

Background:

• Delivery room events critically influence preterm infant outcomes.
• Guidelines were developed to address heat loss, oxygen exposure, and respiratory support for infants weighing ≤1250 g.

Purpose of the Study:

• To improve the care and outcomes of very preterm infants through evidence-based delivery room guidelines.
• To assess the impact of guideline implementation on infant temperature, oxygen use, respiratory support, and clinical outcomes.

Main Methods:

• A cohort study comparing historical (n=80) and prospective (n=80) groups after guideline implementation.
• Guidelines were disseminated via multidisciplinary conferences, checklists, a dedicated resuscitation nurse, and clinician feedback.
• Primary outcome was axillary temperature; secondary outcomes included guideline adherence and patient outcomes.

Main Results:

• Average admission temperatures increased (36.4°C vs 36.7°C), and moderate/severe hypothermia decreased (14% vs 1%).
• Oxygen exposure in the first 10 minutes was reduced (P < .001) with similar oxygen saturations.
• Continuous positive airway pressure use increased (40% vs 61%), while invasive ventilation and hospitalization durations decreased (5 vs 1 days and 80 vs 60 days, respectively).

Conclusions:

• Evidence-based delivery room guidelines significantly improved care quality for very preterm infants.
• Multidisciplinary engagement and continuous reinforcement were key to sustained guideline adherence and improved outcomes.