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Updated: May 1, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Comparing minimally invasive and proactive initial management of extremely preterm infants
A Lando1, K Kure Østergaard, G Greisen
1Department of Neonatology, The Juliane Marie Centre, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark.
Insights
A proactive approach to infant care for premature babies born before 26 weeks gestation did not increase psychomotor deficits. While mechanical ventilation use rose, survival rates showed a positive trend.
Area of Science:
- Neonatal care
- Pediatric development
Background:
- Minimally invasive care policies for extremely premature infants were standard.
- A shift to a proactive approach, including delivery room intubation and surfactant, was implemented in 2005.
Purpose of the Study:
- To evaluate the impact of a policy change towards proactive initial care for infants born before 26 weeks gestation.
- To assess effects on neurodevelopmental outcomes, mortality, and respiratory support.
Main Methods:
- A comparative study analyzing Ages and Stages Questionnaire (ASQ) scores, mortality rates, and mechanical ventilation use.
- Data collected before (1999-2003) and after (2005-2011) the policy change.
Main Results:
- No significant increase in psychomotor deficits (ASQ z-score <-2 SD) was observed (22% vs. 26%).
- Mortality rates decreased from 46% to 36% (p=0.06).
- Mechanical ventilation use increased significantly from 64% to 87% (p<0.0001).
Conclusions:
- A proactive approach to initial care for extremely premature infants did not lead to a major increase in psychomotor deficits.
- The policy change was associated with a trend towards improved survival and a significant increase in mechanical ventilation use.
Aim:
In 2005, we changed our minimally invasive departmental policy for infants born before 26 weeks of gestation to a proactive approach. This included structured guidelines as well as intubation and surfactant in the delivery room, if the parents agreed. The aim of this study was to evaluate the effect of this change of policy.
Method:
We compared the Ages and Stages Questionnaire (ASQ) scores, mortality rates and use of mechanical ventilation before (1999-2003) and after (2005-2011) the introduction of the new policy.
Results:
Twenty-two per cent of 61 infants in the before group had an ASQ z-score of <-2 standard deviation at 18 months' corrected age, compared with 26% of 55 infants in the after group. Mortality decreased from 46% to 36% (p = 0.06) and the use of mechanical ventilation at any time during admission increased from 64% to 87% (p < 0.0001).
Conclusion:
We demonstrated that changing our policy to a proactive approach to the initial care of infants born before 26 weeks did not result in a major increase in psychomotor deficit. However, the use of mechanical ventilation increased significantly and survival tended to improve.
