Less Oxygen, Later Intubation and Reduced Respiratory Pressures for ELBW Infants from 1997 to 2011

Area of Science:

• Neonatalogy
• Pediatric Intensive Care
• Perinatal Medicine

Background:

• Guidelines for extremely low birth weight (ELBW) infant delivery room management have advanced significantly over two decades.
• Local treatment practices and their alignment with current recommendations remained unclear.

Purpose of the Study:

• To assess changes in delivery room management strategies for ELBW infants between 1997 and 2011.
• To determine if these strategies reflect current clinical recommendations.

Main Methods:

• A questionnaire survey of neonatal intensive care units (NICUs) in Germany (1997) and Germany, Austria, Switzerland (2011).
• Comparison of delivery room management practices between the two survey periods.
• Analysis of treatment strategies including oxygenation, ventilation pressures, intubation criteria, and surfactant administration.

Main Results:

• Response rates were consistent across both surveys (63.6% in 1997, 66.2% in 2011).
• Significant changes observed by 2011 included lower initial fraction of inspired oxygen (FiO2) and peak inspiratory pressure (PiP).
• Apnea duration tolerance increased, apnea became less of a sole intubation criterion, and surfactant was used at lower FiO2 levels.

Conclusions:

• Delivery room management for ELBW infants underwent significant evolution between 1997 and 2011.
• The observed changes in treatment strategies largely align with current evidence-based recommendations.