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Delivery room management of ELBW infants in Italy
Francesca Rech Morassutti1, Irene Satariano, Nicoletta Doglioni
1Children and Women's Health Department, Medical School University of Padua Azienda, Padua, Italy. trevo@pediatria.unipd.it.
Insights
This study assessed early delivery room management for extremely low birth weight (ELBW) infants in Italy. Practices showed good adherence to international guidelines, despite some regional variations in oxygen use and surfactant administration.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Clinical Practice Guidelines
Background:
- Effective management of extremely low birth weight (ELBW) infants in the delivery room is crucial for improving outcomes.
- International guidelines provide a framework for optimal neonatal resuscitation and care.
- Variations in clinical practice can impact the quality of care provided to vulnerable newborns.
Purpose of the Study:
- To evaluate the consistency of delivery room practices for ELBW infants in Italy.
- To assess adherence to established International Guidelines for Neonatal Resuscitation.
- To identify any geographic disparities in the implementation of these guidelines across Italian regions.
Main Methods:
- A nationwide survey was conducted across Italian centers managing ELBW infants.
- Data collection focused on key delivery room interventions including temperature management, ventilation, and resuscitation.
- Statistical analysis was used to determine adherence rates and identify regional differences.
Main Results:
- A polyethylene bag/wrap was utilized by 55.1% of centers for temperature management.
- Oxygen concentrations >40% for positive pressure ventilation initiation varied regionally, being higher in Central (14.3%) and Southern (16.2%) Italy compared to the North (2.5%).
- A T-piece device was commonly used (79.4%), with 13% of ELBW infants receiving chest compressions and 47.9% receiving prophylactic surfactant.
Conclusions:
- Italian delivery room practices for ELBW infants demonstrate good general adherence to International Guidelines for Neonatal Resuscitation.
- Geographic differences exist in specific practices, such as the use of higher oxygen concentrations and surfactant administration.
- Further efforts may be needed to standardize care nationwide and ensure consistent application of evidence-based guidelines.
Abstract:
In this article we evaluated the consistency of practice and the adherence to the International Guidelines in early delivery room management of ELBW infants in Italy. A polyethylene bag/wrap was used by 54 centres (55.1%). In Northern regions, one centre (2.5%) reported to use oxygen concentrations >40% to initiate positive pressure ventilation in ELBW infants. These proportions were higher in the Central (14.3%) and Southern (16.2%) areas. A T-piece device for positive pressure ventilation was widely used (77/97, 79.4%). A median of 13% (IQR: 5%-30%) of ELBW infants received chest compressions at birth in Italy. Forty-seven out of 98 (47.9%) centres declared to administer prophylactic surfactant in delivery room. Although there were geographic differences in the country, our results showed a good general adherence to the International Guidelines for Neonatal Resuscitation.
