Resuscitation of extremely preterm infants - controversies and current evidence

Area of Science:

• Perinatal Medicine
• Neonatology
• Pediatric Critical Care

Background:

• Delivery room management of extremely preterm infants (gestational age < 23-25 weeks) presents significant challenges despite advances in perinatal medicine.
• While evidence supports improved outcomes for resuscitation and stabilization, a gap exists for the periviable subgroup (23-25 weeks gestation).
• An experienced delivery team is crucial for optimizing outcomes in extremely preterm infants.

Purpose of the Study:

• To review the evidence for optimal management strategies for extremely preterm infants in the delivery room.
• To highlight the importance of establishing functional residual capacity for cardiorespiratory adaptation.
• To summarize evidence-based practices for the periviable preterm subgroup.

Main Methods:

• Review of existing literature and evidence regarding delivery room resuscitation and stabilization of extremely preterm infants.
• Focus on periviable infants (23-25 weeks gestation) and the transition from fetal to neonatal circulation.
• Analysis of key interventions including antenatal steroids, delayed cord clamping, temperature control, and oxygenation strategies.

Main Results:

• A gentle approach to stabilization in the delivery room is supported by sufficient evidence for these fragile infants.
• Establishing optimal functional residual capacity is critical for adequate gas exchange and cardiorespiratory adaptation.
• Evidence supports the use of antenatal steroids, delayed cord clamping, temperature control, and appropriate oxygenation.

Conclusions:

• Gentle stabilization techniques are recommended for extremely preterm infants in the delivery room.
• Key interventions like antenatal steroids, delayed cord clamping, and optimized respiratory support improve outcomes.
• Further research may be needed to refine management protocols for the periviable subgroup.