Variations in preterm stabilisation practices and caffeine therapy between two European tertiary level neonatal units

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Perinatal Research

Background:

• Interinstitutional variations in clinical practices can impact preterm infant outcomes.
• Standardization of care for very low birth weight (VLBW) infants is crucial for improving survival and reducing morbidity.

Purpose of the Study:

• To compare stabilization practices for preterm infants between two European tertiary neonatal centers.
• To investigate differences in intubation timing, surfactant administration, and caffeine therapy.
• To analyze the impact on neonatal morbidity and mortality.

Main Methods:

• Retrospective study of VLBW infants (2012-2014) from UK and German centers.
• Comparison of antenatal steroid therapy, intubation, surfactant, and caffeine administration timing.
• Analysis of respiratory outcomes, including mechanical ventilation duration, bronchopulmonary dysplasia (BPD), and mortality.

Main Results:

• VLBW infant cohorts were comparable in gestational age, birth weight, and Apgar scores.
• Significant differences noted in antenatal steroid use, intubation, and surfactant therapy timing.
• Caffeine initiation timing varied (median 0 days UK vs. 2 days German), but discontinuation was similar.
• Mechanical ventilation was longer in the UK; however, BPD and mortality rates were comparable (44% vs. 36% and 15% vs. 13%, respectively).

Conclusions:

• Significant intercenter differences exist in the timing of primary intubation and caffeine therapy for VLBW infants.
• Earlier intubation and caffeine administration in the UK center were not associated with a reduction in BPD incidence.