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Initiation of respiratory support for extremely preterm infants at birth

Madeleine C Murphy1,2,3, Lisa K McCarthy1,2, Colm P F O'Donnell4,2

  • 1Department of Neonatology, National Maternity Hospital, Dublin, Ireland.

Archives of Disease in Childhood. Fetal and Neonatal Edition
|August 28, 2020
PubMed

Insights

Most extremely preterm infants received respiratory support shortly after birth, often without knowing their heart rate (HR). Many received positive pressure ventilation (PPV), but a quarter did not require it.

Area of Science:

  • Neonatology
  • Pediatric Critical Care

Background:

  • Neonatal resuscitation guidelines emphasize assessing breathing and heart rate (HR) in newborns.
  • Recommendations suggest continuous positive airway pressure (CPAP) over routine intubation for positive pressure ventilation (PPV) in preterm infants.

Purpose of the Study:

  • To determine the prevalence and timing of respiratory support initiation for extremely preterm and extremely low birthweight (ELBW) infants.
  • To analyze the adherence to current resuscitation guidelines in this vulnerable population.

Main Methods:

  • Retrospective video review of 55 extremely preterm ELBW infants' resuscitation.
  • Analysis of respiratory support methods and timing relative to HR assessment.

Main Results:

  • Nearly all extremely preterm ELBW infants received respiratory support immediately upon arrival to the resuscitation cot.
  • The majority received PPV, often without prior HR assessment.
  • A significant quarter of infants were managed without any PPV.

Conclusions:

  • Respiratory support is initiated very early for extremely preterm ELBW infants, sometimes preceding HR assessment.
  • Current practices may not fully align with guidelines recommending HR assessment before intervention and considering CPAP for preterm infants.

Keywords:
neonatologyresuscitation

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