Opinions of paediatricians who teach neonatal resuscitation about resuscitation practices on extremely preterm infants in the delivery room

2016 ◽  
Vol 42 (11) ◽  
pp. 725-728 ◽  
Author(s):  
Cristiane Ribeiro Ambrosio ◽  
Adriana Sanudo ◽  
Alma M Martinez ◽  
Maria Fernanda Branco de Almeida ◽  
Ruth Guinsburg
Keyword(s):  
Preterm Infants ◽  
Neonatal Resuscitation ◽  
Delivery Room ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Peak Inspiratory Pressure During Delivery Room Resuscitation for Infants Born at Less Than 500 Grams.

2020 ◽  
pp. 1-4
Keyword(s):  
Preterm Infants ◽  
Neonatal Resuscitation ◽  
Peak Inspiratory Pressure ◽  
Delivery Room ◽  
Inspiratory Pressure ◽  
Temperature Management ◽  
Pulmonary Mechanics ◽  
Term Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Introduction: With the advent of technological advancement and better scientific understanding it is possible now to successfully resuscitate and save babies born at less than 500 grams. Stabilization of these infants in the delivery room (DR) is one of the goals of the golden hour management. While some factors, including temperature management and airway care have standards, there is paucity of data on the optimal peak inspiratory pressure (PIP). The Neonatal Resuscitation Program (NRP) recommends using the same inflation pressure of 20 cm to 25 cm H2O for preterm infants as used for term infants. Preterm lungs are not the same as term infants. Due to the smaller lung volume, capacities and dynamic pulmonary mechanics, these preterm infants are prone to pulmonary complications including pneumothorax. Therefore, there is need to use PIP judiciously in the DR. Methods and Results: In this brief report we present two cases of newborn infants that were born at less than 500 grams and were successfully resuscitated with a lower PIP. The success criteria in the DR were heart rate greater than 100 per minute and adequate oxygen saturations minute by minute per NRP guidelines with minimal use of supplemental oxygen. Conclusion: While we need good prospectively designed studies to document the ideal PIP for these extreme preterm infants, we suggest a PIP lower than the currently recommended may be sufficient for some extremely preterm infants.

Controversies about the resuscitation of extremely preterm infants in the delivery room

2005 ◽  
Vol 81 (7) ◽  
pp. 3-15 ◽  
Author(s):  
Maria Fernanda Branco de Almeida ◽  
Ruth Guinsburg
Keyword(s):  
Preterm Infants ◽  
Delivery Room ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Controversies about the resuscitation of extremely preterm infants in the delivery room

10.2223/1295 ◽  
2005 ◽  
Vol 81 (7) ◽  
pp. 3-15 ◽  
Author(s):  
Maria Fernanda Branco de Almeida ◽  
Ruth Guinsburg
Keyword(s):  
Preterm Infants ◽  
Delivery Room ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Guidelines for Resuscitation in the Delivery Room of Extremely Preterm Infants

2004 ◽  
Vol 19 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Giovanna Verlato ◽  
Daniela Gobber ◽  
Donatella Drago ◽  
Lino Chiandetti ◽  
Paola Drigo
Keyword(s):  
Preterm Infants ◽  
Delivery Room ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals

2021 ◽  
pp. fetalneonatal-2020-321273
Author(s):  
Lydia Mietta Di Stefano ◽  
Katherine Wood ◽  
Helen Mactier ◽  
Sarah Elizabeth Bates ◽  
Dominic Wilkinson
Keyword(s):  
Preterm Infants ◽  
Nurse Practitioners ◽  
Active Treatment ◽  
Online Survey ◽  
Neonatal Resuscitation ◽  
Lower Threshold ◽  
Grey Zone ◽  
Perinatal Medicine ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

BackgroundDecisions about treatments for extremely preterm infants (EPIs) born in the ‘grey zone’ of viability can be ethically complex. This 2020 survey aimed to determine views of UK neonatal staff about thresholds for treatment of EPIs given a recently revised national Framework for Practice from the British Association of Perinatal Medicine.MethodsThe online survey requested participants indicate the lowest gestation at which they would be willing to offer active treatment and the highest gestation at which they would withhold active treatment of an EPI at parental request (their lower and upper thresholds). Relative risks were used to compare respondents’ views based on profession and neonatal unit designation. Further questions explored respondents’ conceptual understanding of viability.Results336 respondents included 167 consultants, 127 registrars/fellows and 42 advanced neonatal nurse practitioners (ANNPs). Respondents reported a median grey zone for neonatal resuscitation between 22+1 and 24+0 weeks’ gestation. Registrars/fellows were more likely to select a lower threshold at 22+0 weeks compared with consultants (Relative Risk (RR)=1.37 (95% CI 1.07 to 1.74)) and ANNPs (RR=2.68 (95% CI 1.42 to 5.06)). Those working in neonatal intensive care units compared with other units were also more likely to offer active treatment at 22+0 weeks (RR=1.86 (95% CI 1.18 to 2.94)). Most participants understood a fetus/newborn to be ‘viable’ if it was possible to survive, regardless of disability, with medical interventions accessible to the treating team.ConclusionCompared with previous studies, we found a shift in the reported lower threshold for resuscitation in the UK, with greater acceptance of active treatment for infants <23 weeks’ gestation.

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