Resuscitation of extremely preterm infants - controversies and current evidence

Abstract

Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable (gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.

Delivery room resuscitation intensity and associated neonatal outcomes of 24+0–31+6 weeks’ preterm infants in China: a retrospective cross-sectional study

“…When GA was less than 26 weeks, more than 50% of preterm infants received a higher intensity of resuscitation, including endotracheal intubation and CPR. It has been shown in other studies that half of preterm infants at 24 weeks of GA may be able to maintain respiratory stability on DR-CPAP [ 17 ]. In our study, the proportion stabilized on DR-CPAP was lower (25.1% vs. 32.5%) [ 4 ].…”

“…This means that insulation did not perform effectively during the resuscitation process, which we will enhance in future quality improvements. ANS can accelerate fetal lung development and reduce morbidity and mortality in preterm infants between 22 and 34 weeks of GA [ 17 , 25 ], as well as reduce extensive resuscitation [ 26 ]. In this research, the use of ANS was 83.2% in preterm infants without resuscitation compared with 64.9% who needed CPR, indicating that ANS reduced the intensity of resuscitation.…”

Delivery Room Care for Premature Infants Born after Less than 25 Weeks’ Gestation—A Narrative Review

“…The decision of active management leaves clinicians in a challenging position. Despite the advances that have been achieved in perinatal and neonatal care, there is a lack of strong evidence in delivery room (DR) studies which have included infants at 22 + 0 to 24 + 6 weeks' gestation [2].…”