Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life

Abstract

Aim: To evaluate the outcome of a cohort of extremely low gestational age newborn infants (ELGAN) below 26-week gestation who were treated following a revised, gentle delivery room protocol to assist them in the transition and adaptation to extrauterine life.Methods: A cohort of infants with a gestational age (GA) below 26 weeks (study group; n = 164) was treated according to a revised delivery room protocol. The protocol included an optimized prenatal management, strict use of continuous positive airway pressure (CPAP), avoiding mechanical ventilation and early administration of surfactant without intubation. The parameters management of respiratory distress syndrome, survival, neonatal morbidity and neurodevelopmental outcome were compared with a historical control group (n = 44).Results: Seventy-four per cent of the study group infants were initially treated with CPAP and surfactant administration without intubation. In comparison with the control group, significantly less children were intubated in the delivery room (24% vs. 41%) and needed mechanical ventilation (51% vs. 72%; both p < 0.05). Furthermore, compared with the historical control overall mortality (20% vs. 39%), rate of bronchopulmonary dysplasia (18% vs. 37%) and IVH > II°(10% vs. 33%) in survivors were significantly lower during the observational period (all p < 0.05). Neurodevelopmental outcome was normal in 70% of examined study group infants.

Surfactant Replacement Therapy for Preterm and Term Neonates With Respiratory Distress

“…[25][26][27][28][29][30][31][32] These include use of aerosolized surfactant preparations, laryngeal mask airwayaided delivery of surfactant, instillation of pharyngeal surfactant, and administration of surfactant using thin intratracheal catheters. Theoretically, each of these methods could allow administration of surfactant without intubation in spontaneously breathing infants.…”

An Echocardiographic Screening Program Helps to Identify Pulmonary Hypertension in Extremely Low Birthweight Infants with and without Bronchopulmonary Dysplasia: A Single-Center Experience

“…Our routine management approach of ELBW infants is described in detail elsewhere [7,8,9]. Supplemental O 2 was administered with the aim of maintaining SpO 2 in the range of 85-93% for a postmenstrual age <37 weeks, and between 92 and 96% for a postmenstrual age >37 weeks.…”

Surfactant for Respiratory Distress Syndrome: New Ideas on a Familiar Drug with Innovative Applications

“…This procedure is embedded in a whole package of interventions aimed at the avoidance of positive pressure ventilation, especially during transition and the first 72 h of life [36]. This package includes antenatal steroids, early CPAP, and caffeine treatment in the delivery room [38]. During this technique CPAP is continued as the distribution of surfactant is dependent on alveolar recruitment [7].…”