Delivery room management of infants with less than 27 weeks of gestational age

Abstract

Background: The medical management of a preterm birth is a challenge, and there is not a definite consensus on how to deal with this situation. The aim of this study was to evaluate the effect of delivery room (DR) management on clinical condition (temperature, peripheral oxygen saturation, blood glucose level, hemoglobin level, mean blood pressure and pH) on the Neonatal Intensive Care Unit (NICU) admission of preterm infants born before 27+0 weeks of gestational age (GA). Methods: This study was performed among all preterm infants with a GA between 23+0 and 26+6 weeks admitted to the Level III NICU of Centro Hospitalar Universitário de São João (Porto, Portugal) between 1st January 2005 and 31st December 2018. Maternal demographics, gestation information, infants’ characteristics, DR and NICU data were evaluated. Results: A total of 65 preterm neonates were included in this study. The admission pH was associated to the administration of epinephrine in DR (B = -0.786; p = 0.003; 95%CI [-1.282; -0.290]); blood glucose level to body weight at birth (B = 0.253; p = 0.006; 95%CI [0.078; 0.428]) and epinephrine in DR (B = 72.719; p = 0.02; 95%CI [12.530; 132.908]); body temperature to epinephrine administrated in DR (B = -1.703; p = 0.001; 95%CI [-2.692; -0.714]); and hemoglobin level to early continuous positive airway pressure (CPAP) in DR (B = 6.008; p = 0.013; 95%CI [1.356; 10.660]). Conclusion: DR procedures can have negative or positive effects on early outcomes of preterm newborns. It is crucial to research more about their impact to optimize the NICU management of this particular and challenging neonatal group and support the neonatologists’ clinical decisions.

Keywords

• preterm birth
• extremely low gestational age
• delivery room management
• neonatal intensive care unit
• neonatal mortality
• neonatal resuscitation