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Delivery room management of VLBW infants in Germany, Switzerland and Austria

Presented at the Neonatal Society 2009 Summer Meeting (programme).

Roehr C, Kelm M, Groebe S, Proquitté H, Hammer H, Schmalisch G, Buehrer C

Clinic for Neonatology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Germany

Background: National and international guidelines (ILCOR, AAP and ER) give recommendations on the resuscitation of VLBW infants, including oxygen administration or positive pressure ventilation (1,2,3). We wanted to find out how consistently neonatologist in German speaking European countries adhered to the recommendations of these guidelines.

We surveyed the current management of very low birth weight infants (VLBW) (birth weight <1500g) at birth in Germany (FRG), Switzerland (CH) and Austria (A).

Methods: In a questionnaire based study, we obtained data on delivery room equipment and management of VLBW from all national neonatal units caring for VLBW infants.

Results: In total, 249 units were approached (FRG n=193, CH n=42, A n=14). The recall rate was 77.1% (n=192). Complete answers were obtained from 188 (75%) units. 48 (26%) were university and affiliated units, 140 (74%) non-university units. Management guidelines of VLBW existed in 94% of units. Perinatal management: Most VLBW were cared for in the delivery unit (55%). Placental transfusion (late clamping) was practiced by 43%. Thermoregulation: plastic foil 62%, head cover/woollen hats 81%. Airway management: self inflating bags were used in 92%, bags with mounted manometer in 37%, bags with fixed PEEP-Valves in 71%, T-piece resuscitators (e.g. Neopuff®) in 40%, CPAP with sustained inflations >5s 25%, Starting-CPAP 4-5 cmH2O 76%, humidified gas 42%, use of pulse oximetry 99%. Regarding the use of oxygen in the delivery unit, 80% of clinics used oxygen blenders to titrate the FiO2. 30% of clinics would start with a FiO2 of 0.21, approx. 10% would use an FiO2 of 1.0. For all investigated parameters, no significant differences were found between university and non-university units or between countries.

Discussion: We document the existence of very heterogeneous protocols for the management of VLBW infants, in particular with respect to airway management. Our results are in keeping with those published by O´Donnell (4) for Australia and New Zealand, and by Iriondo (5) and colleagues from Spain or Kiefer (6) and coworkers from the USA. We believe this heterogeneity reflects the need for the generation and rapid distribution of sound evidence from clinical trials.

Conclusion: Data from other European countries should be obtained in order to survey the regional practices of neonatal management and compare these with the current recommendations and the best available evidence from clinical research in order to formulate up to date evidence based recommendations for the care of VLBW infants.

1. European Resuscitation Council Guidelines for Resuscitation 2005. Section 6. Paediatric life support . Resuscitation 2005 ; 67S1 : S97 –S133
2. International Liaison Committee on Resuscitation. 2005 International Consensus on Cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2005; 112: III-1–III-136.
3. American Heart Association. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support. Pediatrics. 2006 ; 117: e989-1004.
4. C O'Donnell, M Stewart, L Mildenhall Neonatal resuscitation in Australia and New Zealand. J Paed Child Heath 2006; 42: 4-5
5. Iriondo M, Thió M, Burón E, Salguero E, Aguayo J, Vento M; the Neonatal Resuscitation Group (NRG) of the Spanish Neonatal Society (SEN). A survey of neonatal resuscitation in Spain: gaps between guidelines and practice. Acta Paediatr 2009 [Epub ahead of print]
6. Kiefer AS, Wickremasinghe AC, Johnson JN, Hartman TK, Hintz SR, Carey WA, Colby CE. Medical Management of Extremely Low-Birth-Weight Infants in the First Week of Life: A Survey of Practices in the United States. Am J Perinatol. 2009 (19) [Epub ahead of print]

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