Resuscitation practices in moderate and late preterm infants are highly variable

 1. Between 2011 and 2020 there was an increase in non-invasive resuscitation interventions and a decrease in resuscitation-associated complications in moderate and late preterm infants.

2. Rates of resuscitation interventions were highly variable between NICU sites, suggesting a need for more thorough practice guidelines to ensure provider consistency and best practices.

Evidence Rating Level: 2 (Good)

Study Rundown: Delivery room (DR) resuscitation is common among moderate and late preterm (MLP) infants and is critical for optimizing management and outcomes. Previous studies of DR resuscitation have focused primarily on very low birth weight or extremely preterm infants. This study aimed to assess intervention frequency stratified by gestational age, types of interventions, and rates of resuscitation-associated complications in MLP infants. The study included infants born between 30 to 36 6/7 weeks gestation between 2011 and 2020 in NICUs throughout the United States that are part of the Vermont Oxford Network (VON). In general, the rate of DR intervention was 55.3% in MLP infants and decreased with increasing gestational age. There was a decrease in resuscitation-related pneumothorax from 1.9% to 1.6% over the study period. The use of DR interventions was widely variable across hospital sites, with most variation occurring in continuous positive airway pressure (CPAP) use. Over the study period, there were significant  increases in CPAP and small increases in PPV use, and decreased ETT ventilation and surfactant administration across all gestational age groups. These findings suggest that MLP DR interventions are trending towards a more non-invasive approach and have lower rates of complications. One notable limitation is that this study does not include infants requiring DR interventions that were not admitted to the NICU, which omits a large subpopulation, limiting generalizability. In general, this study provides compelling evidence that DR resuscitation in MLP infants is highly variable across NICU sites and would likely benefit from specific guidelines to improve practice consistency.

Click here to read the article in PEDIATRICS

Relevant Reading: Delivery Room Resuscitation and Short-Term Outcomes in Moderately Preterm Infants

In Depth [Retrospective cohort]: This study utilized data from the VON which is a nonprofit worldwide dataset for prospective collected data for all NICU admissions. The VON database includes very low birth weight (≤1500 g) and patients >1500 g who were admitted to NICU or die anywhere in hospital within 28 days of birth. The study included 616,110 eligible infants with a median gestational age of 34 weeks. The database included 483 VON centers with 83 (17.2%) Type A (NICUs with restrictions requiring transfer to other sites), 185 (38.3%) Type B NICUs (do not perform surgeries on neonates), and 58 (12.0%) Type C NICUs (perform cardiac surgery requiring bypass). Most interventions involved supplemental oxygen (50.3%) and CPAP (36.2%). The rate of DR intervention decreased with increasing gestational age ranging from 89.7% in 30 weeks gestational age group to 44.2% in the 36-week gestational age group. The rate of CPAP use increased from 17.9% to 47.8% (p<0.001), and the rate of PPV increased from 22.9% to 24.9% (p<0.001) from 2011 to 2020. The rate of ETT ventilation decrease from 6.9% to 4.0% (p<0.001) and the rate of surfactant use decreased from 3.5% to 1.3% (p<0.001). The authors noted the use of DR interventions was widely variable across hospital sites as evidenced by large interquartile ranges (IQR) for each DR intervention, with most variation existing in the use of CPAP (IQR 23-46%).

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