Delivery Room Management of Extremely Low Birth Weight Infants: Spontaneous Breathing or Intubation?

Publisher Website
Google Scholar
Abstract
Objective.: To study the effect of two different delivery room (DR) policies on the rate of endotracheal intubation and mechanical ventilation (EI/MV) and short term morbidity in extremely low birth weight infants (ELBWI; grade 2 and/or periventricular leukomalacia), mortality, and fewer hospital days (mean: 79 vs 105 days). The incidence of gastrointestinal adverse effects like feeding intolerance or necrotizing enterocolitis was not increased in 1996. Paco2 was significantly higher at admission to the neonatal unit in ELBWIs with CPAP in 1996 (54 ± 15 mm Hg, 7.2 ± 2.0 kPa) compared with infants with EI/MV in 1994 (38 ± 11 mm Hg, 5.1 ± 1.5 kPa. A total of 26% of spontaneously breathing infants had hypercapnia (Paco2 ≥60 mm Hg [8.0 kPa]), compared with 7% of infants with EI/MV in 1994. Within the first few hours of life, Paco2decreased to 46 (32 to 57) mm Hg (6.1 [4.3 to 7.6] kPa) in never intubated ELBWIs (n = 17), but increased to 70 (57 to 81) mm Hg (9.3 [7.6 to 10.8] kPa) in ELBWIs (n= 14) with RDS and secondary EI/MV (age 5.5 [1 to 44] hours). Conclusions.: In our setting, the individualized intubation strategy in the DR restricted EI/MV to those ELBWIs who ultimately needed it, without increasing morbidity or mortality in infants with secondary EI/MV attributable to RDS. We speculate that an individualized intubation strategy of the ELBWI is superior to immediate intubation of all ELBWIs with slight signs of respiratory distress after birth.

This publication has 16 references indexed in Scilit: