Variation in delivery room management of preterm infants across Europe: a survey of the Union of European Neonatal and Perinatal Societies

Gizzi, Camilla; Gagliardi, Luigi; Trevisanuto, Daniele; Ghirardello, Stefano; Fabio, Sandra Di; Beke, Artúr; Buonocore, Giuseppe; Charitou, Antonia; Cucerea, Manuela; Degtyareva, Marina; Filipović‐Grčić, Boris; Jekova, N; Koç, Esin; Saldanha, Joana; Sánchez‐Luna, Manuel; Stonienė, Dalia; Varendi, Heili; Calafatti, Matteo; Vertecchi, Giulia; Mosca, Fabio; Moretti, Corrado

doi:10.1007/s00431-023-05107-9

Cited by 6 publications

(2 citation statements)

References 37 publications

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“…The high usage rate of masks in the delivery room in our survey (95.2) is higher than the rate reported by Gizzi et al [43] for centers caring for high-risk neonates (83.6%); short nasal prongs were more often used in level III units in Romania in the delivery room compared to similar units in Italy (23.8% versus 11.8%), while the nasopharyngeal tube was also rarely used in Italian centers. A recent European survey [44] found significantly different preferences for NIV interfaces in the delivery room, but face masks were also the most used (75.9%); short binasal prongs use was reported with rates similar to our survey (20.2%), while nasopharyngeal tubes (either binasal or single) were rarely reported (less than 4%). The recent Romanian report on neonatal resuscitation and stabilization practices in the delivery room confirms that the face mask is the most frequently used interface in level III neonatal units (72.7%), followed by the short binasal prongs (27.3%) [42].…”

Section: Discussionsupporting

confidence: 81%

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units – Results of a Recent Survey

OGNEAN,

Bivoleanu,

Cucerea

et al. 2024

Preprint

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Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS). Multiple noninvasive respiratory support modes are currently available in Romania, but little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). We aimed to identify the usage extent and clinical application of nHFOV in Romania. A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. The questionnaire was addressed to the leaders of all level III Romanian NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU’s size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10-17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%), heated, humidified high flow nasal cannula (HHHFNC) (61.9%), and nHFOV (11/21 units; 52.4%); 5/11 units reported frequent nHFOV use (in 2 or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). 10/11 units reported setting a mean airway pressure (MAP) equal to the CPAP level plus 1-2 cmH2O on rescue nHFOV after CPAP failure. Both dedicated equipment (45.5%) and hybrid ventilators (63.6%) were used for nHFOV delivery, with face/nasal masks and short binasal prongs being the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV; none of the units mentioned pneumothorax as an adverse effect. Only 3 of the NICUs had a written protocol for nHFOV use. Initial, minimum, and maximum amplitude and initial and minimum MAP settings used were significantly higher with hybrid ventilators as compared to dedicated equipment (p<0.05). Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV. A need for training for nHFOV use was identified, and efforts are needed at the national level to develop courses and training sessions, including using simulation workshops, to offer more information on optimal nHFOV use in clinical practice.

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Section: Discussionsupporting

confidence: 81%

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units – Results of a Recent Survey

OGNEAN,

Bivoleanu,

Cucerea

et al. 2024

Preprint

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“…Survival rates in our study are slightly lower than those reported by Bell et al [5], who conducted a study of a large cohort of infants with the same GA (78.3%). According to a study conducted by Higgins in California (2011-2019) on infants ≤ 28 weeks, the survival rate of infants increases with each week of gestation, ranging from 33% at 22 weeks to 90% at 28 weeks [27].…”

Section: Discussionmentioning

confidence: 99%

Updated Clinical Practice Guidelines in Resuscitation and the Management of Respiratory Distress Syndrome in Extremely Preterm Infants during Two Epochs in Romania: Impact on Outcomes

Cucerea,

Simon,

Anciuc-Crauciuc

et al. 2024

JCM

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Background: Adequate perinatal management is essential in caring for extremely preterm (EP) infants. We aimed to evaluate and compare the impact of different protocols on short-term outcomes. Methods: A retrospective study was conducted on EP infants in a Romanian perinatal tertiary center during 2008–2012 and 2018–2022. Results: Data on 270 EP infants (121 in period I, 149 in period II) were analyzed collectively and stratified into two subgroups by gestational age. Initial FiO2 administration (100% vs. 40%% p < 0.001), lung recruitment at birth (19.0% vs. 55.7% p < 0.001), early rescue surfactant administration (34.7% vs. 65.8%; p < 0.001), and the mechanical ventilation rate (98.3% vs. 58.4%; p < 0.001) were significantly improved during period II. Survival rates of EP infants significantly improved from 41.3% to 72.5%, particularly in the 26–28 weeks subgroup (63.8% to 83%). Compared to period I, the overall frequency of severe IVH decreased in period II from 30.6% to 14.1%; also, BPD rates were lower (36.6% vs. 23.4%; p = 0.045) in the 26–28 weeks subgroup. Despite improvements, there were no significant differences in the frequencies of NEC, sepsis, PVL, ROP, or PDA. Conclusions: Implementing evidence-based clinical guidelines can improve short-term outcomes.

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Resuscitation With Placental Circulation Intact Compared With Cord Milking

Pratesi,

Ciarcià,

Boni

et al. 2024

JAMA Netw Open

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ImportanceAmong preterm newborns undergoing resuscitation, delayed cord clamping for 60 seconds is associated with reduced mortality compared with early clamping. However, the effects of longer durations of cord clamping with respiratory support are unknown.ObjectiveTo determine whether resuscitating preterm newborns while keeping the placental circulation intact and clamping the cord after a long delay would improve outcomes compared with umbilical cord milking.Design, Setting, and ParticipantsThis randomized clinical trial (PCI Trial) was conducted at 8 Italian neonatal intensive care units from April 2016 through February 2023 and enrolled preterm newborns born between 23 weeks 0 days and 29 weeks 6 days of gestation from singleton pregnancies.InterventionsEnrolled newborns were randomly allocated to receive at-birth resuscitation with intact placental circulation for 180 seconds or umbilical cord milking followed by an early cord clamping (within 20 seconds of life).Main Outcomes and MeasuresThe primary outcome was the composite end point of death, grade 3 to 4 intraventricular hemorrhage, and bronchopulmonary dysplasia at 36 weeks of postconception age. Prespecified secondary end points were the single components of the composite primary outcome. An intention-to-treat analysis was conducted.ResultsOf 212 mother-newborn dyads who were randomized, 209 (median [IQR] gestational age, 27 [26-28] weeks; median [IQR] birth weight, 900 [700-1070] g) were enrolled in the intention-to-treat population; 105 were randomized to the placental circulation intact group, and 104 were randomized to the cord milking group. The composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia occurred in 35 of 105 newborns (33%) in the placental circulation intact group vs 39 of 104 newborns (38%) in the cord milking group (odds ratio, 0.83; 95% CI, 0.47-1.47; P = .53).Conclusions and RelevanceIn a randomized clinical trial of preterm newborns at 23 to 29 weeks’ gestational age, intact placental resuscitation for 3 minutes did not lower the composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia compared with umbilical cord milking.Trial RegistrationClinicaltrials.gov Identifier: NCT02671305

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Variation in delivery room management of preterm infants across Europe: a survey of the Union of European Neonatal and Perinatal Societies

Cited by 6 publications

References 37 publications

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units – Results of a Recent Survey

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units – Results of a Recent Survey

Updated Clinical Practice Guidelines in Resuscitation and the Management of Respiratory Distress Syndrome in Extremely Preterm Infants during Two Epochs in Romania: Impact on Outcomes

Resuscitation With Placental Circulation Intact Compared With Cord Milking

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