The management of the preterm infants in the delivery room (DR) has evolved with emphasis on thermal control and supporting transition. Traditionally, respiratory support in the DR has been provided through mechanical ventilation following intubation. However, mechanical ventilation is known to increase neonatal morbidity including bronchopulmonary dysplasia and sepsis. As such, the provision of non-invasive support (CPAP) may be preferred.Objective
To review the management of extremely preterm infants in the DR at the Royal Women’s Hospital (RWH). Specifically, we will evaluate whether there has been a changing trend in the respiratory support provided over a ten year period (2003–2012).Methods
We carried out a retrospective cohort study on infants born between 25+0 and 28+6 weeks gestation at RWH from January 2003 to December 2012 using the neonatal database. Information on demographic factors, management received in the DR and admission temperature was recorded.Results
1180 infants were identified, (mean gestational age 27+0 weeks, SD = 1.12 and mean birth weight 953 g, SD=241.9). Admission temperature improved over the time period with 30% of infants hypothermic on admission in 2012 (mean temperature 36.6oC) 2012 compared to 79% of infants (mean temperature 35.8oC) in 2003. Within the cohort, 97% of infants received respiratory support in the DR. Table 1 illustrates percentage of infants who were intubated in DR by year and gestation.Conclusion
The number of infants who were intubated in DR has fallen since 2003 in all 4 gestational ages and remains highest in the lower gestational age (25–26 weeks).