950 Low Compliance with Guidelines for Respiratory Support of Preterm Infants at Birth

Abstract

Objective: To investigate the compliance of clinicians with guidelines for respiratory support of preterm infants and to identify bottlenecks. Methods: Respiratory interventions at birth in preterm infants born at the Leiden University Medical Center were observed by an independent researcher. Video recordings and recordings of airway pressure, gas flow, heart rate and oxygen saturation were reviewed with the resuscitator and compared with Dutch neonatal resuscitation guidelines. Results: In 34 infants (mean (SD) gestational age 30.6 (3.2) weeks, birth weight 1292 (570) grams) respiratory interventions were: 8/34 (23%) none given, 3/34 (9%) continuous positive airway pressure (CPAP) and 23/34 (68%) mask ventilation followed by CPAP (6 were intubated later on). Review of the recordings showed that respiratory support was not in accordance with guidelines in 25/34 (74%) infants. In 14/34 (42%) infants choice of support was not as recommended: 6 infants received no respiratory support despite insufficient breathing and bradycardia, 2 received CPAP despite prolonged apnea, 4 received mask ventilation although breathing and heart rate were adequate and 2 infants were intubated despite sufficient breathing and adequate saturation and heart rate. In 5/23 (22%) mask ventilated infants no initial sustained inflations were given. 18/23 (78%) infants received initial sustained inflations, but 9 different combinations were observed (range (1-9) × (2-10) seconds). In 9/34 (26%) infants set pressures were not as recommended. Conclusion: The compliance with guidelines for respiratory support in preterm infants at birth is low and clinicians have difficulty in judging the presence and/or efficacy of breathing.