Abstract
Objective: The aim of the study is to describe a delivery room intensive care unit (DRICU) model and evaluate its effectiveness in preventing morbidity and mortality in high-risk newborns.Design: This retrospective case series includes all DRICU procedures performed from 2016 to 2020.Setting: Gaslini Children's Hospital is a major pediatric tertiary care center where high-risk pregnancies are centralized. The Neonatal and Pediatric Intensive Care Unit admits every year about 100 high-risk newborns.Patients: The selected patients are newborns at risk of critical conditions immediately after birth for respiratory or cardiovascular congenital disorders.Interventions: The perinatal plan is defined by the multidisciplinary team of Fetal and Perinatal Medicine. The DRICU procedure provides highly specialized care through a protocol that includes logistics, personnel, equipment, and clinical pathways.Main Outcome Measures: The primary outcome is the prevention of acute complications and mortality in the delivery room and early neonatal period.Results: From 2016 to 2020, 40 DRICU procedures were performed. The main prenatal diagnoses included congenital heart disease with a high risk of life-threatening events immediately after birth (38%), congenital diaphragmatic hernia (35%), and fetal hydrops/hydrothorax (23%). Mean gestational age was 35.9 weeks (range: 31–39), and mean birth weight was 2,740 grams (range: 1,480–3,920). DRICU assistance completed in all patients by neonatal intensivists included tracheal intubation and arterial and central venous cannulation; complex procedures such as ex-utero intrapartum technique and extracorporeal membrane oxygenation cannulation are described. No deaths nor severe acute complications occurred in the delivery room or in the immediate postnatal period.Conclusions: The outcome in critical newborns is potentially affected by planned assistance strategies and specialized competencies through the implementation of a DRICU protocol.
Highlights
delivery room intensive care unit (DRICU) assistance completed in all patients by neonatal intensivists included tracheal intubation and arterial and central venous cannulation; complex procedures such as ex-utero intrapartum technique and extracorporeal membrane oxygenation cannulation are described
No deaths nor severe acute complications occurred in the delivery room or in the immediate postnatal period
The outcome in critical newborns is potentially affected by planned assistance strategies and specialized competencies through the implementation of a DRICU protocol
Summary
The delivery room intensive care unit (DRICU) concept has been introduced by Vento et al in 2008 as a practice to enhance the survival rates and reduce the morbidity of extremely preterm infants (1). The intention of DRICU is to initiate intensive care environment and technology in the delivery room (DR) to adequately provide care immediately after birth in critical newborns (1–3). As in extremely preterm newborns, the survival and morbidity rates in conditions like critical congenital heart disease (CHD) or congenital diaphragmatic hernia (CDH) are potentially affected by the clinical management in the first few minutes of life. Our institution has revised and implemented the DRICU concept to include resuscitation protocols that require advanced equipment and highly specialized personnel for the assistance of critical newborns with complex conditions. Our aim is to describe the Gaslini Children’s Hospital DRICU model since its full implementation in 2016 and evaluate its effectiveness in preventing morbidity and mortality in high-risk newborns
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