Using Intensive Care Technology in the Delivery Room: A New Concept for the Resuscitation of Extremely Preterm Neonates

Abstract

Despite dramatic improvements in survival rates of preterm infants over the last 50 years, there have been no significant further improvements in survival or morbidity rates over the most recent 10 years.1,2 Survival rates among infants with a birth weight of 500 to 1500 g in participating centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network of the United States were 84% in 1995–1996 and 85% in 1997–2002; the survival rate without major neonatal morbidity (which included bronchopulmonary dysplasia [BPD], intraventricular hemorrhage, and necrotizing enterocolitis) was unchanged (70%) between these 2 time periods.1 Similar findings were observed in epidemiologic data from Norway and Germany, which were published almost coincidentally.2,3 New paradigms for addressing care of extremely preterm infants may be necessary to achieve further improvements in outcome. Before the last decade, increased survival rates of preterm infants had been attributed to regionalization of high-risk pregnancies, use of prenatal corticosteroids, and an aggressive approach to perinatal therapy.4 Birth in a high-risk perinatal center with a higher level of neonatal care is associated with better survival rates than birth in a center that provides a lower level of care,5 and mortality and morbidity rates are increased for the most immature infants who require transport after birth.6 Some of the major morbidities associated with extreme prematurity such as BPD and intraventricular/periventricular hemorrhage could potentially be affected by management in the first minutes of life. However, the principles of care that occur in the NICU are not always used in the delivery room (DR). Care of the smallest preterm infants in the DR has received very little attention in newborn-resuscitation protocols. It is only with the most recent edition of the Neonatal Resuscitation Program textbook7 … Address correspondence to Maximo Vento, PhD, MD, Hospital Universitario Materno Infantil La Fe, Neonatal Research Unit, Division of Neonatology, Avenida de Campanar, 21, E46009 Valencia, Spain. E-mail: maximo.vento{at}uv.es or maximovento{at}telefonica.net