Less Oxygen, Later Intubation and Reduced Respiratory Pressures for ELBW Infants from 1997 to 2011

 

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Abstract

Introduction: Evidence concerning delivery room management in extremely low birth weight infants (ELBW) has grown substantially within the last 20 years, leading to several guidelines and recommendations. However, it is unknown in which extent local treatment strategies have changed and if they reflect current recommendations.

Methods: A detailed questionnaire about treatment strategies for ELBW infants was sent to all German neonatal intensive care units (NICUs) treating ELBW infants in 1997. A follow-up survey was conducted in 2011 and sent to all NICUs in Germany, Austria and Switzerland. Results on delivery room management were compared to the first survey.

Results: In 1997 and 2011, 63.6 and 66.2% of the approached hospitals responded. In 2011 similar results were observed between university and non-university hospitals as well as NICUs of different size. Differences between Germany, Austria and Switzerland were minimal. Changes over time were a lower initially applied fraction of inspired oxygen (FiO2) and peak inspiratory pressure (PiP) in 2011 compared to 1997. A longer time of apnea was tolerated before tracheal intubation is performed; the time of apnea was less frequently a sole criterion for intubation and surfactant was applied at lower FiO2 in 2011. The time of no thorax excursions and transport of the infant were considered an indication for intubation in 30.2 and 22.5%, and did not change in the observation period.

Conclusion: Treatment strategies for delivery room management in ELBW infants changed significantly between 1997 and 2011 and largely reflect current recommendations.

Zusammenfassung

Hintergrund: Die Evidence über Erstversorgung von extrem kleinen Frühgeborenen (ELBW) ist in den letzten 20 Jahren stark gestiegen und ist in Empfehlungen zusammengefasst. Es ist weitgehend unbekannt, in welchem Umfang sich lokale Therapiestrategien geändert haben und ob diese den aktuellen Empfehlungen entsprechen.

Methode: Ein detaillierter Fragebogen über Therapiestrategien bei ELBW wurde 1997 an alle deutschen Kliniken gesendet, die diese Patienten behandelten. Eine erneute Umfrage wurde 2011 an alle neonatalen Intensivstationen in Deutschland, Österreich und der Schweiz gesendet. Veränderungen der Erstversorgung von ELBW zwischen 1997 und 2011 sind in dieser Publikation zusammengefasst.

Ergebnisse: 1997 und 2011 haben 63.6 bzw. 66.2% der Kliniken einen Fragebogen ausgefüllt. 2011 wurden ähnliche Resultate zwischen Universitäten und nicht-universitären Krankenhäusern sowie zwischen Intensivstationen verschiedener Größe gefunden. Die Unterschiede zwischen Deutschland, Österreich und der Schweiz waren minimal. Veränderungen zwischen 1997 und 2011 beinhalteten niedrigere initial eingesetzte Sauerstoffkonzentration (FiO2) und geringeren Beatmungsdruck. 2011 wurde eine längere Zeit initialer Apnoe toleriert bevor eine Intubation erfolgte; die Zeit der initialen Apnoe war weniger häufig ein Kriterium, welches eine Intubation erforderte. Surfactant wurde 2011 bereits bei niedrigerem FiO2 appliziert. Die Zeit fehlender Thoraxexkursion und Transport waren 2011 in 30,2% und 22,5%. Kriterium für Intubation, welche sich nicht signifikant im Vergleich zu 1997 änderte.

Schlussfolgerung: Therapiestrategien der Erstversorgung von ELBW Frühgeborenen haben sich signifikant zwischen 1997 und 2011 verändert und entsprechen weitgehend den aktuellen Empfehlungen.

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