Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Pediatrics. 2022 Aug 1;150(2). doi: 10.1542/peds.2021-055994.
Although delivery room (DR) intervention decreases with increasing gestational age (GA), little is known about DR management of moderate and late preterm (MLP) infants.
Using the Vermont Oxford Network database of all NICU admissions, we examined the receipt of DR interventions including supplemental oxygen, positive pressure ventilation, continuous positive airway pressure, endotracheal tube ventilation, chest compressions, epinephrine, and surfactant among MLP infants (30 to 36 weeks') without congenital anomalies born from 2011 to 2020. Pneumothorax was examined as a potential resuscitation-associated complication. Intervention frequency was assessed at the infant- and hospital-level, stratified by GA and over time.
Overall, 55.3% of 616 110 infants (median GA: 34 weeks) from 483 Vermont Oxford Network centers received any DR intervention. Any DR intervention frequency decreased from 89.7% at 30 weeks to 44.2% at 36 weeks. From 2011 to 2020, there was an increase in the provision of continuous positive airway pressure (17.9% to 47.8%, P ≤.001) and positive pressure ventilation (22.9% to 24.9%, P ≤.001) and a decrease in endotracheal tube ventilation (6.9% to 4.0% P ≤.001), surfactant administration (3.5% to 1.3%, P ≤.001), and pneumothorax (1.9% to 1.6%, P ≤.001). Hospital rates of any DR intervention varied (median 54%, interquartile range 47% to 62%), though the frequency was similar across hospitals with different NICU capabilities after adjustment.
The DR management of MLP infants varies at the individual- and hospital-level and is changing over time. These findings illustrate the differing interpretation of resuscitation guidelines and emphasize the need to study MLP infants to improve evidence-based DR care.
尽管随着胎龄（GA）的增加，产房（DR）干预措施会减少，但对于中度和晚期早产儿（MLP）的 DR 管理知之甚少。
利用所有新生儿重症监护病房（NICU）入院的佛蒙特州牛津网络数据库，我们研究了 2011 年至 2020 年间无先天性畸形且胎龄为 30 至 36 周出生的 MLP 婴儿（中位数 GA：34 周）在 DR 中接受的补充氧气、正压通气、持续气道正压通气、气管内插管通气、胸外按压、肾上腺素和表面活性剂等干预措施。气胸被视为一种潜在的复苏相关并发症进行了检查。按 GA 分层并随时间评估婴儿和医院级别的干预频率。
总体而言，483 个佛蒙特州牛津网络中心的 616110 名婴儿（中位数 GA：34 周）中有 55.3%接受了任何 DR 干预。任何 DR 干预的频率从 30 周时的 89.7%下降到 36 周时的 44.2%。从 2011 年到 2020 年，持续气道正压通气（17.9%至 47.8%，P ≤.001）和正压通气（22.9%至 24.9%，P ≤.001）的提供有所增加，而气管内插管通气（6.9%至 4.0%，P ≤.001）、表面活性剂给药（3.5%至 1.3%，P ≤.001）和气胸（1.9%至 1.6%，P ≤.001）有所减少。各医院接受任何 DR 干预的比例存在差异（中位数 54%，四分位距 47%至 62%），但调整 NICU 能力不同的医院后，其频率相似。
MLP 婴儿的 DR 管理在个体和医院层面上存在差异，并且随着时间的推移而发生变化。这些发现说明了复苏指南的不同解释，并强调了需要研究 MLP 婴儿以改善基于证据的 DR 护理。
