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Abstract
Background and aims In the delivery room (DR), respiratory support for preterm infants has traditionally been provided through mechanical ventilation following intubation, which is known to increase neonatal morbidities including BPD and sepsis. The Nasal CPAP or Intubation at birth for very preterm infants (COIN) Trial demonstrated that infants spontaneously breathing at birth may be managed in the DR with non invasive support (CPAP) rather than intubation, which may be preferred. We aimed to review the management of extremely preterm infants in the DR at the Royal Women’s Hospital (RWH) during a ten-year period and evaluate whether respiratory support practices differed during and after the COIN trial.
Methods We compared DR resuscitation practices (obtained from the neonatal database) of infants born between 25+0 and 28+6 weeks gestation at RWH between 2003–2006 and 2007–2012.
Results 1013 infants were included in the study, 97% of which received respiratory support in the DR during the ten-year period (Figure 1). Mean gestation (SD) and birth weight (SD) were 27+0 (1.11) weeks and 947(244) grams, respectively. There was a substantial decrease in the number of newborns intubated in the DR between 2003–2006 (58%) and 2007–2012 (47%) (p = 0.05). The number of infants intubated in the DR remains highest at lower gestational ages.
Conclusion There has continued to be an increase in the use of CPAP instead of intubation in the DR since completion of the COIN trial, suggesting a change in clinical practice.
