Medical management of extremely low-birth-weight infants in the first week of life: a survey of practices in the United States.
We sought to determine the current practices of neonatologists in their management of extremely low-birth-weight (< 1000 g) infants. We directly mailed an anonymous survey to the medical directors of 809 neonatal intensive care units in the United States. More than one-third of those surveyed responded, with a substantial majority from intensive care (level III) nurseries or extracorporeal membrane oxygenation centers. Academic centers and private practice environments were both well represented. Some traditional practices have changed, such as beginning resuscitation with 40% rather than 100% oxygen. Many practices vary based on whether neonates are cared for in private versus academic centers, including initial resuscitation method, type of ventilation used, use of intraventricular hemorrhage prophylaxis, and routine antibiotic therapy. Parenteral nutrition composition and the use of inhaled nitric oxide differ based on the responding center's participation in clinical trials. The number of years in practice as a neonatologist does not affect practice decisions. Among all our findings, the prevalence of one potentially harmful practice, the continued use of dexamethasone for corticosteroid therapy, was particularly noteworthy. In conclusion, the strength of evidence does not always predict whether practices are adopted or abandoned. Further research is necessary to clarify the optimal management for this high-risk patient population.
Kiefer
Autumn S
AS
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Wickremasinghe
Andrea C
AC
Johnson
Jonathan N
JN
Hartman
Tyler K
TK
Hintz
Susan R
SR
Carey
William A
WA
Colby
Christopher E
CE
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000517:prevention & control; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy; D019538:Health Care Surveys; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007239:Infections / Q000175:diagnosis / Q000188:drug therapy; D009359:Neonatology / Q000379:methods* / Q000706:statistics & numerical data*; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012138:Respiratory Therapy / Q000706:statistics & numerical data; D014481:United States
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal