Marked variation in delivery room management in very preterm infants.
BACKGROUND
The International Liaison Committee on Resuscitation (ILCOR) and U.K. Resuscitation Council (UKRC) updated guidance on newborn resuscitation in late 2010.


OBJECTIVE
To describe delivery room (DR) practice in stabilisation following very preterm birth (<32 weeks gestation) in the U.K.


METHODS
We emailed a national survey of current DR stabilisation practice of very preterm infants to all U.K. delivery units and conducted telephone follow-up calls.


RESULTS
We obtained 197 responses from 199 units (99%) and complete data from 186 units. Tertiary units administered surfactant in the DR (93% vs. 78%, P=0.01), instituted DR CPAP (77% vs. 50%, P=0.0007), provided PEEP in the delivery room (91% vs. 69%, P=0.0008), and started resuscitation in air or blended oxygen (91% vs. 78%, P=0.04) more often than non-tertiary units. Routine out of hours consultant attendance at very preterm birth was more common in tertiary units (82% vs. 55%, P=0.0005).


CONCLUSIONS
Marked variation in DR stabilisation practice of very preterm infants persisted one year after the publication of revised UKRC guidance. Delivery room care provided in non-tertiary units was less consistent with current international guidance.
Department of Neonatology, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, United Kingdom; Bradford Neonatology, Bradford Teaching Hospitals NHS Trust, United Kingdom. Electronic address: Yogen.Singh@nhs.net.
Yoginder
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Oddie
D001833:Body Temperature Regulation; D045422:Continuous Positive Airway Pressure; D003696:Delivery Rooms / Q000458:organization & administration*; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration; D010092:Oximetry; D010102:Oxygen Inhalation Therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012151:Resuscitation / Q000592:standards*; D011795:Surveys and Questionnaires; D014470:Umbilical Cord / Q000098:blood supply
D011663:Pulmonary Surfactants
CPAP; DR; NDAU; NICU; NPEU; Neonatal resuscitation; PEEP; Practice variation; Stabilisation practice in preterm infants; Survey; continuous positive airway pressure; delivery room; national perinatal epidemiology unit; neonatal data analysis unit; neonatal intensive care unit; positive end expiratory pressure