title: Improving delivery room management for very preterm infants.
abstract: OBJECTIVE
  Events in the delivery room significantly impact the outcomes of preterm infants. We developed evidence-based guidelines to prevent heat loss, reduce exposure to supplemental oxygen, and increase use of noninvasive respiratory support to improve the care and outcomes of infants with birth weight ≤1250 g at our institution.
  
  
  METHODS
  The guidelines were implemented through multidisciplinary conferences, routine use of a checklist, appointment of a dedicated resuscitation nurse, and frequent feedback to clinicians. This cohort study compares a historical group (n = 80) to a prospective group (n = 80, after guidelines were implemented). Primary outcome was axillary temperature at admission to the intensive care nursery. Secondary outcomes measured adherence to the guidelines and changes in clinically relevant patient outcomes.
  
  
  RESULTS
  Baseline characteristics of the groups were similar. After introduction of the guidelines, average admission temperatures increased (36.4°C vs 36.7°C, P < .001) and the proportion of infants admitted with moderate/severe hypothermia fell (14% vs 1%, P = .003). Infants were exposed to less oxygen during the first 10 minutes (P < .001), with similar oxygen saturations. Although more patients were tried on continuous positive airway pressure (40% vs 61%, P = .007), the intubation rate was not significantly different (64% vs 54%, P = .20). Median durations of invasive ventilation and hospitalization decreased after the quality initiative (5 vs 1 days [P = .008] and 80 vs 60 days [P = .02], respectively).
  
  
  CONCLUSIONS
  We have demonstrated significantly improved quality of delivery room care for very preterm infants after introduction of evidence-based delivery room guidelines. Multidisciplinary involvement and continuous education and reinforcement of the guidelines permitted sustained change.
authors.affiliation: MSCE, The Children's Hospital of Philadelphia, 2nd Floor Main Building, Division of Neonatology, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. demauro@email.chop.edu.
authors.forename: Sara B
authors.initials: SB
authors.lastname: DeMauro
authors.forename: Emily
authors.initials: E
authors.lastname: Douglas
authors.forename: Kelley
authors.initials: K
authors.lastname: Karp
authors.forename: Barbara
authors.initials: B
authors.lastname: Schmidt
authors.forename: Jay
authors.initials: J
authors.lastname: Patel
authors.forename: Amy
authors.initials: A
authors.lastname: Kronberger
authors.forename: Russell
authors.initials: R
authors.lastname: Scarboro
authors.forename: Michael
authors.initials: M
authors.lastname: Posencheg
mesh_terms: D015331:Cohort Studies; D003696:Delivery Rooms / Q000592:standards* / Q000639:trends; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000592:standards; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature / Q000502:physiology; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: outcomes of high-risk infants; preterm; resuscitation; temperature; thermal regulation