title: Comparing minimally invasive and proactive initial management of extremely preterm infants.
abstract: OBJECTIVE
  In 2005, we changed our minimally invasive departmental policy for infants born before 26 weeks of gestation to a proactive approach. This included structured guidelines as well as intubation and surfactant in the delivery room, if the parents agreed. The aim of this study was to evaluate the effect of this change of policy.
  
  
  METHODS
  We compared the Ages and Stages Questionnaire (ASQ) scores, mortality rates and use of mechanical ventilation before (1999-2003) and after (2005-2011) the introduction of the new policy.
  
  
  RESULTS
  Twenty-two per cent of 61 infants in the before group had an ASQ z-score of <-2 standard deviation at 18 months' corrected age, compared with 26% of 55 infants in the after group. Mortality decreased from 46% to 36% (p = 0.06) and the use of mechanical ventilation at any time during admission increased from 64% to 87% (p < 0.0001).
  
  
  CONCLUSIONS
  We demonstrated that changing our policy to a proactive approach to the initial care of infants born before 26 weeks did not result in a major increase in psychomotor deficit. However, the use of mechanical ventilation increased significantly and survival tended to improve.
authors.affiliation: Department of Neonatology, The Juliane Marie Centre, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Lando
authors.forename: K
authors.initials: K
authors.lastname: Kure Østergaard
authors.forename: G
authors.initials: G
authors.lastname: Greisen
mesh_terms: D003718:Denmark / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods*; D012121:Respiration, Artificial / Q000706:statistics & numerical data
keywords: Extremely preterm; Proactive approach; Prophylactic surfactant; Survival
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