title: Less Oxygen, Later Intubation and Reduced Respiratory Pressures for ELBW Infants from 1997 to 2011.
abstract: BACKGROUND
  Evidence concerning delivery room management in extremely low birth weight infants (ELBW) has grown substantially within the last 20 years, leading to several guidelines and recommendations. However, it is unknown in which extent local treatment strategies have changed and if they reflect current recommendations.
  
  
  METHODS
  A detailed questionnaire about treatment strategies for ELBW infants was sent to all German neonatal intensive care units (NICUs) treating ELBW infants in 1997. A follow-up survey was conducted in 2011 and sent to all NICUs in Germany, Austria and Switzerland. RESULTS on delivery room management were compared to the first survey.
  
  
  RESULTS
  In 1997 and 2011, 63.6 and 66.2% of the approached hospitals responded. In 2011 similar results were observed between university and non-university hospitals as well as NICUs of different size. Differences between Germany, Austria and Switzerland were minimal. Changes over time were a lower initially applied fraction of inspired oxygen (FiO2) and peak inspiratory pressure (PiP) in 2011 compared to 1997. A longer time of apnea was tolerated before tracheal intubation is performed; the time of apnea was less frequently a sole criterion for intubation and surfactant was applied at lower FiO2 in 2011. The time of no thorax excursions and transport of the infant were considered an indication for intubation in 30.2 and 22.5%, and did not change in the observation period.
  
  
  CONCLUSIONS
  Treatment strategies for delivery room management in ELBW infants changed significantly between 1997 and 2011 and largely reflect current recommendations.
authors.affiliation: Department of Neonatology, University Hospital Inselspital Bern, Bern, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Gerull
authors.affiliation: Department of Neonatology, University Hospital Inselspital Bern, Bern, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: Manser
authors.affiliation: Neonatology, University Hospital Göttingen, Göttingen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Küster
authors.affiliation: Pediatrics, University Hospital Inselspital Bern, Bern, Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Arenz
authors.affiliation: Department of Neonatology, University Hospital Inselspital Bern, Bern, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Arenz
authors.affiliation: Department of Neonatology, University Hospital Inselspital Bern, Bern, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Nelle
mesh_terms: D000399:Air Pressure; D001317:Austria; D003696:Delivery Rooms; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007363:Intensive Care Units, Neonatal / Q000639:trends; D007442:Intubation, Intratracheal / Q000379:methods* / Q000639:trends*; D010102:Oxygen Inhalation Therapy / Q000379:methods* / Q000639:trends*; D011795:Surveys and Questionnaires; D013557:Switzerland