title: Respiratory management of extremely low birth weight infants: survey of neonatal specialists.
abstract: BACKGROUND
  To investigate strategies used for the management of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants.
  
  
  METHODS
  A survey of neonatal specialists working in US academic institutions with fellowship training programs.
  
  
  RESULTS
  Eighty percent (72/89) of the identified academic institutions had at least one physician who responded to the survey. Among respondents, 85% (171/201) agreed or strongly agreed to use continuous positive airway pressure (CPAP) initially for the management of RDS, and the majority agreed or strongly agreed to use a fraction of inspired oxygen (FiO2) ≥0.4 and a mean airway pressure (MAP) ≥10 cm H2O as a criteria for surfactant therapy; and 73% (146/200) sometimes or always used caffeine to prevent BPD. Only 25% (50/202) sometimes or almost always used steroids to prevent or treat BPD. Identified indications to use steroids were 3 or more extubation failures or inability to extubate beyond 8 weeks of age.
  
  
  CONCLUSIONS
  Variability in treatment strategies of ELBW is common among neonatal specialists. However, the majority of the respondents agreed or strongly agreed to use early CPAP for the management of RDS, consider a FiO2 ≥0.4 and a MAP ≥10 cm H2O as criteria for surfactant therapy, and sometimes or almost always used caffeine to prevent BPD. Steroids continue to have a role in the management of BPD in infants who are difficult to extubate.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.
authors.forename: Sumesh
authors.initials: S
authors.lastname: Parat
authors.affiliation: Department of Pediatrics, Division of Neonatology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH, USA. mmhanna@metrohealth.org.
authors.forename: Maroun Jean
authors.initials: MJ
authors.lastname: Mhanna
mesh_terms: D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D000072156:Neonatologists; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012016:Reference Values; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000628:therapy*; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014481:United States
chemical_list: D011663:Pulmonary Surfactants
keywords: bronchopulmonary dysplasia; extremely low birth weight infants; respiratory distress syndrome; survey