Daniele Trevisanuto1, Irene Satariano2, Nicoletta Doglioni2, Giulio Criscoli3, Francesco Cavallin4, Camilla Gizzi5, Claudio Martano6, Fabrizio Ciralli7, Flaminia Torielli8, Paolo Ernesto Villani9, Sandra Di Fabio10, Lorenzo Quartulli11, Luigi Giannini12. 1. Children and Women's Health Department Medical School, University of Padua, Azienda Ospedaliera Padova, 35128 Padua, Italy. Electronic address: trevo@pediatria.unipd.it. 2. Children and Women's Health Department Medical School, University of Padua, Azienda Ospedaliera Padova, 35128 Padua, Italy. 3. Italian Army - Signals and Information Technology HQ - C4 Systems Integration Development, Treviso, Italy. 4. Independent Statistician, Padua, Italy. 5. Neonatal Intensive Care Unit, Pediatric and Neonatal Department, "S.Giovanni Calibita" Fatebenefratelli Hospital - Isola Tiberina, 00186 Rome, Italy. 6. Neonatal Intensive Care Unit, Pediatric Department, Medical School, University of Turin, Azienda Ospedaliera, OIRM-S.Anna, 10126 Torino, Italy. 7. Neonatal Intensive Care Unit, Department of Mother and Infant Science, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy. 8. Neonatology Unit, University of Genova, Azienda Ospedaliera San Martino IRCCS - IST National Institute on Cancer Research, 16100 Genova, Italy. 9. Neonatal Intensive Care Unit, Maternal and Pediatric Department, Carlo Poma Hospital, Mantova, Italy. 10. Neonatal Intensive Care Unit, Department of Mother and Infant Science, "San Salvatore" Hospital, L'Aquila, Italy. 11. Neonatology Unit, "A. Perrino" Hospital - ASL, 72100 Brindisi, Italy. 12. Pediatric Department, Medical School University "La Sapienza" Rome, Azienda Ospedaliera Policlinico Umberto I, 00161 Rome, Italy.
Abstract
AIM: To identify changes in practice between two historical periods (2002 vs. 2011) in early delivery room (DR) management of ELBWI in Italian tertiary centres. METHODS: A questionnaire was sent to the directors of all Italian level III centres between April and August 2012. The same questionnaire was used in a national survey conducted in 2002. Among the participating centres, those that filled the questionnaire in both study periods were selected for inclusion in this study. RESULTS: There was an 88% (n=76/86) and 92% (n=98/107) response rate in the 2 surveys, respectively. The two groups overlapped for 64 centres. During the study period, the use of polyethylene bags/wraps increased from 4.7% to 59.4% of the centres. The units using 100% oxygen concentrations to initiate resuscitation of ELBWI decreased from 56.2% to 6.2%. The approach to respiratory management was changed for the majority of the examined issues: positive pressure ventilation (PPV) administered through a T-piece resuscitator (from 14.0% to 85.9%); use of PEEP during PPV (from 35.9% to 95.3%); use of CPAP (from 43.1% to 86.2%). From 2002 to 2011, the percentages of ELBWI intubated in DR decreased in favor of those managed with N-CPAP; ELBWI receiving chest compressions and medications at birth were clinically comparable. CONCLUSIONS: During the two study periods, the approach to the ELBWI at birth significantly changed. More attention was devoted to temperature control, use of oxygen, and less-invasive respiratory support. Nevertheless, some relevant interventions were not uniformly followed by the surveyed centres.
AIM: To identify changes in practice between two historical periods (2002 vs. 2011) in early delivery room (DR) management of ELBWI in Italian tertiary centres. METHODS: A questionnaire was sent to the directors of all Italian level III centres between April and August 2012. The same questionnaire was used in a national survey conducted in 2002. Among the participating centres, those that filled the questionnaire in both study periods were selected for inclusion in this study. RESULTS: There was an 88% (n=76/86) and 92% (n=98/107) response rate in the 2 surveys, respectively. The two groups overlapped for 64 centres. During the study period, the use of polyethylene bags/wraps increased from 4.7% to 59.4% of the centres. The units using 100% oxygen concentrations to initiate resuscitation of ELBWI decreased from 56.2% to 6.2%. The approach to respiratory management was changed for the majority of the examined issues: positive pressure ventilation (PPV) administered through a T-piece resuscitator (from 14.0% to 85.9%); use of PEEP during PPV (from 35.9% to 95.3%); use of CPAP (from 43.1% to 86.2%). From 2002 to 2011, the percentages of ELBWI intubated in DR decreased in favor of those managed with N-CPAP; ELBWI receiving chest compressions and medications at birth were clinically comparable. CONCLUSIONS: During the two study periods, the approach to the ELBWI at birth significantly changed. More attention was devoted to temperature control, use of oxygen, and less-invasive respiratory support. Nevertheless, some relevant interventions were not uniformly followed by the surveyed centres.
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