Premature infants born at <25weeks of gestation may be compromised bycurrently recommended resuscitation techniques

AimStandard resuscitation guidelines are based on data from a range of gestational ages. We sought to evaluate the effectiveness of our delivery room resuscitation protocol across a range of gestational ages in preterm infants born at <29weeks. MethodsWe performed an observational study of prospectively collected video recordings of 73 preterm infants. The percentage of bradycardic patients, time to reach target oxygen saturation and the extent of all interventions were compared between three gestational age groups: 22-24weeks (n=22), 25-26weeks (n=27) and 27-28weeks (n=24). ResultsAlthough the same resuscitation protocol was followed for all infants, bradycardic infants born <25weeks responded poorly and required significantly longer to reach oxygen saturation targets of >70%, >80% and >90% (p<0.03). They required significantly more interventions and had higher rate of death (p<0.05) and severe intraventricular haemorrhage (p<0.03). Significantly lower heart rate and oxygen saturation values were found in infants with intraventricular haemorrhage. ConclusionCurrent recommendations for resuscitation may fail to achieve timely lung aeration in infants born at the borderline of viability, leading to higher mortality and morbidity. Sustained inflation and delayed cord clamping may be effective alternatives.