Am J Perinatol 2017; 34(08): 759-764
DOI: 10.1055/s-0037-1598106
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Quality Improvement Initiative to Reduce the Need for Mechanical Ventilation in Extremely Low Gestational Age Neonates

Ludivine Templin
1  Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France
,
Camille Grosse
1  Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France
,
Virginie Andres
1  Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France
,
Clotilde Des Robert
1  Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France
,
Laurence Fayol
1  Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France
,
Umberto Simeoni
2  Division of Pediatrics, Lausanne University Hospital, University of Lausanne, Switzerland
,
Farid Boubred
1  Department of Neonatology, University Hospital La Conception, Aix-Marseille University, Marseille, France
› Author Affiliations
Further Information

Publication History

28 June 2016

21 December 2016

Publication Date:
31 January 2017 (online)

Abstract

Objective Limiting early intubation and mechanical ventilation in extremely low gestational age neonates (ELGAN) may decrease neonatal morbidity and mortality. The aim of our study was to demonstrate the feasibility, efficacy, and tolerability of a delivery room respiratory management protocol, including delayed umbilical cord clamping (DUCC) in combination with optimized nCPAP with high PEEP levels and less invasive surfactant administration (LISA).

Study Design This cohort quality improvement study analyzed the respiratory and neonatal outcomes of all consecutive infants born between 24+0 and 26+6 weeks' gestation before (period 1, n = 40) and after (period 2, n = 52) implementing the new protocol.

Results Compared with the period 1 infants, the period 2 infants had a lower rate of intubation in the delivery room (31 vs. 90%, p = 0.001) and were less likely to need mechanical ventilation on day 3 (28 vs. 62%, p = 0.002) and during the hospital stay (75 vs. 92.5%, p < 0.05). The two groups did not differ in terms of mortality or neonatal morbidity.

Conclusion A delivery room respiratory management protocol based on DUCC, optimized nCPAP with high PEEP levels, and LISA procedure is both feasible and safe, and improved ELGAN respiratory outcomes.