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Variation in delivery room management of preterm infants across Europe: a survey of the Union of European Neonatal and Perinatal Societies.
Gizzi, Camilla; Gagliardi, Luigi; Trevisanuto, Daniele; Ghirardello, Stefano; Di Fabio, Sandra; Beke, Artur; Buonocore, Giuseppe; Charitou, Antonia; Cucerea, Manuela; Degtyareva, Marina V; Filipovic-Grcic, Boris; Jekova, Nelly Georgieva; Koç, Esin; Saldanha, Joana; Luna, Manuel Sanchez; Stoniene, Dalia; Varendi, Heili; Calafatti, Matteo; Vertecchi, Giulia; Mosca, Fabio; Moretti, Corrado.
Afiliação
  • Gizzi C; Department of Pediatrics and Neonatology, Ospedale Sandro Pertini, Rome, Italy. camillagizzi@gmail.com.
  • Gagliardi L; Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy. camillagizzi@gmail.com.
  • Trevisanuto D; Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Azienda USL Toscana Nord Ovest, Pisa, Italy.
  • Ghirardello S; Department of Woman's and Child's Health, University of Padova, Padova, Italy.
  • Di Fabio S; Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • Beke A; Department of Pediatrics, Ospedale San Salvatore, L'Aquila, Italy.
  • Buonocore G; Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  • Charitou A; 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
  • Cucerea M; Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  • Degtyareva MV; Department of Pediatrics, Università degli Studi di Siena, Siena, Italy.
  • Filipovic-Grcic B; Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  • Jekova NG; Department of Pediatrics, Rea Maternity Hospital, Athens, Greece.
  • Koç E; Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  • Saldanha J; Neonatology Department, University of Medicine Pharmacy Sciences and Technology "George Emil Palade", Târgu Mures, Romania.
  • Luna MS; Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  • Stoniene D; Department of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia.
  • Varendi H; Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  • Calafatti M; Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, HR, Croatia.
  • Vertecchi G; Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
  • Mosca F; Department of Pediatrics, University Hospital "Majchin Dom", Sofia, Bulgaria.
  • Moretti C; Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy.
Eur J Pediatr ; 182(9): 4173-4183, 2023 Sep.
Article em En | MEDLINE | ID: mdl-37436521
ABSTRACT
The aim of the present study, endorsed by the Union of European Neonatal and Perinatal Societies (UENPS) and the Italian Society of Neonatology (SIN), was to analyze the current delivery room (DR) stabilization practices in a large sample of European birth centers that care for preterm infants with gestational age (GA) < 33 weeks. Cross-sectional electronic survey was used in this study. A questionnaire focusing on the current DR practices for infants < 33 weeks' GA, divided in 6 neonatal resuscitation domains, was individually sent to the directors of European neonatal facilities, made available as a web-based link. A comparison was made between hospitals grouped into 5 geographical areas (Eastern Europe (EE), Italy (ITA), Mediterranean countries (MC), Turkey (TUR), and Western Europe (WE)) and between high- and low-volume units across Europe. Two hundred and sixty-two centers from 33 European countries responded to the survey. At the time of the survey, approximately 20,000 very low birth weight (VLBW, < 1500 g) infants were admitted to the participating hospitals, with a median (IQR) of 48 (27-89) infants per center per year. Significant differences between the 5 geographical areas concerned the volume of neonatal care, ranging from 86 (53-206) admitted VLBW infants per center per year in TUR to 35 (IQR 25-53) in MC; the umbilical cord (UC) management, being the delayed cord clamping performed in < 50% of centers in EE, ITA, and MC, and the cord milking the preferred strategy in TUR; the spotty use of some body temperature control strategies, including thermal mattress mainly employed in WE, and heated humidified gases for ventilation seldom available in MC; and some of the ventilation practices, mainly in regard to the initial FiO2 for < 28 weeks' GA infants, pressures selected for ventilation, and the preferred interface to start ventilation. Specifically, 62.5% of TUR centers indicated the short binasal prongs as the preferred interface, as opposed to the face mask which is widely adopted as first choice in > 80% of the rest of the responding units; the DR surfactant administration, which ranges from 44.4% of the birth centers in MC to 87.5% in WE; and, finally, the ethical issues around the minimal GA limit to provide full resuscitation, ranging from 22 to 25 weeks across Europe. A comparison between high- and low-volume units showed significant differences in the domains of UC management and ventilation practices.    

Conclusion:

Current DR practice and ethical choices show similarities and divergences across Europe. Some areas of assistance, like UC management and DR ventilation strategies, would benefit of standardization. Clinicians and stakeholders should consider this information when allocating resources and planning European perinatal programs. What is Known • Delivery room (DR) support of preterm infants has a direct influence on both immediate survival and long-term morbidity. • Resuscitation practices for preterm infants often deviate from the internationally defined algorithms. What is New • Current DR practice and ethical choices show similarities and divergences across Europe. Some areas of assistance, like UC management and DR ventilation strategies, would benefit of standardization. • Clinicians and stakeholders should consider this information when allocating resources and planning European perinatal programs.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Eur J Pediatr Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Itália

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Eur J Pediatr Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Itália