Variation and Temporal Trends in Delivery Room Management of Moderate and Late Preterm Infants

BACKGROUND: Although delivery room (DR) intervention decreases with increasing gestational age (GA), little is known about DR management of moderate and late preterm (MLP) infants. METHODS: Using the Vermont Oxford Network database of all NICU admissions, we examined the receipt of DR interventions including supplemental oxygen, positive pressure ventilation, continuous positive airway pressure, endotracheal tube ventilation, chest compressions, epinephrine, and surfactant among MLP infants (30 to 36 weeks') without congenital anomalies born from 2011 to 2020. Pneumothorax was examined as a potential resuscitationassociated complication. Intervention frequency was assessed at the infant- and hospital-level, stratified by GA and over time. RESULTS: Overall, 55.3% of 616 110 infants (median GA: 34 weeks) from 483 Vermont Oxford Network centers received any DR intervention. Any DR intervention frequency decreased from 89.7% at 30 weeks to 44.2% at 36 weeks. From 2011 to 2020, there was an increase in the provision of continuous positive airway pressure (17.9% to 47.8%, P <=.001) and positive pressure ventilation (22.9% to 24.9%, P <=.001) and a decrease in endotracheal tube ventilation (6.9% to 4.0% P <=.001), surfactant administration (3.5% to 1.3%, P <=.001), and pneumothorax (1.9% to 1.6%, P <=.001). Hospital rates of any DR intervention varied (median 54%, interquartile range 47% to 62%), though the frequency was similar across hospitals with different NICU capabilities after adjustment. CONCLUSIONS: The DR management of MLP infants varies at the individual- and hospital-level and is changing over time. These findings illustrate the differing interpretation of resuscitation guidelines and emphasize the need to study MLP infants to improve evidence-based DR care.

Automated summary

This study examines the delivery room management of moderate and late preterm infants. The study finds that the frequency of delivery room interventions decreases with increasing gestational age and varies across hospitals. The study also highlights the differing interpretation of resuscitation guidelines and the need for further research to improve evidence-based care for preterm infants in the delivery room.