PC1045: Effects of Delivery Room Interventions on Neonatal Outcomes in Very Low Birth Weight Infants

Background: Interventions such as high oxygen administration and intubation in the delivery room (DR) have been shown to carry poor outcomes in preterm infants. There is sparse knowledge on effects of high pressures administered while performing positive pressure ventilation (PPV) and number of intubation attempts in DR on neonatal outcomes. This study aims to evaluate outcomes in very low birth weight (VLBW) infants receiving PPV with high peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP) and analyze effects of multiple DR intubation attempts in VLBW infants.

Methods: The data on VLBW infants from single center for last 12 years was retrospectively collected from electronic medical records. High PIP was defined as pressure > 25 cm H2O and high PEEP was defined as pressures > 6 cm H2O. More than 2 intubation attempts were considered as increased number of attempts. Information on maternal and DR factors as well as common neonatal outcomes were tested for significance.

Results: Out of 267 VLBW infants who received PPV in the DR 40 infants (15%) received high PIP. Maternal risk factors for delivery and prenatal steroid use were not different. Birth weight (BW), gestational age (GA), and intubation in DR were similar. Duration of invasive mechanical ventilation was higher in the high PIP group. More infants receiving high PIP were diagnosed as having bronchopulmonary dysplasia (BPD) (P=0.030) and were discharged home on oxygen (P 0.010). Neonatal outcomes including intraventricular hemorrhage, necrotizing enterocolitis (NEC) and retinopathy of prematurity were similar in both groups. (Table 1) Only 10 patients received high PEEP (4%) in DR. It did not have any impact on neonatal outcomes.
Out of 166 infants intubated in DR during the study period 41 infants (25%) required >2 attempts. Maternal risk factors, BW and GA were similar in both groups. More small for gestational age infants required multiple intubation attempts (P= 0.047). Infants requiring multiple intubation attempts were more likely to need chest compressions (p= 0.023) and epinephrine (p < 0.001) in the DR. Pulmonary as well as non-pulmonary morbidities in NICU were similar except higher risk to develop NEC with increased attempts. Mortality was higher in infants requiring multiple DR intubation attempts (p=0.010). (Table 2)

Conclusion: VLBW infants requiring higher PIP while receiving PPV in DR are at high risk for long term pulmonary morbidities such as BPD and home oxygen therapy. VLBW infants requiring >2 intubation attempts in DR are at higher risk for advanced cardiopulmonary resuscitation measures with increased mortality.