Marked variation in delivery room management in very preterm infants

Resuscitation. 2013 Nov;84(11):1558-61. doi: 10.1016/j.resuscitation.2013.06.026. Epub 2013 Aug 12.


Background: The International Liaison Committee on Resuscitation (ILCOR) and U.K. Resuscitation Council (UKRC) updated guidance on newborn resuscitation in late 2010.

Objectives: To describe delivery room (DR) practice in stabilisation following very preterm birth (<32 weeks gestation) in the U.K.

Methods: We emailed a national survey of current DR stabilisation practice of very preterm infants to all U.K. delivery units and conducted telephone follow-up calls.

Results: We obtained 197 responses from 199 units (99%) and complete data from 186 units. Tertiary units administered surfactant in the DR (93% vs. 78%, P=0.01), instituted DR CPAP (77% vs. 50%, P=0.0007), provided PEEP in the delivery room (91% vs. 69%, P=0.0008), and started resuscitation in air or blended oxygen (91% vs. 78%, P=0.04) more often than non-tertiary units. Routine out of hours consultant attendance at very preterm birth was more common in tertiary units (82% vs. 55%, P=0.0005).

Conclusions: Marked variation in DR stabilisation practice of very preterm infants persisted one year after the publication of revised UKRC guidance. Delivery room care provided in non-tertiary units was less consistent with current international guidance.

Keywords: CPAP; DR; NDAU; NICU; NPEU; Neonatal resuscitation; PEEP; Practice variation; Stabilisation practice in preterm infants; Survey; continuous positive airway pressure; delivery room; national perinatal epidemiology unit; neonatal data analysis unit; neonatal intensive care unit; positive end expiratory pressure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Body Temperature Regulation
  • Continuous Positive Airway Pressure
  • Delivery Rooms / organization & administration*
  • Guideline Adherence*
  • Humans
  • Infant, Newborn
  • Infant, Premature*
  • Intensive Care Units, Neonatal / organization & administration
  • Oximetry
  • Oxygen Inhalation Therapy
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Pulmonary Surfactants / therapeutic use
  • Resuscitation / standards*
  • Surveys and Questionnaires
  • Umbilical Cord / blood supply


  • Pulmonary Surfactants