Medical Management of Extremely Low-Birth-Weight Infants in the First Week of Life: A Survey of Practices in the United States

Autumn S Kiefer; Andrea C Wickremasinghe; Jonathan N Johnson; Tyler K Hartman; Susan R Hintz; William A Carey; Christopher E Colby

doi:10.1055/s-0029-1214235

American Journal of Perinatology, Table of Contents

Am J Perinatol 2009; 26(6): 407-418
DOI: 10.1055/s-0029-1214235

Medical Management of Extremely Low-Birth-Weight Infants in the First Week of Life: A Survey of Practices in the United States

Autumn S. Kiefer¹ , Andrea C. Wickremasinghe¹ , Jonathan N. Johnson¹ , Tyler K. Hartman² , Susan R. Hintz³ , William A. Carey¹ , Christopher E. Colby¹

¹Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
²Division of Newborn Medicine, Children's Hospital Boston, Boston, Massachusetts
³Division of Neonatal and Developmental Medicine, Lucile Salter Packard Children's Hospital, Palo Alto, California

Abstract

ABSTRACT

We sought to determine the current practices of neonatologists in their management of extremely low-birth-weight (< 1000 g) infants. We directly mailed an anonymous survey to the medical directors of 809 neonatal intensive care units in the United States. More than one-third of those surveyed responded, with a substantial majority from intensive care (level III) nurseries or extracorporeal membrane oxygenation centers. Academic centers and private practice environments were both well represented. Some traditional practices have changed, such as beginning resuscitation with 40% rather than 100% oxygen. Many practices vary based on whether neonates are cared for in private versus academic centers, including initial resuscitation method, type of ventilation used, use of intraventricular hemorrhage prophylaxis, and routine antibiotic therapy. Parenteral nutrition composition and the use of inhaled nitric oxide differ based on the responding center's participation in clinical trials. The number of years in practice as a neonatologist does not affect practice decisions. Among all our findings, the prevalence of one potentially harmful practice, the continued use of dexamethasone for corticosteroid therapy, was particularly noteworthy. In conclusion, the strength of evidence does not always predict whether practices are adopted or abandoned. Further research is necessary to clarify the optimal management for this high-risk patient population.

KEYWORDS

Extremely low birth weight - survey - practice variation - neonatal resuscitation - corticosteroids

Full Text

References

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Christopher E ColbyM.D.

Assistant Professor of Pediatrics, Department of Pediatric and Adolescent Medicine

Mayo Clinic, 200 First Street SW, Rochester MN 55905

Email: colby.christopher@mayo.edu