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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

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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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Data availability

All data generated or analyzed during this study are included in this article and its online supplementary material. Further inquiries can be directed to the corresponding author.

Abbreviations

BPD:

Bronchopulmonary dysplasia

DDC:

Delayed cord clamping

DR:

Delivery room

EE:

Eastern Europe

GA:

Gestational age

ICC:

Immediate cord clamping

INSURE:

Intubation-SURfactant-Extubation

IVH:

Intraventricular hemorrhage

SIN:

Italian Society of Neonatology

ITA:

Italy

IQR:

Interquartile range

LISA:

Less invasive surfactant administration

MV:

Mechanical ventilation

MC:

Mediterranean countries

PRBC:

Packed red blood cell

PIP:

Peak inspiratory pressures

PBCC:

Physiological-based cord clamping

PPV:

Positive pressure ventilation

RFM:

Respiratory function monitor

SD:

Standard deviation

TUR:

Turkey

UCM:

Umbilical cord milking

UENPS:

Union of European Neonatal and Perinatal Societies

VLBW:

Very low birth weight

WE:

Western Europe

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Acknowledgements

We are very grateful to the UENPS Study Committee and to the directors of Neonatal and Pediatric Departments who participated in the survey.

UENPS Study Committee

Orion Gliozheni, Albania; Ursula Kiechl-Kohlendorfer, Austria; Hajrija Maksić, Bosnia and Herzegovina; Julia Rogko, Belarus; Maya Kristeva, Bulgaria; Jiri Dort, Czech Republik; Pille Andresson, Estonia; Ilkka Ketola, Finland; Élie Saliba, France; George Mitsiakos, Greece;  Gyula Tálosi, Hungary; Michael Boyle, Ireland; Anne Doolan, Ireland; Samuel Zangen, Israel; Karin Bekturgan, Kazakhstan; Burbuqe Skenderi Mustafa, Kosovo; Amanda Smildzere, Latvia; Rasa Tamelienė, Lithuania; Vesna Delovska, Republic of Macedonia; Enrico Lopriore, Netherland; Beate Horsberg Eriksen, Norway; Ryszard Lauterbach, Poland; Carmen Carvalho, Portugal; Maria Stamatin, Romania; Georgios Konstantinidis, Serbia; Milan Kuchta, Slovakia; Darja Paro Panjan, Slovenia; Tatiana Znamenska, Ukraine; Helen MacTier, United Kingdom.

Author information

Authors and Affiliations

  1. Department of Pediatrics and Neonatology, Ospedale Sandro Pertini, Rome, Italy

    Camilla Gizzi

  2. Union of European Neonatal and Perinatal Societies (UENPS), Milan, Italy

    Camilla Gizzi, Artur Beke, Giuseppe Buonocore, Antonia Charitou, Manuela Cucerea, Marina V. Degtyareva, Boris Filipović-Grčić, Nelly Georgieva Jekova, Esin Koç, Joana Saldanha, Manuel Sanchez Luna, Dalia Stoniene, Heili Varendi, Giulia Vertecchi & Corrado Moretti

  3. Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Azienda USL Toscana Nord Ovest, Pisa, Italy

    Luigi Gagliardi

  4. Department of Woman’s and Child’s Health, University of Padova, Padova, Italy

    Daniele Trevisanuto

  5. Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Stefano Ghirardello

  6. Department of Pediatrics, Ospedale San Salvatore, L’Aquila, Italy

    Sandra Di Fabio

  7. 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary

    Artur Beke

  8. Department of Pediatrics, Università degli Studi di Siena, Siena, Italy

    Giuseppe Buonocore

  9. Department of Pediatrics, Rea Maternity Hospital, Athens, Greece

    Antonia Charitou

  10. Neonatology Department, University of Medicine Pharmacy Sciences and Technology “George Emil Palade”, Târgu Mures, Romania

    Manuela Cucerea

  11. Department of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia

    Marina V. Degtyareva

  12. Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, HR, Croatia

    Boris Filipović-Grčić

  13. Department of Pediatrics, University Hospital “Majchin Dom”, Sofia, Bulgaria

    Nelly Georgieva Jekova

  14. Division of Neonatology, Department of Pediatrics, School of Medicine, Gazi University, Ankara, Turkey

    Esin Koç

  15. Department of Pediatrics, Hospital de Santa Maria, Lisbon, Portugal

    Joana Saldanha

  16. Neonatology Division, Department of Pediatrics, Hospital General Universitario “Gregorio Marañón”, Madrid, Spain

    Manuel Sanchez Luna

  17. Department of Pediatrics, Lithuanian University of Health Sciences, Kaunas, Lithuania

    Dalia Stoniene

  18. Department of Pediatrics, Tartu University Hospital, Tartu, Estonia

    Heili Varendi

  19. Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy

    Matteo Calafatti

  20. Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy

    Fabio Mosca

  21. Department of Pediatrics, Policlinico Umberto I, Sapienza University, Rome, Italy

    Corrado Moretti

Authors
  1. Camilla Gizzi
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  2. Luigi Gagliardi
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  3. Daniele Trevisanuto
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  4. Stefano Ghirardello
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  8. Antonia Charitou
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  19. Giulia Vertecchi
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Consortia

on behalf of the Union of European Neonatal and Perinatal Societies (UENPS) Study Committee

  • Orion Gliozheni
  • , Ursula Kiechl-Kohlendorfer
  • , Hajrija Maksić
  • , Julia Rogko
  • , Maya Kristeva
  • , Jiri Dort
  • , Pille Andresson
  • , Ilkka Ketola
  • , Élie Saliba
  • , George Mitsiakos
  • , Gyula Tálosi
  • , Michael Boyle
  • , Anne Doolan
  • , Samuel Zangen
  • , Karin Bekturgan
  • , Burbuqe Skenderi Mustafa
  • , Amanda Smildzere
  • , Rasa Tamelienė
  • , Vesna Delovska
  • , Enrico Lopriore
  • , Beate Horsberg Eriksen
  • , Ryszard Lauterbach
  • , Carmen Carvalho
  • , Maria Stamatin
  • , Georgios Konstantinidis
  • , Milan Kuchta
  • , Darja Paro Panjan
  • , Tatiana Znamenska
  •  & Helen MacTier

Contributions

Dr. Gizzi contributed to the study concept and preparation of the survey, wrote the initial draft, and critically reviewed the manuscript. Dr. Gagliardi contributed to the study concept, data analysis, and writing of the manuscript and critically reviewed the manuscript. Dr. Trevisanuto contributed to the study concept, preparation of the survey, and writing of the manuscript and critically reviewed the manuscript. Dr. Ghirardello, Dr. Di Fabio, Dr. Beke, and Dr. Buonocore contributed to the study concept, data curation, and writing the draft of the manuscript and critically reviewed the manuscript. Dr. Charitou, Dr. Cucerea, Dr. Degtyareva, Dr. Filipović-Grčić, Dr. Jekova, Dr. Koç, Dr. Saldanha, Dr. Sanchez Luna, Dr. Stoniene, and Dr. Varendi contributed to the study concept, data collection, and writing the draft of the manuscript and critically reviewed the manuscript. Dr. Calafatti contributed to data curation, writing the draft of the manuscript, and critically reviewed the manuscript. Dr. Vertecchi coordinated the contacts with participating centers; contributed to the study concept, data curation, and writing the draft of the manuscript; and critically reviewed the manuscript. Dr. Mosca contributed to the study concept and to writing the draft of the manuscript, provided relevant expertise, and critically reviewed the manuscript. Dr. Moretti contributed to the study concept and to writing the draft of the manuscript, provided relevant expertise, and critically reviewed the manuscript. All the authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Camilla Gizzi.

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Ethics approval

The study received the approval from the Padua Provincial Institutional Review Board (protocol # 0035420) as not meeting criteria for human subject research. Research was carried out in line with the principles of the Declaration of Helsinki.

Competing interests

The authors declare no competing interests.

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Communicated by Daniele De Luca

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Gizzi, C., Gagliardi, L., Trevisanuto, D. et al. Variation in delivery room management of preterm infants across Europe: a survey of the Union of European Neonatal and Perinatal Societies. Eur J Pediatr 182, 4173–4183 (2023). https://doi.org/10.1007/s00431-023-05107-9

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