Improved growth and decreased morbidities in <1000 g neonates after early management changes

C A Geary, R A Fonseca, M A Caskey, M H Malloy
Journal of Perinatology: Official Journal of the California Perinatal Association 2008, 28 (5): 347-53

OBJECTIVE: To test the hypothesis that three changes in the early management of extremely low birth weight (ELBW) neonates would decrease the incidence of extra-uterine growth restriction (EUGR) by 25%. The three early management practice changes (EMPC) included surfactant at delivery followed by immediate extubation to nasal continuous positive airway pressure (CPAP), decreased oxygen exposure and early parenteral amino acids.

STUDY DESIGN: Historical cohort study of preterm infants<or=1000 g birth weight (BW) born at the University of Texas Medical Branch between January 2001 and June 2002 (pre-EMPC, before changes, n=87) and July 2004 to December 2005 (post-EMPC, after changes, n=76). Outcomes measured included feeding and growth parameters, morbidities and interventions. Statistical analysis included chi2-analysis, Student's t-test, and analysis of variance.

RESULT: Infants in the post-EMPC cohort regained BW more quickly, maintained appropriate size for weight at 36 weeks and had less morbidity associated with poor long-term outcome. Predictors of EUGR included BW<750 g and surgical necrotizing enterocolitis.

CONCLUSION: The introduction of surfactant at delivery followed by immediate extubation to CPAP, decreased oxygen exposure and early parenteral amino acids in ELBW infants is possible, safe and associated with improvements in growth and morbidity.

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