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Medical management of extremely low-birth-weight infants in the first week of life: a survey of practices in the United States.

Authors
  • Kiefer, Autumn S
  • Wickremasinghe, Andrea C
  • Johnson, Jonathan N
  • Hartman, Tyler K
  • Hintz, Susan R
  • Carey, William A
  • Colby, Christopher E
Type
Published Article
Journal
American Journal of Perinatology
Publisher
Georg Thieme Verlag KG
Publication Date
Jun 01, 2009
Volume
26
Issue
6
Pages
407–418
Identifiers
DOI: 10.1055/s-0029-1214235
PMID: 19301226
Source
Medline
License
Unknown

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.

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