Table 1.

Delivery Room Management of ELBWI

AgeMeasureObjectiveRemarks
1.  0–15 sDrying, wrapping into a plastic film (complete infant, only face free)Prevention of heat lossShortening of the cold umbilical cord if neccessary
2.  15–30 sOropharyngeal, gastric suctioning Insertion of a nasal-pharyngeal tubeClearing of the airways, prevention of aspiration/gastric refluxTube: ∅ int.: 2.0–2.5 mm, fixed at 4–5 cm. A suction catheter (6Ch) is used as guide. Blood or meconium aspiration? → Start with 2. → 1.
3.  30–45 sFirst continuous sustained inflation 20 cm H2O, Fio 2: 1.0, PEEP after inflation: 4–6 cm H2ORecruitment of lung volumeHead position? Mouth and nostril are closed during inflation. Chest movement? Skin color? Heart rate >100 min−1? Spontaneous breathing? If sufficient → 6. and 8., If not → 4.
4.  50–65 sSecond continuous sustained inflation, 25 cm H2O, Fio 2: 1.0, PEEP after inflation: 4–6 cm H2ORecruitment of lung volumePharyngeal suctioning? Chest movement? Skin color? Heart rate? Spontaneous breathing? If sufficient → 6. and 8., Improvement but insufficient or apnea → 5. No improvement → 7.
5.  70 s–10 minIMV up to 10 min, Ti 0.3 sec, 60 min−1, PIP 20–25 cm H2O, Spo 2 monitorSpo 280%–93%If apnea but HR >100 min−1 and Spo 2 >80, (maternal drugs?) Improvement → 6. and 8. No improvement → 7.
6.  45 s–30 minCPAP, 4–6 cm H2OMaintenance of lung volumeSpo 2 sensor site: right wrist preferential. Adjustment of Fio 2. Open gastric tube as pop off valve.
7.  (70 s)
5–10 min
Endotracheal intubation and IPPV Ti 0.3 sec, 60 min−1, PIP 20 cm H2OHR >100 min−1, Spo 2 80%–93% normal chest movementSurfactant (100 mg/kg BW) if Fio 21.0 and Spo 2 <80 or no chest movement (air leak?). Epinephrine if heart rate <100 min−1 Adequate PIP?
8.  5–30 minPeripheral venous line, umbilical arterial lineNormoglycemia, monitoring of arterial blood pressureGlucose 10% 0.5–1.0 ml iv bolus, continuous infusion 3 mL/kg/h
9.  20–30 minTransfer to NICUHeart rate? Spo2? Chest movement? X-ray after admission
  • Abbreviations: PEEP, positive end-expiratory pressure; IMV, intermittent mandatory ventilation.

    Immediate intubation: diaphragmatic hernia (prenatal sonography), large abdominal wall defects or clinical signs of hemorrhagic shock (eg, twin-twin transfusion). The resuscitation bed should be preheated. Radiant warmer: 20 mW/m2 (distance from matress: 82 cm), mattress: 38.5°C.