Delivery room management of extremely low birth weight infants in Italian level III hospitals

Results There was a 92% (n=98/107) response rate. Participating centers reported an overall number of 198.322 births during 2011, and of these, 1933 were ELBW infants. Northern and Central centers had a higher median of births and of ELBW infants than Southern centers. A provider skilled in neonatal resuscitation is present in high-risk deliveries in 46% of III level centers: this rate was higher in Northern (77.5%) than in Central (33.3%) and Southern (21.6%) centers. The team leader for neonatal resuscitation is generally a Pediatrician/ Neonatologist (67.2%). The median delivery room temperature was 24°C (IQR: 22–25). Only 18 centers (20.2%) achieved a delivery room temperature over 25°C. A polyethylene bag/wrap was used by 54 centers (55.1%). Most centers had a pulse oxymeter (91/98, 92.9%) available in delivery room and used saturation targets (82/98, 83.7%). In Northern regions, one centre (2.5%) said it used oxygen concentrations >40% to initiate positive pressure ventilation in ELBW infants. These proportions were higher in the Central (14.3%) and Southern (16.2%) areas. A T-piece device for positive pressure ventilation was widely used (77/97, 79.4%). The percentage of ELBW infants intubated at birth had a median of 60% (IQR: 40%–80%), with the highest values in Central group (median 66%, IQR: 50%–75%). A median of 13% (IQR: 5%–30%) of ELBW infants received chest compressions at birth in Italy.