Published online May 8, 2016. doi: 10.5409/wjcp.v5.i2.151
Peer-review started: July 16, 2015
First decision: September 19, 2015
Revised: November 24, 2015
Accepted: January 16, 2016
Article in press: January 19, 2016
Published online: May 8, 2016
Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable (gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.
Core tip: Management of extremely preterm resuscitation is one of the most challenging aspects of perinatal medicine. There is increasing evidence towards a trend for a more gentle measure of resuscitation to avoid injury both immediate and long term. In this article, we review the evolving strategies to aid the complex process of adaption to extra uterine life for extreme preterm infants.