Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. May 8, 2016; 5(2): 151-158
Published online May 8, 2016. doi: 10.5409/wjcp.v5.i2.151
Resuscitation of extremely preterm infants - controversies and current evidence
Pooja N Patel, Jayanta Banerjee, Sunit V Godambe
Pooja N Patel, Jayanta Banerjee, Sunit V Godambe, Department of Neonatology, Imperial College Healthcare NHS Trust, London W12 0HY, United Kingdom
Author contributions: All authors have conceived the project.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Sunit V Godambe, Consultant Neonatologist, Department of Neonatology, Imperial College Healthcare NHS Trust, Du Cane Road, Ham House, 5th Floor, London W12 0HY, United Kingdom.
Telephone: +44-203-33133270 Fax: +44-203-33131122
Received: July 16, 2015
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.

Keywords: Extremely preterm infants, Resuscitation, Antenatal steroids, Delayed cord clamping, Ventilator support, Oxygenation in delivery room, Temperature stability

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.