Airway management during resuscitation of VLBW neonates during resuscitation in Germany, Austria and Switzerland

Background Surveys from the USA, Australia and Spain exemplify wide variations in airway management of very low birth weight infants (VLBW) at birth. No data was available from German speaking countries under the GNPI directive. We sought to investigate the airway management in the delivery room (DR) management of very low birth weight neonates (VLBW) in Germany (D), Switzerland (CH) and Austria (A). Methods Data on airway management of VLBW in the DR was obtained in a prospective, questionnaire-based international survey. Results In total 249 units were approached, recall rate: 75.4%. Management guidelines existed in 94% of units. Statistically significant differences were found regarding the provision of 24hr neonatal service: D 96.8%, A 100%, CH 84.0% (p=0.014); use of devices for respiratory support: self-inflating bags (SI-bags): D 98.3%; A 80.0% and CH 76.9% (p=0.0001); flow-inflating bags D 1.7%, A 20.0%, CH 23.1% (p=0.0001); use of pressure-controlled manual ventilation devices (Perivent®): D 41.7%; A 81.8%; 20.0% (P=0.002); pressure control by respirator D 48.2%, Au 18.2%, CH 16.7% (p=0.003); and regarding dosage of Surfactant: D 100mg/kg (89.2%), A 100–200mg/kg (62.5%) and CH 100mg/kg (85.9%) (p=0.0001). No statistically significant differences were found regarding use and monitoring of oxygen and target oxygen saturation levels. Conclusion We found very heterogeneous protocols for the airway management of VLBW infants. Airway management of VLBW in German speaking countries is not always conform to recommendations given by ILCOR. Methods should be refined to distribute and incorporate the best available evidence from clinical research without delay into the care of VLBW infants.