Variation in Stabilization and Resuscitation Practices at Birth of Preterm Infants Among 12 National or Regional Neonatal Networks

AIM: Neonatal resuscitation follows national or regional guidelines, but uptake varies in clinical practice. This study aimed to examine variations in reported delivery room practices for infants < 29 weeks' gestation across neonatal units in 12 networks of the International Network for Evaluating Outcomes in Neonates. METHODS: An online pre-piloted survey was sent to 608 neonatal units across 12 networks. Responses, based on 2022-2023 practices, were categorized as very frequent (90%-100%), often (50%-89%), sometimes (10%-49%), rarely (1%-9%), and never, and summarized as frequency of units per network. RESULTS: Overall, 382 units (63%) responded (37%-100% within network). Active resuscitation at 22, 23 and 24 weeks was reported as 'very frequent/often' by 22%, 53% and 76% of units, with variation. Delayed cord clamping, cord milking, and resuscitation with intact cord were 'very frequent/often' in 47%, 27% and 7% of units. Japan reported 75% cord milking. For initial respiratory support, 86% reported oxygen concentration < 40%. Intubation at birth for infants 27-28 weeks was uncommon except in Japan. Surfactant delivery room use was reported by 24% of units. CONCLUSIONS: Delivery room management of very preterm infants varies across networks. Future studies should analyse the impact of reported delivery room practices on neonatal outcomes.