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Medical management of extremely low-birth-weight infants in the first week of life: a survey of practices in the United States.

CPQCC Publication
TitleMedical management of extremely low-birth-weight infants in the first week of life: a survey of practices in the United States.
Publication TypeJournal Article
Year of Publication2009
AuthorsKiefer AS, Wickremasinghe AC, Johnson JN, Hartman TK, Hintz SR, Carey WA, Colby CE
JournalAm J Perinatol
Date Published2009 Jun
KeywordsAdrenal Cortex Hormones, Anti-Inflammatory Agents, Non-Steroidal, Cerebral Hemorrhage, Ductus Arteriosus, Patent, Health Care Surveys, Humans, Infant, Low Birth Weight, Infant, Newborn, Infections, Neonatology, Parenteral Nutrition, Total, Practice Patterns, Physicians', Respiratory Therapy, United States

We sought to determine the current practices of neonatologists in their management of extremely low-birth-weight (< 1000 g) infants. We directly mailed an anonymous survey to the medical directors of 809 neonatal intensive care units in the United States. More than one-third of those surveyed responded, with a substantial majority from intensive care (level III) nurseries or extracorporeal membrane oxygenation centers. Academic centers and private practice environments were both well represented. Some traditional practices have changed, such as beginning resuscitation with 40% rather than 100% oxygen. Many practices vary based on whether neonates are cared for in private versus academic centers, including initial resuscitation method, type of ventilation used, use of intraventricular hemorrhage prophylaxis, and routine antibiotic therapy. Parenteral nutrition composition and the use of inhaled nitric oxide differ based on the responding center's participation in clinical trials. The number of years in practice as a neonatologist does not affect practice decisions. Among all our findings, the prevalence of one potentially harmful practice, the continued use of dexamethasone for corticosteroid therapy, was particularly noteworthy. In conclusion, the strength of evidence does not always predict whether practices are adopted or abandoned. Further research is necessary to clarify the optimal management for this high-risk patient population.

Alternate JournalAm J Perinatol
PubMed ID19301226