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

Autumn S. Kiefer, Andrea C. Wickremasinghe, Jonathan N. Johnson, Tyler K. Hartman, Susan R. Hintz, William A. Carey, Christopher E. Colby

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)407-418
Number of pages12
JournalAmerican Journal of Perinatology
Volume26
Issue number6
DOIs
StatePublished - Jun 2009

Fingerprint

Extremely Low Birth Weight Infant
Resuscitation
Physician Executives
Extracorporeal Membrane Oxygenation
Antibiotic Prophylaxis
Nurseries
Private Practice
Neonatal Intensive Care Units
Parenteral Nutrition
Risk Management
Low Birth Weight Infant
Critical Care
Dexamethasone
Ventilation
Adrenal Cortex Hormones
Nitric Oxide
Clinical Trials
Newborn Infant
Hemorrhage
Oxygen

Keywords

  • Corticosteroids
  • Extremely low birth weight
  • Neonatal resuscitation
  • Practice variation
  • Survey

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Kiefer, A. S., Wickremasinghe, A. C., Johnson, J. N., Hartman, T. K., Hintz, S. R., Carey, W. A., & Colby, C. E. (2009). Medical management of extremely low-birth-weight infants in the first week of life: A survey of practices in the United States. American Journal of Perinatology, 26(6), 407-418. https://doi.org/10.1055/s-0029-1214235

Medical management of extremely low-birth-weight infants in the first week of life : A survey of practices in the United States. / Kiefer, Autumn S.; Wickremasinghe, Andrea C.; Johnson, Jonathan N.; Hartman, Tyler K.; Hintz, Susan R.; Carey, William A.; Colby, Christopher E.

In: American Journal of Perinatology, Vol. 26, No. 6, 06.2009, p. 407-418.

Research output: Contribution to journalArticle

Kiefer, AS, Wickremasinghe, AC, Johnson, JN, Hartman, TK, Hintz, SR, Carey, WA & Colby, CE 2009, 'Medical management of extremely low-birth-weight infants in the first week of life: A survey of practices in the United States', American Journal of Perinatology, vol. 26, no. 6, pp. 407-418. https://doi.org/10.1055/s-0029-1214235
Kiefer, Autumn S. ; Wickremasinghe, Andrea C. ; Johnson, Jonathan N. ; Hartman, Tyler K. ; Hintz, Susan R. ; Carey, William A. ; Colby, Christopher E. / Medical management of extremely low-birth-weight infants in the first week of life : A survey of practices in the United States. In: American Journal of Perinatology. 2009 ; Vol. 26, No. 6. pp. 407-418.
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