Abstract 1310

Endotracheal intubation (EOT) is a routine procedure in the delivery room for the resuscitation of the very low birth weight baby in many perinatal units. Current recommendations of the Neonatal Resuscitation Program of the American Academy of Pediatrics also includes EOT for infants with less than a 1000 g. Should we intubate all babies < 1000 g.?

In order to address this question, we studied the procedures performed in the delivery room with all babies born with less than 1000 g. admitted to our unit between January 96 and December 97, and compared morbidity and mortality in intubated (I) and non-intubated infants(NI). A total of 38 infants were included in the analysis( 3 infants excluded). Mean birth weight was 765 g. (460-780g.) and mean gestational age was 30 weeks (29-32 weeks). Data for NI and I infants was compared regarding BW, GA, Apgar scores, and subsequent need of IMV, Surfactant (Surf), severity score (CRIB) and survival to discharge. "{table}"

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The incidence of IVH was 21.4% and 4.7% in I and NI infants. Most NI infants were SGA(13/20). 12/20 NI infants were intubated in the nursery to receive surfactant(9) or because of apneic spells. Our data show that babies with low apgar scores, AGA and less mature are the most likely to be intubated. 8/35(22%)infants of the total population were never intubated. These infants were predominantly SGA, had good apgar scores and were more mature. Our data showed, for our study population, that bag and mask could be used safely in the delivery room for the small infant, as 22% never needed intubation. We suggest that birth weight alone should not guide the decision to intubate the extreme low birth weight baby in the delivery room.