Immediate delivery room interventions for prevention of preterm brain injury: An evidence-based review

Preterm brain injury is multifactorial and can occur at any point along the continuum from prenatal to postnatal life. Management in the few minutes after birth plays a critical role in mitigating the development of brain injury and subsequent adverse neurodevelopmental outcome in very preterm infants born at < 32 weeks of gestation. Facilitating a smooth transition from intrauterine to extrauterine life is a complex and time-sensitive team sport that requires preparation and training. Delivery room interventions aim is to achieve smooth thermal, respiratory, and circulatory physiological transition that ensures adequate perfusion and oxygenation of vital organs, particularly, the brain. Disruption of cerebral blood flow and oxygen delivery during the first minutes of life is a key mechanistic pathway leading to germinal matrix hemorrhage and white matter injury. Vigorous stimulation, excessive respiratory pressures and volumes, and drastic changes in oxygen delivery should be avoided. In this article, common interventions in the delivery room that may impact the development of brain injury will be discussed.