Preterm Bebekte Doğum Odası Yönetimi

ÖzPreterm bebekler sıklıkla doğum sonrası yaşama uyum sağlamada güçlük çekerler. Yenidoğan bebeğin doğumdan sonraki ilk dakikaları "Altın dakikalar" olarak tanımlanır. Bu dakikalar, uterus-içi yaşamdan uterusdışı yaşama geçis ve canlandırma ile birlikte, yenidoğan yoğun bakım ünitesine taşınmasını kapsar. "Altın dakikalar" kavramı preterm yenidoğanın daha iyi uzun vadeli sonucu için yaşamın ilk dakikalarında, özellikle aşırı preterm, çok düşük doğum ağırlığı (ÇDDA) ve aşırı düşük doğum ağırlığı (ADDA) olan pretermlere uygulanan kanıta dayalı girişimleri içermektedir. Bu derlemede ağırlıklı olarak hayatın ilk altın dakikalarında preterm bebeklere uygulanan; gecikmiş kord klemplenmesi, non-invazif ventilasyon, uygun vü-cut ısısının sağlanması ve bireyselleştirilmiş oksijen tedavisi gibi doğum odası yönetimi uygulamalarının temel bileşenleri ele alınmıştır.

Preterm Baby Birth Room Management

AbstractPremature infants often experience difficulties adapting to postnatal life. Goldenfirst minutes “or “Golden minutes” is defined as the first minutes of the newborn after birth. These minutes includes transition with resuscitation care and transport to neonatal intensive care unit. The concept of “Golden minutes” includes evidence based interventions that are done in the first minutes of postnatal life for the better longterm outcome of the preterm newborn especially extreme premature, very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. The main components of the delivery room management of preterm births, such as delayed cord clamping, non-invasive ventilation, individualized oxygen supplementation, and maintaining an adequate body temperature so as to avoid hyperthermia and/or hypothermia which is included in the first minutes approach will be discussed in this review.

___

  • Kaynaklar 1.Perlman JM, Wyllie J, Kattwinkel J, Wyckoff MH, Aziz K, Gu-insburg R, Kim HS, Liley HG, Mildenhall L, Simon WM, SzyldE, Tamura M, Velaphi S; Neonatal Resuscitation Chapter Col-laborators. Part 7: Neonatal Resuscitation: 2015 InternationalConsensus on Cardiopulmonary Resuscitation and EmergencyCardiovascular Care Science With Treatment Recommendations.Circulation. 2015 Oct 20;132(16 Suppl 1):S204-41. doi:10.1161/CIR.0000000000000276. , 2.Crowley PA. Antenatal corticosteroid therapy: a meta-analysisof therandomized trials, 1972 to 1994. Am J Obstet Gynecol. 1995Jul;173(1):322-35. 3.Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fe-tal lungmaturation for women at risk of preterm birth. Cochrane Da-tabase Syst Rev. 2006 Jul 19;(3):CD00445 4. Review. 4.Oygür N, Önal E, Zenciroğlu A. Türk Neonatoloji Derneği Do-ğum SalonuYönetimi Rehberi (2016) 5.Jia Y-S, Lin Z-L, Lv H, Li Y-M, Green RJ, Lin J. Effect of deli-very room temperature on the admission temperature of prema-ture infants: a randomized controlled trial. J Perinatol2013;33:264-267 6.DeMauro SB, Douglas E, Karp K, Schmidt B, Patel, J, Kronber-ger A, Scarboro R, Posencheg M. Improving Delivery Room Ma-nagement for Very Preterm Infants. Pediatrics2013;132:1018–1025 7.Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, PlavkaR, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GH, Hal-liday HL. European Consensus Guidelines on the Managementof Respiratory Distress Syndrome - 2016 Update. Neonatology.2017;111(2):107-125. doi: 10.1159/000448985. 8.Sharma D. Golden 60 minutes of newborn's life: Part 1: Pretermneonate. J Matern Fetal Neonatal Med. 2016 Dec 1:1-12.DOI:10.1080/14767058.2016.1261398. 9.Vento M, Cheung PY, Aguar M. The first golden minutes of theextremely- low-gestational-age neonate: a gentle approach. Neo-natology 2009;95:286–98. 10.Wyckoff MH. Initial resuscitation and stabilization of the peri-viable neonate: the Golden-Hour approach. Semin Perinatol. 2014Feb;38(1):12–6. 11.TC Sağlık Bakanlığı Yenidoğan Canlandırması (Neonatal Resu-sitasyon) Rehberi (2017). (Basımda). 12.Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: Neonatal re-suscitation: 2015 American Heart Association Guidelines Upda-te for Cardiopulmonary Resuscitation and Emergency Cardio-vascular Care. Circulation 2015132:S543–60. 13.Özkan H, Erdeve Ö, Karadağ A.Türk Neonatoloji Derneği Res-piratuvar Distres Sendromu Rehberi 2014, sy 9. 14.Neonatal resusitasyon yenidoğan canlandırması. İbiş M, Günayİ, Aksoy M, Özbaş S, Tezel B, Keskinkılıç B, editörler. Canlan-dırmaya genel bakış ve ilkeler. TC Sağlık Bakanlığı Neonatal Re-susitasyon Rehberi, 2013 Kızılay Ankara sayfa 1-33. 15.Kim AJH, Warren JB. Optimal timing of umbilical cordclamping:is the debate settled? Part 1 of 2: history, rationale, influencingfactors, and concerns. NeoReviews 2015;16:e263–9. 16.Farrar D, Airey R, Law GR, et al. Measuring placentaltransfu-sion for term births: weighing babies with cordintact. BJOG IntJ Obstet Gynaecol 2011;118:70–5. 17.Duley L, Batey N. Optimal timing of umbilical cord clamping forterm and preterm babies. Earl Hum Dev 2013;89:905–908. 18.Raju TNK. Timing of umbilical cord clamping after birth for op-timizing placental transfusion. Curr Opin Pediatr2013;25:180–187. 19.Jelin AC, Zlatnik MG, Kuppermann M, et al. Clamp late and ma-intain perfusion (CLAMP) policy: delayed cord clamping in pre-term infants. J Matern-Fetal Neonatal Med 2016;29:1705–9. 20.Arca G, Botet F, Palacio M, Carbonell-Estrany X. Timing of um-bilical cord clamping: new thoughts on an old discussion. J Ma-tern-Fetal Neonatal Med 2010;23:1274–85.) 21.Niermeyer S, Velaphi S. Promoting Physiologic transition at birth:Re-examining resuscitation and the timing of cord clamping. Se-min Fetal Neonatal Med 2013;18:385- 392. 22.Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timingof umbilical cord clamping and other strategies to influence pla-cental transfusion at preterm birth on maternal and infant out-comes. The Cochrane Library 2012; CD003248. 23.McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of ti-ming of umbilical cord clamping of term infants on maternal andneonatal outcomes. The Cochrane Library 2013;CD004074. 24.Tarnow-Mordi WO, Duley L, Field D et al. Timing of cord clam-ping in very preterm infants: more evidence is needed. Am J Obs-tet Gynecol 2014;211:118-123. 25.The WHO Reproductive Health Library Guideline 2014: Dela-yed umbilical cord clamping for improved maternal and infanthealth and nutrition outcomes. ISBN 978924 1508209. 26.Laptook AR, Salhab W, Bhaskar B. Neonatal Research Network.Admission temperature of low birth weight infants: predictors andassociated morbidities. Pediatrics 2007;119:e643–9. 27.Costeloe K, Hennessy E, Gibson AT, et al. The EPICure study:outcomes to discharge from hospital for infants born at the thres-hold of viability. Pediatrics 2000;106:659–71. 28.Bhatt DR, White R, Martin G, et al. Transitional hypothermia inpreterm newborns. J Perinatol 2007;27:S45–7. 29.Boo N-Y, Guat-Sim Cheah I. Malaysian National Neonatal Re-gistry. Admission hypothermia among VLBW infants in Malay-sian NICUs. J Trop Pediatr 2013;59:447–52. 30.Watkinson M. Temperature control of premature infants in thedelivery room. Clin Perinatol 2006;33:43–53,vi. 31.Szymankiewicz M. Thermoregulation and maintenance of app-ropriate temperature in newborns. Ginekol Pol 2003;74:1487–97. 32.Laptook AR, Watkinson M. Temperature management in the de-livery room. Semin Fetal Neonatal Med 2008;13:383–91. 33.Rathod D, Adhisivam B, Bhat BV. Transport of sick neonates toa tertiary care hospital, South India: condition at arrival and out-come. Trop Doct2015;45:96–9. 34.Kumar PP, Kumar CD, Shaik F, et al. Transported neonatesbya specialist team – how STABLE are they. Indian J Pediatr2011;78:860–2. 35.Chang H-Y, Sung Y-H, Wang S-M, et al. Short- and long-term out-comes in very low birth weight infants with admission hypother-mia. PLoS One2015;10:e0131976. 36.Mathur NB, Krishnamurthy S, Mishra TK. Evaluation of WHOclassification of hypothermia in sick extramural neonates as pre-dictor of fatality. J Trop Pediatr 2005;51:341–5. 37.WHO recommendations on Postnatal care of the mother and new-born. Geneva, WHO, 2014., 38.WHO guidelines review comittee. Recommendations on newbornhealth. Handbook for guideline development. Geneva, WHO,2013., 39.Lenclen R, Mazraani M, Jugie M, et al. Use of a polyethylene bag:a way to improve the thermal environmentof the premature new-born at the deliveryroom. Arch Pediatrie Organe Off Societe FrPediatrie 2002;9:238–44. 40.McCall EM, Alderdice F, Halliday HL, et al. Interventions to pre-vent hypothermia at birth in preterm and/or low birthweight in-fants. Cochrane Database Syst Rev 2010;CD004210. 41.L’Herault J, Petroff L, Jeffrey J. The effectiveness ofa thermal matt-ress in stabilizing and maintaining body temperature during thetransport of verylow-birth weight newborns. Appl NursRes2001;14:210–19. 42.Mathew B, Lakshminrusimha S, Sengupta S, Carrion V. Rando-mized controlled trial of vinyl bags versus thermal mattress to pre-vent hypothermia in extremely low-gestational-age infants. AmJ Perinatol 2013;30:317–22. 43.Singh A, Duckett J, Newton T, Watkinson M. Improving neona-tal unit admission temperatures in preterm babies: exothermicmattresses, polythene bags or a traditional approach? J Perina-tol 2010;30: 45–9. 44.McCarthy LK, O’Donnell CPF. Warming preterm infants in thedelivery room: polyethylene bags, exothermic mattresses or both?Acta Paediatr Oslo Nor 1992 2011;100:1534–7. 45.McCarthy LK, Molloy EJ, Twomey AR, et al. A randomized tri-al of exothermic mattresses for preterm newborns in polyethy-lene bags. Pediatrics 2013;132: e135–41. 46.Meyer MP, Hou D, Ishrar NN, et al. Initial respiratory supportwith cold, dry gas versus heated humidified gas and admissiontemperature of preterm infants. J Pediatr 2015;166:245–50.e1. 47.te Pas AB, Lopriore E, Dito I, et al. Humidified and heated airduring stabilization at birth improves temperature in preterm in-fants. Pediatrics 2010;125: e1427–32. 48.Bergman NJ, Linley LL, Fawcus SR. Randomized controlled tri-al of skin-to-skin contact from birth versus conventional incuba-tor for physiological stabilization in 1200- to 2199-gram new-borns. Acta Paediatr Oslo Nor 1992 2004;93:779–85. 49.Hillman N, Kallapur SG, Jobe AH. Physiology of transition fromintrauterine to extrauterine life. Clin Perinatol 2012;39:769–83. 50.Hooper SB, Siew ML, Kitchen MJ, te Pas AB. Establishing func-tional residual capacity in the non-breathing infants. Semin Fe-tal Neonatal Med 2013;18: 336–43. 51.Jobe A, Ikegami M, Jacobs H, Jones S. Surfactant and pulmonaryblood flow distributions following treatment of premature lambswith natural surfactant. J Clin Invest 1984;73:848–56. 52.Brown MK, DiBiasi RM. Mechanical ventilation of the prema-ture neonate. Respir Care 2011;56:1298–311. 53.Kanmaz Kutman HG, Oğuz ŞS, Uraş N.Altın Dakikalar: PretermBebeğin Doğum Salonunda Yönetimi. Jinekoloji - Obstetrik ve Neo-natoloji Tıp Dergisi 2015; Volum:12, Sayı:4, Sayfa: 162-166. 54.Auten RL, Vozzelli M, Clark RH. Volutrauma. What is it, and howdo we avoid it? Clin Perinatol 2001;28:505–15. 55.Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Res-pir Crit Care Med 2001;163:1723–9. 56.Patel PN, Banerjee J, Godambe SV. Resuscitation of extremelypreterm infants – controversies and current evidence. World J ClinPediatr 2016;5:151–8. 57.O’Donnell CPF, Schmölzer GM. Resuscitation of Preterm InfantsDelivery Room Interventions and Their Effect on Outcomes. ClinPerinatol 2012;39: 857–869. 58.Schmölzer GM, Te Pas AB, Davis PG, Morley CJ. Reducing lunginjury during neonatal resuscitation of preterm infants. J Pedi-atr 2008;153:741-745. 59.Schmölzer GM, Kumar M, Pichler G, Aziz K, O'Reilly M, Che-ung PY. Non-invasive versus invasive respiratory support in pre-term infants at birth: systematic review and metaanalysis. BMJ2013; 347:f5980. 60.Saugstad OD, Aune D. Optimal Oxygenation of Extremely LowBirth Weight Infants: A Meta-Analysis and Systematic Review ofthe Oxygen Saturation Target Studies. Neonatology2014;105:55–63. 61.Manja V, Lakshminrusimha S, Cook DJ. Oxygen Saturation Tar-get Range for Extremely Preterm Infants A Systematic Review andMeta-analysis. JAMA Pediatr 2015;169:332- 340. 62.Goldsmith JP, Kattwinkel J. The Role of Oxygen in the DeliveryRoom. Clin Perinatol 39 2012;39: 803–815. 63.Rabi Y, Lodha A, Soraisham A, Singhal N, Barrington K, ShahPS. Outcomes of preterm infants following the introduction of roomair resuscitation. Resuscitation 2015;96:252– 259. 64.Askie LM, Brocklehurst P, Darlow BA, Finer N, Schmidt B, Tar-now-Mordi W, NeOProM Collaborative Group: NeOProM: Neo-natal Oxygenation Prospective Meta-analysis CollaborationStudy Protocol. BMC Pediatr 2011;11:6. 65.Armanian AM, Badiee Z. Resuscitation of preterm newborns withlow concentration oxygen versus high concentration oxygen. JRes Pharm Pract 2012;1:25–9. 66.Kapadia VS, Chalak LF, Sparks JE, et al. Resuscitation of pre-term neonates with limited versus high oxygen strategy. Pediat-rics 2013;132:e1488–96. 67.Lundstrøm KE, Pryds O, Greisen G. Oxygen at birth and prolon-ged cerebral vasoconstriction in preterminfants. Arch Dis ChildFetal Neonatal Ed 1995;73:F81–6. 68.Rabi Y, Singhal N, Nettel-Aguirre A. Room-air versus oxygen ad-ministration for resuscitation of preterm infants: the ROAR study.Pediatrics 2011;128:e374–81.69.Rook D, Schierbeek H, Vento M, et al. Resuscitation of preterminfants with different inspired oxygen fractions. J Pediatr2014;164:1322–6.e3. 70.Vento M, Moro M, Escrig R, et al. Preterm resuscitation with lowoxygen causes less oxidative stress, inflammation, and chroniclung disease. Pediatrics 2009;124:e439–49. 71.Wang CL, Anderson C, Leone TA, et al. Resuscitation of pretermneonates by using room air or 100% oxygen. Pediatrics2008;121:1083–9. 72.Kattwinkel J, Perlman JM, Aziz K, et al. Neonatal resuscitation:2010 American Heart Association Guidelines for Cardiopulmo-nary Resuscitation and Emergency Cardiovascular Care. Pedi-atrics 2010;126:e1400–13. 73.Vaucher YE, Peralta-Carcelen M, Finer NN, Carlo WA, et al. SUP-PORT Study Group of the Eunice Kennedy Shriver NICHD Neo-natal Research Network. Neurodevelopmental outcomes in theearly CPAP and pulse oximetry trial. N Engl J Med.2012;367:2495-2504. 74.Arsan S, Korkmaz Toygar A, Oğuz S. Türk Neonatoloji Derne-ği Bronkopulmoner displazi Korunma, Tedavi ve İzlem Rehberi2014, sy 13. 75.Roehr CC, Morley CJ, Vento M. Improving neonatal transitionby giving ventilatory support in the delivery room. Neoreviews2012;13:343–52. 76.Schmölzer GM, Kumar M, Aziz K, et al. Sustained inflation ver-sus positive pressure ventilation at birth: asystematic review andmeta-analysis. Arch Dis ChildFetal Neonatal Ed2015;100:F361–8. 77.Morley CJ, Davis PG, Doyle LW, et al. Nasal CPAP or intuba-tion at birth for very preterm infants. N Engl J Med2008;358:700–8. 78.SUPPORT Study Group of the Eunice Kennedy Shriver NICHDNeonatal Research Network, Finer NN, CarloWA, Walsh MC, etal. Early CPAP versus surfactant in extremely preterm infants.N Engl J Med 2010;362:1970–9. 79.Gupta N, Saini SS, Murki S, et al. Continuous positive airway pres-sure in preterm neonates: an update of current evidence and im-plications for developing countries. Indian Pediatr2015;52:319–28. 80.Mehler K, Grimme J, Abele J, Huenseler C, Roth B, Kribs A. Out-come of extremely low gestational age newborns after introduc-tion of a revised protocol to assist preterm infants in their tran-sition to extrauterine life. Acta Pædiatr 2012;101:1232–9. 81.Milner AD. Resuscitation of the newborn. Archives of Disease inChildhood 1991;66:66–9. 82.Vyas H, Field D, Milner AD, Hopkin IE. Determinants of the firstinspiratory volume and functional residual capacity at birth. Pe-diatric Pulmonology 1986;2:189–93. 83.Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L,Goldsmith JP, et al. Part 11: Neonatal resuscitation: 2010 In-ternational Consensus on Cardiopulmonary Resuscitation andEmergency Cardiovascular Care Science with treatment recom-mendations. Circulation 2010;122:516–38. 84.Te Pas AB, Walther FJ. A randomized, controlled trial of deli-very-room respi-ratory management in very preterm infants. Pe-diatrics 2007;120:322–9. 85.Fuchs H, Lindner W, Buschko A, Trischberger T, Schmid M,Hummler HD. Cerebral oxygenation in very low birth weight in-fants supported withsus-tained lung inflations after birth. Pedi-atr Res 2011;70:176–80. 86.Vali P, Mathew B, Lakshminrusimha S. Neonatal resuscitation:evolving strategies. Matern Health Neonatol Perinatol 2015;1. 87.Lista G, Fontana P, Castoldi F, et al. Does sustained lung infla-tion at birth improve outcome of preterm infants at risk for res-piratory distress syndrome? Neonatology 2011;99:45–50. 88.Lista G, Boni L, Scopesi F, et al. Sustained lung inflation at birthfor preterm infants: a randomized clinical trial. Pediatrics2015;135:e457–64. 89.Lindner W, H€ogel J, Pohlandt F. Sustained pressure control-led inflation or intermittent mandatory ventilation in preterm in-fants in the delivery room? A randomized, controlled trial on ini-tial respiratory support via nasopharyngeal tube. Acta PaediatrOslo Nor 1992 2005;94:303–9. 90.Harling AE, Beresford MW, Vince GS, et al. Does sustained lunginflation at resuscitation reduce lung injury in the preterm infant?Arch Dis Child Fetal Neonatal Ed 2005;90:F406–10. 91.El-Chimi MS, Awad HA, El-Gammasy TM, El-Farghali OG, Sal-lam MT, Shinkar DM.Sustained versus intermittent lung inflati-on for resuscitation of preterm infants: a randomized controlledtrial. J Matern Fetal Neonatal Med. 2016;2:1-6. 92.Davis PG, Morley CJ, Owen LS. Non-invasive respiratory sup-port of preterm neonates with respiratory distress: continuous po-sitive airway pressure and nasal intermittent positive pressure ven-tilation. Semin Fetal Neonatal Med 2009;14:14–20. 93.Morley CJ. Volume-limited and volume-targeted ventilation. ClinPerinatol 2012;39:513–23. 94.Björklund LJ, Ingimarsson J, Curstedt T, et al. Manual ventila-tion with a few large breaths at birth compromises the therapeu-tic effect of subsequent surfactant replacement in immature lambs.Pediatr Res 1997;42:348–55. 95.Hawkes CP, Ryan CA, Dempsey EM. Comparison of the T-pie-ce resuscitator with other neonatal manual ventilation devices:a qualitative review. Resuscitation 2012;83:797–802. 96.Szyld E, Aguilar A, Musante GA, et al. Comparison of devices fornewborn ventilation in the delivery room. J Pediatr2014;165:234–9.e3. 97.Foglia EE, Owen LS, Thio M, et al. Sustained Aeration of In-fant Lungs (SAIL) trial: study protocol for a randomized con-trolled trial. Trials 2015;16:95. 98.Thome UH, Ambalavanan N. Permissive hypercapniato decrea-se lung injury in ventilated preterm neonates. Semin Fetal Neo-natal Med 2009;14:21–7. 99.Hummler H, Schulze A. New and alternative modes ofmecha-nical ventilation in neonates. Semin FetalNeonatal Med2009;14:42–8. 100.Guven S, Bozdag S, Saner H, et al. Early neonatal outcomesofvolume guaranteed ventilation in Preterm infants with respira-tory distress syndrome. J MaternFetal Neonatal Med2013;26:396–401. 101.Özkan H, Duman N, Kumral A, Gülcan H. Synchronized ven-tilation of very-low-birth-weight infants; report of 6 years’ ex-perience. J Matern FetalNeonatal Med 2004;15:261–5. 102.Warren JB, Anderson JM. Core concepts. NeoReviews2009;10:e351–61. 103.Bohlin K. RDS–CPAP or surfactant or both. Acta Paediatr OsloNor 1992 2012;101:24–8. 104.Blennow M, Bohlin K. Surfactant and noninvasive ventilation.Neonatology 2015;107:330–6. 105.Rojas-Reyes MX, Morley CJ, Soll R. Prophylactic versus selec-tive use of surfactant in preventing morbidity and mortality inpreterm infants. Cochrane Database Syst Rev 2012;CD000510. 106.Sweet DG, Carnielli V, Greisen G, et al. European consensusguidelines on the management of neonatal respiratory distresssyndrome in preterm infants – 2010 update. Neonatology2010;97:402–17. 107.Rojas MA, Lozano JM, Rojas MX, et al. Very early surfactantwithout mandatory ventilation in premature infants treated withearly continuous positive airway pressure: a randomized,controlled trial. Pediatrics 2009;123:137–42. 108.Kandraju H, Murki S, Subramanian S, et al. Early routine versuslate selective surfactant in preterm neonates with respiratory dis-tress syndrome on nasal continuous positive airway pressure: a ran-domized controlled trial. Neonatology 2013;103: 148–54. 109.Verder H, Agertoft L, Albertsen P, et al. Surfactant treatment ofnewborn infants with respiratory distress syndrome primarily trea-ted with nasal continuous positive air pressure. A pilot study.Ugeskr Laeger 1992;154:2136–9 [Article in Danish ]. 110.Stevens TP, Harrington EW, Blennow M, Soll RF. Early sur-factant administration with brief ventilation vs. selective sur-factant and continued mechanical ventilation for preterm infantswith or at risk for respiratory distress syndrome. Cochrane Da-tabase Syst Rev 2007;CD003063. 111.Bahadue FL, Soll R. Early versus delayed selective surfactanttreatment for neonatal respiratory distress syndrome. Cochra-ne Database Syst Rev. 2012;11:CD001456. 112.Göpel W, Kribs A, Ziegler A, Laux R, Hoehn T, Wieg C, et al:Avoidance of mechanical ventilation by surfactant treatment ofspontaneously breathing preterm infants (AMV): an open-la-bel, randomised, controlled trial. Lancet 2011; 378: 1627–1633. 113.Dargaville PA, Aiyappan A, de Paoli AG, Kuschel CA, Kam-lin CO, Carlin JB, Davis PG: Minimally invasive surfactant the-rapy in Preterm infants on continuous positive airway pressu-re. Arch Dis Child Fetal Neonatal Ed 2013; 98:F122–F126. 114.Conway-Orgel M. Management of hypotension in the very low-birth-weight infant during the golden hour. Adv Neonatal Care2010;10:241–5. 115.Binder-Heschl C, Urlesberger B, Schwaberger B, et al. Border-line hypotension: how does it influence cerebral regional tis-sue oxygenation in preterm infants? J Matern Fetal NeonatalMed 2016;29:2341–6. 116.Seri I, Evans J. Controversies in the diagnosis and managementof hypotension in the newborn infant. Curr Opin Pediatr2001;13:116–23. 117.Vento M, Lista G. Managing preterm infants in the first minu-tes of life. Paediatr Respir Rev. 2015 Jun;16(3):151-6. doi:10.1016/j.prrv.2015.02.004.