Figure 4.

Suggested steps to be followed in very preterm delivery. The main issues in the delivery room are (i) maintaining an adequate body temperature and avoiding hypothermia; (ii) improving hemodynamics stability, delaying cord clamping, or including an obstetrician or midwife in the first seconds of neonatal stimulation; (iii) in spontaneously breathing babies, providing non-invasive ventilation with mask or nasal prongs CPAP, trying to avoid intubation. If the respiratory efforts are insufficient to achieve an adequate FRC, IPPV with PEEP should be provided. (iv) In apneic babies, initial non-invasive ventilation with IPPV and PEEP should be provided. If IPPV and PEEP are not efficient, intubation is required. (v) Initial FiO₂ of 0.21 to 0.3 should be titrated using an air/oxygen blender according to HR and SPO₂ response. Modified from Vento et al. Pediatr Respir Rev. (2015) [8]. Abbreviations: GA: Gestational age; w: Week; sec: Second; DCC: Delayed cord clamping; min: Minute; CPAP: Continuous positive airway pressure; IPPV: Intermittent positive pressure ventilation; PEEP: Positive-end expiratory pressure; iFiO₂: Initial fraction of inspired oxygen; AHA: American Heart Association; SpO₂: Oxygen saturation.