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Ortiz-Movilla R, Beato-Merino M, Funes Moñux RM, Martínez-Bernat L, Domingo-Comeche L, Royuela-Vicente A, Román-Riechmann E, Marín-Gabriel MÁ. What is the Opinion of the Health Care Personnel Regarding the Use of Different Assistive Tools to Improve the Quality of Neonatal Resuscitation? Am J Perinatol 2024. [PMID: 38190977 DOI: 10.1055/a-2240-2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE It is important to determine whether the use of different quality improvement tools in neonatal resuscitation is well-received by health care teams and improves coordination and perceived quality of the stabilization of the newborn at birth. This study aimed to explore the satisfaction of personnel involved in resuscitation for infants under 32 weeks of gestational age (<32 wGA) at birth with the use of an assistance toolkit: Random Real-time Safety Audits (RRSA) of neonatal stabilization stations, the use of pre-resuscitation checklists, and the implementation of briefings and debriefings. STUDY DESIGN A quasi-experimental, prospective, multicenter intervention study was conducted in five level III-A neonatal intensive care units in Madrid (Spain). The intervention involved conducting weekly RRSA of neonatal resuscitation stations and the systematic use of checklists, briefings, and debriefings during stabilization at birth for infants <32 wGA. The satisfaction with their use was analyzed through surveys conducted with the personnel responsible for resuscitating these newborns. These surveys were conducted both before and after the intervention phase (each lasting 1 year) and used a Likert scale response model to assess various aspects of the utility of the introduced assistance tools, team coordination, and perceived quality of the resuscitation. RESULTS Comparison of data from 200 preintervention surveys and 155 postintervention surveys revealed statistically significant differences (p < 0.001) between the two phases. The postintervention phase scored higher in all aspects related to the effective utilization of these tools. Improvements were observed in team coordination and the perceived quality of neonatal resuscitation. These improved scores were consistent across personnel roles and years of experience. CONCLUSION Personnel attending to infants <32 wGA in the delivery room are satisfied with the application of RRSA, checklists, briefings, and debriefings in the neonatal resuscitation and perceive a higher level of quality in the stabilization of these newborns following the introduction of these tools. KEY POINTS · RRSA, checklists, briefings, and debriefings improve the quality of neonatal resuscitation at birth.. · These tools, when used together, are well-received and enhance perceived resuscitation quality.. · Perception of utility and quality improvement is consistent across roles and experience..
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Affiliation(s)
- Roberto Ortiz-Movilla
- Pediatric Service, Neonatology Unit, Puerta de Hierro-Majadahonda University Hospital, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain
| | - Maite Beato-Merino
- Pediatric Service, Neonatology Unit, Severo Ochoa University Hospital, Leganés, Madrid, Spain
| | - Rosa María Funes Moñux
- Pediatric Service, Neonatology Unit, Príncipe de Asturias University Hospital, Universidad de Alcalá de Henares, Madrid, Spain
| | - Lucía Martínez-Bernat
- Pediatric Service, Neonatology Unit, Getafe University Hospital, Getafe, Madrid, Spain
| | - Laura Domingo-Comeche
- Pediatric Service, Neonatology Unit, Fuenlabrada University Hospital, Fuenlabrada, Madrid, Spain
| | - Ana Royuela-Vicente
- Biostatistics Unit, Puerta de Hierro Biomedical Research Institute, CIBERESP, Madrid, Spain
| | - Enriqueta Román-Riechmann
- Pediatric Service, Puerta de Hierro-Majadahonda University Hospital, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain
| | - Miguel Ángel Marín-Gabriel
- Pediatric Service, Neonatology Unit, Puerta de Hierro-Majadahonda University Hospital, Universidad Autónoma de Madrid, Majadahonda, Madrid, Spain
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Porta R, García-Muñoz Rodrigo F, Avila-Alvarez A, Ventura PS, Izquierdo Renau M, Ginovart G. Active approach in delivery room and survival of infants born between 22 and 26 gestational weeks are increasing in Spain. Acta Paediatr 2023; 112:417-423. [PMID: 36515614 DOI: 10.1111/apa.16625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
AIM To describe the trends in the delivery room approach and survival of extremely premature infants over the past two decades. METHODS Time-series analysis of infants included in the Spanish SEN1500 network from 2004 to 2019. Patients born from 22 + 0 to 26 + 6 weeks were included. The primary outcome was an active approach in the delivery room. Survival and temporal trends were also studied. RESULTS The study population included 8284 patients. At 22 and 23 weeks, an active approach was followed in 41.4% and 80.8%. A temporal trend toward a more active approach was observed at 23 weeks. Antenatal steroids were administered in 19.6% and 58.1% at 22 and 23 weeks. From 24 weeks, an active approach was applied in nearly all cases throughout the period, and more than 80% of patients received antenatal steroids. The rates of survival after an active approach were 8.7%, 21.6%, 40.6%, 59.9%, and 74.7% at 22, 23, 24, 25, and 26 weeks and significantly increased over the period, except for infants born at 22 weeks. CONCLUSION Active management and survival of infants born from 23 weeks increased over the period, but the frequency of antenatal steroid administration was lower than the intention to resuscitate.
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Affiliation(s)
- Roser Porta
- Division of Neonatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Alejandro Avila-Alvarez
- Division of Neonatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Paula Sol Ventura
- Division of Neonatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Gemma Ginovart
- Division of Neonatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
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Combined application of various quality assessment tools in neonatal resuscitation. An Pediatr (Barc) 2022; 97:405-414. [PMID: 36257893 DOI: 10.1016/j.anpede.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION In neonatal resuscitation, it is important to know whether the use of a combination of quality assessment tools has an impact on the preparation of the resuscitation bed and equipment, the correct performance of the procedure and the clinical outcomes of the most vulnerable neonates. MATERIAL AND METHODS Multicentre, prospective, quasi-experimental interventional study in five level III-A neonatal units. In the pre- and post-intervention phases, both of which lasted 1 year, there were weekly random audits of the stabilization beds in the delivery room to assess their preparation. In the post-intervention phase, checklists, briefings and debriefings were used in the resuscitation of neonates delivered before 32 weeks. We compared the performance of the procedure and early post-resuscitation outcomes in the 2 periods. RESULTS Total of 852 audits were carried out in the pre-intervention period and 877 in the post-intervention period. There was a greater percentage of audits that did not identify defects in the second phase (63% vs 81%; P < .001). The first phase included 75 resuscitations and the second 48, out of which all the quality assessment tools had been used in 36 (75%). We did not find any differences in the main clinical variables during stabilization, although we observed a trend towards fewer technical problems during the procedure in the second period. CONCLUSIONS The use of random audits, checklists, briefings and debriefings in the resuscitation of newborns delivered before 32 weeks is feasible but has no impact on short-term clinical outcomes or correct performance of the procedure. Audits of neonatal resuscitation beds significantly improved their preparation.
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Porta R, Ventura PS, Ginovart G, García-Muñoz F, Ávila-Alvarez A, Izquierdo M. Changes in perinatal management and outcomes in infants born at 23 weeks of gestational age during the last decade in Spain. J Matern Fetal Neonatal Med 2022; 35:10296-10304. [PMID: 36176058 DOI: 10.1080/14767058.2022.2122801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The 2021-updated guidelines of the Spanish Society of Neonatology Guidelines have moved the zone of parental discretion to 23 + 0-23 + 6 weeks. The objective of this study was to describe the changes in perinatal management at this gestational age along the last decade and to determine if a more active perinatal management has contributed to improved outcomes. METHODS Retrospective analysis of prospectively collected data from the 23-week infants included in the Spanish SEN 1500 neonatal network during the period 2010-2019. The main study outcomes were survival at discharge and survival without major morbidity of actively managed infants. Two periods were compared: 2010-2014 (Period 1) and 2015-2019 (Period 2). NICUs were classified into low activity NICUs (less than 50 admissions of very low birth weight infants per year) and high activity NICUs (50 or more admissions). RESULTS A total of 381 infants were included, 182 in Period 1 and 199 in Period 2. In Period 2 an increase in the use of intrapartum magnesium sulfate (21.5% vs 39.9%, p .002), antenatal steroids (56.6% vs 69.3%, p .011) and active neonatal approach in delivery room (76.9% vs 86.9%, p .011) were observed.The clinical outcomes of the actively managed 313 infants were similar in both periods, except for less arterial hypotension in Period 2. Survival was 27.1% in Period 1 and 25% in Period 2 (p .068) and survival without major morbidity was 2.1% and 2.3% respectively (p .914). No difference was found between low and high activity NICUs. CONCLUSION A change to a more active intention to treat infants born at 23 weeks is taking place in Spain. But the survival rate of the actively-managed infants has remained stable around 25-30% during the study period. A multidisciplinary effort is needed to improve outcomes in this population.
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Affiliation(s)
- Roser Porta
- Neonatology Unit, Paediatric Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Paula Sol Ventura
- Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona, Spain
| | - Gemma Ginovart
- Neonatology Unit, Paediatric Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Fermín García-Muñoz
- Division of Neonatology, Complejo Hospitalario Universitario Insular-Materno-Infantil, Las Palmas, Spain
| | - Alejandro Ávila-Alvarez
- Division of Neonatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, A Coruña, Spain
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Ortiz Movilla R, Funes Moñux RM, Domingo Comeche L, Beato Merino M, Martínez Bernat L, Royuela Vicente A, Román Riechmann E, Marín Gabriel MÁ. Aplicación conjunta de diversas herramientas de calidad en la reanimación neonatal. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fernandez-Gonzalez SM, Sucasas Alonso A, Ogando Martinez A, Avila-Alvarez A. Incidence, Predictors and Outcomes of Noninvasive Ventilation Failure in Very Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2022; 9:426. [PMID: 35327798 PMCID: PMC8947251 DOI: 10.3390/children9030426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/26/2022]
Abstract
Non-invasive ventilation (NIV) is now considered the first-line treatment for respiratory distress syndrome in preterm infants. We aimed to evaluate the rates of non-invasive ventilation failure rate in very preterm infants, as well as to identify its predictors and associated outcomes. We designed a single-center retrospective cohort study including infants ≤32 weeks gestational age and ≤1500 g. The NIV failure was defined as the need for intubation at <72 h of life. After applying inclusion and exclusion criteria, 154 patients were included in the study, with a mean GA of 29.7 ± two weeks. The NIV failure rate was 16.2% (n = 25) and it was associated with lower bronchopulmonary dysplasia (BPD)-free survival (OR 0.08; 95% CI 0.02−0.32) and higher incidence of intraventricular hemorrhage > II (OR 6.22; 95% CI 1.36−28.3). These infants were significantly smaller in GA and weight. Higher FiO2 during resuscitation (OR 1.14; 95% CI 1.06−1.22) and after surfactant administration (OR 1.17; 95% CI 1.05−1.31) represented independent risk factors for NIV failure. In conclusion, NIV failure is frequent and it could be predicted by a higher oxygen requirement during resuscitation and a modest response to surfactant therapy. Importantly, this NIV failure is associated with worse clinical outcomes.
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Affiliation(s)
- Sara M. Fernandez-Gonzalez
- Neonatology Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain; (S.M.F.-G.); (A.S.A.); (A.O.M.)
| | - Andrea Sucasas Alonso
- Neonatology Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain; (S.M.F.-G.); (A.S.A.); (A.O.M.)
| | - Alicia Ogando Martinez
- Neonatology Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain; (S.M.F.-G.); (A.S.A.); (A.O.M.)
| | - Alejandro Avila-Alvarez
- Neonatology Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Spain; (S.M.F.-G.); (A.S.A.); (A.O.M.)
- A Coruña Biomedical Research Institute (INIBIC), 15006 A Coruña, Spain
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Zeballos Sarrato G, Ávila-Álvarez A, Escrig Fernández R, Izquierdo Renau M, Ruiz Campillo CW, Gómez Robles C, Iriondo Sanz M. Spanish guide for neonatal stabilization and resuscitation 2021: Analysis, adaptation and consensus on international recommendations. An Pediatr (Barc) 2022; 96:145.e1-145.e9. [PMID: 35216951 DOI: 10.1016/j.anpede.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022] Open
Abstract
After the publication of the recommendations, agreed by all the scientific societies through the ILCOR, at the end of 2020, the GRN-SENeo began a process of analysis and review of the main changes since the last guidelines, to which a specific consensus positioning on controversial issues, trying to avoid ambiguities and trying to adapt the evidence to our environment. This text summarizes the main conclusions of this work and reflects the positioning of that group.
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Affiliation(s)
| | - Alejandro Ávila-Álvarez
- Unidad de Neonatología, Servicio de Pediatría, Complexo Hospitalario Universitario, A Coruña (CHUAC), Sergas, A Coruña, Spain
| | | | - Montserrat Izquierdo Renau
- Servicio de Neonatología, Sant Joan de Déu, BCNatal, Hospital Sant Joan de Déu-Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | | | - Celia Gómez Robles
- Servicio de Neonatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Martín Iriondo Sanz
- Servicio de Neonatología, Sant Joan de Déu, BCNatal, Hospital Sant Joan de Déu-Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
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Pescador Chamorro MI, Zeballos Sarrato SE, Marsinyach Ros MI, Zeballos Sarrato G, Márquez Isidro EM, Sánchez Luna M. Training, experience and need of booster courses in neonatal cardiopulmonary resuscitation. Survey to pediatricians. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 96:122-129. [DOI: 10.1016/j.anpede.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022] Open
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Zeballos Sarrato G, Avila-Alvarez A, Escrig Fernández R, Izquierdo Renau M, Ruiz Campillo CW, Gómez Robles C, Iriondo Sanz M. [Spanish guide for neonatal stabilization and resuscitation 2021: Analysis, adaptation and consensus on international recommendations]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00213-7. [PMID: 34304987 DOI: 10.1016/j.anpedi.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/24/2022] Open
Abstract
After the publication of the recommendations, agreed by all the scientific societies through the ILCOR, at the end of 2020, the GRN-SENeo began a process of analysis and review of the main changes since the last guidelines, to which a specific consensus positioning on controversial issues, trying to avoid ambiguities and trying to adapt the evidence to our environment. This text summarizes the main conclusions of this work and reflects the positioning of that group.
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Affiliation(s)
| | - Alejandro Avila-Alvarez
- Unidad de Neonatología, Servicio de Pediatría, Complexo Hospitalario Universitario, A Coruña (CHUAC), Sergas, A Coruña, España
| | | | - Montserrat Izquierdo Renau
- Servicio de Neonatología, Sant Joan de Déu, BCNatal, Hospital Sant Joan de Déu-Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | | | - Celia Gómez Robles
- Servicio de Neonatología, Hospital Regional Universitario de Málaga, Málaga, España
| | - Martín Iriondo Sanz
- Servicio de Neonatología, Sant Joan de Déu, BCNatal, Hospital Sant Joan de Déu-Hospital Clínic, Universidad de Barcelona, Barcelona, España
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Sucasas Alonso A, Pértega Díaz S, Sáez Soto R, Ávila-Álvarez A. [Epidemiology and risk factors for bronchopulmonary dysplasia in prematures infants born at or less than 32 weeks of gestation]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00153-3. [PMID: 33814331 DOI: 10.1016/j.anpedi.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/18/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To describe risk factors of bronchopulmonary dysplasia in very preterm infants in the first weeks of life. MATERIAL AND METHODS Retrospective cohort study of preterm infants ≤ 32 weeks of gestational age and birth weight ≤ 1500 g. A multivariate logistic regression analysis was performed to identify independent risk factors for bronchopulmonary dysplasia in the first weeks of life. RESULTS A total of 202 newborns were included in the study (mean gestational age 29.5 ± 2.1 weeks), 61.4% never received invasive mechanical ventilation. The incidence of bronchopulmonary dysplasia was 28.7%, and 10.4% of the patients were diagnosed with moderate-severe bronchopulmonary dysplasia. Bronchopulmonary dysplasia was independently associated with gestational age at birth (p < 0.001; OR = 0.44 [95% CI = 0.30-0.65]), the need for mechanical ventilation on the first day of life (p = 0.001; OR = 8.13 [95% CI = 2.41-27.42]), nosocomial sepsis (p < 0.001; OR = 9.51 [95% CI = 2.99-30.28]) and FiO2 on day 14 (p < 0.001; OR = 1.39 [95% CI = 1.16-1.66]). Receiving mechanical ventilation at the first day of life (p = 0.008; OR = 5.39 [95% CI = 1.54-18.89]) and at the third day of life (p = 0.001; OR = 9.99 [95% CI = 2.47-40.44]) and nosocomial sepsis (p = 0.001; OR = 9.87 [95% CI = 2.58-37.80]) were independent risk factors for moderate-severe bronchopulmonary dysplasia. CONCLUSIONS Gestational age at birth, mechanical ventilation in the first days of life and nosocomial sepsis are early risk factors for bronchopulmonary dysplasia. The analysis of simple and objective clinical data, allows us to select a group of patients at high risk of bronchopulmonary dysplasia in whom it could be justified to act more aggressively, and shows areas for improvement to prevent its development or reduce its severity.
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Affiliation(s)
- Andrea Sucasas Alonso
- Unidad de Neonatología, Servicio de Pediatría, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, A Coruña, España
| | - Sonia Pértega Díaz
- Unidad de Apoyo a la Investigación, Complexo Hospitalario Universitario A Coruña (CHUAC), SERGAS. Universidade da Coruña (UDC), A Coruña, España
| | - Rebeca Sáez Soto
- Unidad de Neonatología, Servicio de Pediatría, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, A Coruña, España
| | - Alejandro Ávila-Álvarez
- Unidad de Neonatología, Servicio de Pediatría, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, A Coruña, España; Instituto de Investigación Biomédica A Coruña (INIBIC), SERGAS, A Coruña, España.
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Recommendations on cardiopulmonary resuscitation in patients with suspected or confirmed SARS-CoV-2 infection (COVID-19). Executive summary. MEDICINA INTENSIVA (ENGLISH EDITION) 2020. [PMCID: PMC7667400 DOI: 10.1016/j.medine.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The SARS-CoV-2 pandemic has created new scenarios that require modifications to the usual cardiopulmonary resuscitation protocols. The current clinical guidelines on the management of cardiorespiratory arrest do not include recommendations for situations that apply to this context. Therefore, the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), in collaboration with the Spanish Group of Pediatric and Neonatal CPR and with the Teaching Life Support in Primary Care program of the Spanish Society of Family and Community Medicine (SEMFyC), have written these recommendations, which are divided into five parts that address the main aspects for each healthcare setting. This article consists of an executive summary of them.
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Abstract
Babies born at the limit of viability have a high risk of morbidity and mortality. Despite great advances in science, the approach to these newborns remains challenging. Thus, this study reviewed the literature regarding the treatment of newborns at the limit of viability. There are several interventions that can be applied before and after birth to increase the baby's survival with the least sequelae possible, but different countries make different recommendations on the gestational age that each treatment should be given. There is more consensus on the extremities of viability, being that, at the lower extremity, comfort care is preferred and active care in newborns with higher gestational age. The higher the gestational age at birth, the higher the survival and survival without morbidity rates. At all gestational ages, it is important to take into account the suffering of these babies and to provide them the best quality of life possible. Sometimes palliative care is the best therapeutic approach. The parents of these babies should be included in the decision-making process, if they wish, always respecting their needs and wishes. Nevertheless, the process of having such an immature child can be very painful for parents, so it is also important to take into account their suffering and provide them with all the necessary support. This support should be maintained even after the death of the newborn.
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Affiliation(s)
- Ana Lemos
- Faculty of Medicine, University of Porto, Porto, Portugal -
| | - Henrique Soares
- Faculty of Medicine, University of Porto, Porto, Portugal.,Neonatal Intensive Care Unit, Department of Pediatrics, São João University Hospital, Porto, Portugal
| | - Hercília Guimarães
- Faculty of Medicine, University of Porto, Porto, Portugal.,Neonatal Intensive Care Unit, Department of Pediatrics, São João University Hospital, Porto, Portugal.,Unit of Cardiovascular Research and Development, Faculty of Medicine, University of Porto, Porto, Portugal
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Rodríguez Yago MA, Alcalde Mayayo I, Gómez López R, Parias Ángel MN, Pérez Miranda A, Canals Aracil M, Civantos Fuentes E, Rodríguez Núñez A, Manrique Martínez I, López-Herce Cid J, Zeballos Sarrato G, Calvo Macías C, Hernández-Tejedor A. [Recommendations on cardiopulmonary resuscitation in patients with suspected or confirmed SARS-CoV-2 infection (COVID-19). Executive summary]. Med Intensiva 2020; 44:566-576. [PMID: 32425289 PMCID: PMC7229968 DOI: 10.1016/j.medin.2020.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
La pandemia por SARS-CoV-2 ha generado nuevos escenarios que requieren modificaciones de los protocolos habituales de reanimación cardiopulmonar. Las guías clínicas vigentes sobre el manejo de la parada cardiorrespiratoria no incluyen recomendaciones para situaciones aplicables a este contexto. Por ello, el Plan Nacional de Reanimación Cardiopulmonar de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias, en colaboración con el Grupo Español de RCP Pediátrica y Neonatal y con el programa de Enseñanza de Soporte Vital en Atención Primaria de la Sociedad Española de Medicina Familiar y Comunitaria, ha redactado las siguientes recomendaciones, que están divididas en 5 partes que tratan los principales aspectos para cada entorno asistencial. En este artículo se presenta un resumen ejecutivo de las mismas.
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Affiliation(s)
- M A Rodríguez Yago
- Servicio de Medicina Intensiva, Hospital Universitari Son Espases, Palma, España.
| | - I Alcalde Mayayo
- Servicio de Medicina Intensiva, Hospital QuirónSalud Palma Planas, Palma, España
| | - R Gómez López
- Servicio de Medicina Intensiva, Hospital QuirónSalud Miguel Domínguez, Pontevedra, España
| | - M N Parias Ángel
- Servicio de Medicina Intensiva, Hospital Santa Bárbara, Puertollano, España
| | - A Pérez Miranda
- Servicio de Urgencias, Hospital Nuestra Señora de los Reyes, Valverde, El Hierro, España
| | | | | | - A Rodríguez Núñez
- Unidad de Cuidados Intensivos Pediátricos, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - I Manrique Martínez
- Presidente del GERCPyN. Instituto Valenciano de Pediatría y Puericultura, Valencia, España
| | - J López-Herce Cid
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - G Zeballos Sarrato
- Servicio de Neonatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - C Calvo Macías
- Coordinador del Grupo de Trabajo de RCP Pediátrica y Neonatal del CERP, Málaga, España
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Lara-Cantón I, Solaz A, Parra-Llorca A, García-Robles A, Millán I, Torres-Cuevas I, Vento M. Oxygen Supplementation During Preterm Stabilization and the Relevance of the First 5 min After Birth. Front Pediatr 2020; 8:12. [PMID: 32083039 PMCID: PMC7005009 DOI: 10.3389/fped.2020.00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/10/2020] [Indexed: 11/26/2022] Open
Abstract
Fetal to neonatal transition entails cardiorespiratory, hemodynamic, and metabolic changes coinciding with the switch from placental to airborne respiration with partial pressures of oxygen of 4-5 kPa in utero raising to 8-9 kPa ex utero in few minutes. Preterm infants have immature lung and antioxidant defense system. Very preterm infants (<32 weeks' gestation) frequently require positive pressure ventilation and oxygen to establish lung aeration, a functional residual capacity, and overcome a tendency toward hypoxemia and bradycardia in the first minutes after birth. Recent studies have shown that prolonged bradycardia (heart rate <100 beats per minute) and/or hypoxemia (oxygen saturation <80%) are associated with increased mortality and/or intracranial hemorrhage. However, despite the accumulated evidence, the way in which oxygen should be supplemented in the first minutes after birth still has not yet been clearly established. The initial inspired fraction of oxygen and its adjustment within a safe arterial oxygen saturation range measured by pulse oximetry that avoids hyper-or-hypoxia is still a matter of debate. Herewith, we present a current summary aiming to assist the practical neonatologist who has to aerate the lung and establish an efficacious respiration in very preterm infants in the delivery room.
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Affiliation(s)
| | - Alvaro Solaz
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Anna Parra-Llorca
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Ana García-Robles
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Ivan Millán
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | | | - Maximo Vento
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
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Alvarez-Fuente M, Moreno L, Lopez-Ortego P, Arruza L, Avila-Alvarez A, Muro M, Gutierrez E, Zozaya C, Sanchez-Helguera G, Elorza D, Martinez-Ramas A, Villar G, Labrandero C, Martinez L, Casado T, Cuadrado I, Del Cerro MJ. Exploring clinical, echocardiographic and molecular biomarkers to predict bronchopulmonary dysplasia. PLoS One 2019; 14:e0213210. [PMID: 30840669 PMCID: PMC6402695 DOI: 10.1371/journal.pone.0213210] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/15/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in childhood, related to prematurity, and the most common cause of pulmonary hypertension (PH) secondary to pulmonary disease in children. Moderate and severe BPD have a worse outcome and relate more frequently with PH. The prediction of moderate or severe BPD development in extremely premature newborns is vital to implement preventive strategies. Starting with the hypothesis that molecular biomarkers were better than clinical and echocardiographic factors, this study aims to explore the ability of clinical, echocardiographic and analytical variables to predict moderate or severe BPD in a cohort of extremely preterm infants. Patients and methods We designed a prospective longitudinal study, in which we followed a cohort of preterm newborns (gestational age <28 weeks and weight ≤ 1250 grams). In these newborns we recorded weekly clinical and echocardiographic variables as well as blood and tracheal aspirate samples, to analyze molecular biomarkers (IL-6, IL-1, IP10, uric acid, HGF, endothelin-1, VEGF, CCL5). Variables and samples were collected since birth up to week 36 (postmenstrual age), time-point at which the diagnosis of BPD is established. Results We included 50 patients with a median gestational age of 26 weeks (IQR 25–27) and weight of 871 g (SD 161,0) (range 590-1200g). Three patients were excluded due to an early death. Thirty-five patients (74.5%) developed BPD (mild n = 14, moderate n = 15, severe n = 6). We performed a logistic regression in order to identify risk factors for moderate or severe BPD. We compared two predictive models, one with two variables (mechanical ventilation and inter-ventricular septum flattening), and another-one with an additional molecular biomarker (ET-1). Conclusions The combination of clinical and echocardiographic variables is a valuable tool for determining the risk of BPD. We find the two variable model (mechanical ventilation and echocardiographic signs of PH) more practical for clinical and research purposes. Future research on BPD prediction should be oriented to explore the potential role of ET-1.
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Affiliation(s)
- Maria Alvarez-Fuente
- Pediatric Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Laura Moreno
- Department of Pharmacology, School of Medicine, University Complutense of Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | | | - Luis Arruza
- Neonatology Department, Institute of the Child and Adolescent, Clínico San Carlos University Hospital-IdISSC, Madrid, Spain
| | | | - Marta Muro
- Neonatology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Enrique Gutierrez
- Public Health and Preventive Medicine Unit, School of Public Health- Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Zozaya
- Neonatology Department, La Paz University Hospital, Madrid, Spain
| | | | - Dolores Elorza
- Neonatology Department, La Paz University Hospital, Madrid, Spain
| | - Andrea Martinez-Ramas
- Department of Pharmacology, School of Medicine, University Complutense of Madrid, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gema Villar
- Neonatology Department, Getafe University Hospital, Getafe, Madrid, Spain
| | - Carlos Labrandero
- Pediatric Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Lucia Martinez
- Neonatology Department, Getafe University Hospital, Getafe, Madrid, Spain
| | - Teresa Casado
- Pediatric Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Irene Cuadrado
- Neonatology Department, Getafe University Hospital, Getafe, Madrid, Spain
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López-Herce Cid J, Rodríguez Núñez A, Carrillo Álvarez Á, Zeballos Sarrato G, Martínez Fernández-Llamazares C, Calvo Macías C. Materials for the paediatric resuscitation trolley or backpack: Expert recommendations. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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17
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López-Herce Cid J, Rodríguez Núñez A, Carrillo Álvarez Á, Zeballos Sarrato G, Martínez Fernández-Llamazares C, Calvo Macías C. [Materials for the paediatric resuscitation trolley or backpack: Expert recommendations]. An Pediatr (Barc) 2017; 88:173.e1-173.e7. [PMID: 28688610 DOI: 10.1016/j.anpedi.2017.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/15/2017] [Accepted: 05/25/2017] [Indexed: 11/25/2022] Open
Abstract
Cardio-respiratory arrest (CPA) is infrequent in children, but it can occur in any place and at any time. This fact means that every health care facility must always have the staff and material ready to resuscitate a child. These recommendations are the consensus of experts of the Spanish Paediatric and Neonatal Resuscitation Group on the material and medication for paediatric and neonatal resuscitation and their distribution and use. CPR trolleys and backpacks must include the essential material to quickly and efficiently perform a paediatric CPR. At least one CPR trolley must be available in every Primary Care facility, Paediatric Intensive Care Unit, Emergency Department, and Pre-hospital Emergency Areas, as well as in paediatric wards, paediatric ambulatory areas, and radiology suites. This trolley must be easily accessible and exclusively include the essential items to perform a CPR and to assist children (from newborns to adolescents) who present with a life-threatening event. Such material must be familiar to all healthcare staff and also include the needed spare parts, as well as enough drug doses. It must also be re-checked periodically. The standardisation and unification of the material and medication of paediatric CPR carts, trolleys, and backpacks, as well as the training of the personnel in their use are an essential part of the paediatric CPR.
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Affiliation(s)
- Jesús López-Herce Cid
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Facultad de Medicina. Universidad Complutense de Madrid. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal. Red de Salud Maternoinfantil y del Desarrollo (RedSAMID). RETICS financiada por el PN I+D+I 2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD16/0022.
| | - Antonio Rodríguez Núñez
- Área de Pediatría, Servicio de Críticos, Intermedios y Urgencias Pediátricas. Hospital Clínico Universitario de Santiago de Compostela. Departamento de Radiología, Psiquiatría, Salud Pública, Enfermería y Medicina de la Universidad de Santiago de Compostela (USC). Grupos de Investigación CLINURSID (USC) y Soporte Vital y Simulación (Instituto de Investigación de Santiago). Instituto de Investigación de Santiago (IDIS). Red de Salud Maternoinfantil (SAMID II). RETICS financiada por el PN 2018-2011, el ISCIII- Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER) ref: RD16/0022
| | - Ángel Carrillo Álvarez
- Servicio de Cuidados Intensivos Pediátricos. Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Facultad de Medicina. Universidad Complutense de Madrid. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal. Red de Salud Maternoinfantil y del Desarrollo (RedSAMID). RETICS financiada por el PN I+D+I 2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD16/0022
| | - Gonzalo Zeballos Sarrato
- Servicio de Neonatología. Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
| | - Cecilia Martínez Fernández-Llamazares
- Servicio de Farmacia. Hospital General Universitario Gregorio Marañón de Madrid. Instituto de investigación sanitaria del Hospital Gregorio Marañón. Red de Salud Maternoinfantil y del Desarrollo (RedSAMID). RETICS financiada por el PN I+D+I 2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD16/0022
| | - Custodio Calvo Macías
- Emérito SAS. Asociado a UGC Críticos y Urgencias Pediátricas. Hospital Regional Universitario de Málaga. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal
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