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Ni Chathasaigh CM, Smiles L, O'Currain E, Curley AE. Integration of a respiratory function monitor into newborn positive pressure ventilation training; development of a standardised training intervention. Resusc Plus 2024; 18:100602. [PMID: 38495224 PMCID: PMC10940760 DOI: 10.1016/j.resplu.2024.100602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
Objective One in twenty newborns require resuscitation with positive pressure ventilation (PPV) at birth. Newborn face mask ventilation is often poorly performed. To address this, the potential role of respiratory function monitors (RFM) in newborn resuscitation training has been highlighted. The objective of this study was to develop a standardised training intervention on newborn PPV using an RFM with a simple visual display to identify and correct suboptimal ventilations. Methods We adapted the framework from a simulation development guideline to create a hands-on intervention on newborn PPV using an RFM with simple visual feedback (Monivent NeoTraining). We enrolled a group of healthcare professionals to a manikin-based pilot study as part of this process, conducting a series of teaching sessions to refine the intervention. Suggested changes were gathered from participants and instructors. Our main objective was to develop a standardised, reproducible training intervention. Results A standardised training intervention on newborn PPV was systematically developed. Twenty-six healthcare professionals working in tertiary neonatal care participated in a pilot study, consisting of eight training sessions. Each iteration of the intervention was informed by the previous session. Instructions for the delivery of teaching were standardised and a training algorithm was developed. Conclusion RFM's have been shown to be effective tools in research settings, addressing poor technique and face mask leak. They are not routinely used in newborn resuscitation training. To address this, we developed a standardised training intervention on newborn PPV using an RFM with simple visual feedback.
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Affiliation(s)
- CM Ni Chathasaigh
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Ireland
| | - L Smiles
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
| | - E O'Currain
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Ireland
| | - AE Curley
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Ireland
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Diggikar S, Ramaswamy VV, Koo J, Prasath A, Schmölzer GM. Positive Pressure Ventilation in Preterm Infants in the Delivery Room: A Review of Current Practices, Challenges, and Emerging Technologies. Neonatology 2024; 121:288-297. [PMID: 38467119 DOI: 10.1159/000537800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/05/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND A major proportion of preterm neonates require positive pressure ventilation (PPV) immediately after delivery. PPV may be administered through a face mask (FM) or nasal prongs. Current literature indicates that either of these are associated with similar outcomes. SUMMARY Nonetheless, FM remains the most utilized and the best choice. However, most available FM sizes are too large for extremely preterm infants, which leads to mask leak and ineffective PPV. Challenges to providing effective PPV include poor respiratory drive, complaint chest wall, weak thoracic muscle, delayed liquid clearance, and surfactant deficiency in preterm infants. Mask leak, airway obstruction, poor technique, and inappropriate size are correctable causes of ineffective PPV. Visual assessment of chest rise is often used to assess the efficacy of PPV. However, its accuracy is debatable. Though end tidal CO2 may adjudge the effectiveness of PPV, clinical studies are limited. The compliance of a preterm lung is highly dynamic. The inflating pressure set on T-piece is constant throughout the resuscitation, but the lung volume and dynamics changes with every breath. This leads to huge fluctuations of tidal volume delivery and can trigger inflammatory cascade in preterm infants leading to brain and lung injury. Respiratory function monitoring in the delivery room has potential for guiding and optimizing delivery room resuscitation. This is, however, limited by high costs, complex information that is difficult to interpret during resuscitation, and absence of clinical trials. KEY MESSAGES This review summarizes the existing literature on PPV in preterm infants, the various aspects related to it such as the pathophysiology, interfaces, devices utilized to deliver it, appropriate technique, emerging technologies, and future directions.
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Affiliation(s)
| | | | - Jenny Koo
- Sharp Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Arun Prasath
- Department of Neonatal-Perinatal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Georg M Schmölzer
- Neonatal Research Unit, Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Dalley A, Hodgson K, Dawson J, Tracy M, Davis P, Thio M. Introducing a novel respiratory function monitor for neonatal resuscitation training. Resusc Plus 2024; 17:100535. [PMID: 38234876 PMCID: PMC10792740 DOI: 10.1016/j.resplu.2023.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
Background A respiratory function monitor (RFM) gives immediate feedback, allowing clinicians to adjust face mask ventilation to correct leak or inappropriate tidal volumes. We audited the satisfaction of clinicians with a neonatal resuscitation training package, incorporating a novel RFM. Methods This was a mixed-methods study conducted at The Royal Women's Hospital, Melbourne, Australia. Clinicians were approached to complete a neonatal resuscitation training session. Participants watched a training video, then provided ventilation to term and preterm manikins first without, and then with, the RFM. Clinicians completed a survey after the session and undertook a follow-up session three months later. The primary outcome was participant satisfaction with the RFM. Secondary outcomes included participants' self-assessment of face mask leak and tidal volumes when using the RFM. Results Fifty clinicians completed both the initial and follow-up session. Participants reported high levels of satisfaction with the RFM for both term and preterm manikins: on a scale from 0, meaning "not at all", and 100, meaning "yes, for all resuscitations", the median response (interquartile range, IQR) was 82 (74-94) vs 81.5 (69-94.5). Levels of satisfaction were similar for less experienced and more experienced clinicians: median (IQR) 83 (77-93) vs 81 (71.5-95) respectively. When using the monitor, clinicians accurately self-assessed that they achieved leak below 30% and tidal volumes within the target range at least 80% of the time. Conclusion Clinicians of all experience levels had a high level of satisfaction with a training package including a novel RFM.
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Affiliation(s)
- A.M. Dalley
- Newborn Research Centre, The Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
| | - K.A. Hodgson
- Newborn Research Centre, The Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Paediatric Infant and Perinatal Emergency Retrieval, The Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - J.A. Dawson
- Newborn Research Centre, The Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - M.B. Tracy
- Westmead Hospital, Department of Neonatology, Cnr Hawkesbury Road and Darcy Road, Westmead, New South Wales 2145, Australia
- The University of Sydney, City Road Level 2 & 3, Sydney, New South Wales 2006, Australia
| | - P.G. Davis
- Newborn Research Centre, The Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - M. Thio
- Newborn Research Centre, The Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Paediatric Infant and Perinatal Emergency Retrieval, The Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia
- Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia
- Gandel Simulation Service, The Royal Women’s Hospital & The University of Melbourne, 20 Flemington Road, Parkville, Victoria 3052, Australia
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Tracy MB, Hinder M, Morakeas S, Lowe K, Priyadarshi A, Crott M, Boustred M, Culcer M. Randomised study of a new inline respiratory function monitor (Juno) to improve mask seal and delivered ventilation with neonatal manikins. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326256. [PMID: 38336472 DOI: 10.1136/archdischild-2023-326256] [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: 08/29/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Respiratory function monitors (RFMs) have been used extensively in manikin and infant studies yet have not become the standard of training. We report the outcomes of a new portable, lightweight RFM, the Juno, designed to show mask leak and deflation tidal volume to assist in positive pressure ventilation (PPV) competency training using manikins. METHODS Two leak-free manikins (preterm and term) were used. Participants provided PPV to manikins using two randomised devices, self-inflating bag (SIB) and T-piece resuscitator (TPR), with Juno display initially blinded then unblinded in four 90 s paired sequences, aiming for adequate chest wall rise and target minimal mask leak with appropriate target delivered volume when using the monitor. RESULTS 49 experienced neonatal staff delivered 15 569 inflations to the term manikin and 14 580 inflations to the preterm. Comparing blinded to unblinded RFM display, there were significant reductions in all groups in the number of inflations out of target range volumes (preterm: SIB 22.6-6.6%, TPR 7.1-4.2% and term: SIB 54.8-37.8%, TPR 67.2-63.8%). The percentage of mask leak inflations >60% was reduced in preterm: SIB 20.7-7.2%, TPR 23.4-7.4% and in term: SIB 8.7-3.6%, TPR 23.5-6.2%). CONCLUSIONS Using the Juno monitor during simulated resuscitation significantly improved mask leak and delivered ventilation among otherwise experienced staff using preterm and term manikins. The Juno is a novel RFM that may assist in teaching and self-assessment of resuscitation PPV technique.
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Affiliation(s)
- Mark Brian Tracy
- Westmead Hospital, Sydney, New South Wales, Australia
- Department of Paediatrics and Child Health, Sydney University, Sydney, New South Wales, Australia
| | - Murray Hinder
- Department of Paediatrics and Child Health, Sydney University, Sydney, New South Wales, Australia
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stephanie Morakeas
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney University, Sydney, New South Wales, Australia
| | - Krista Lowe
- Newborn Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Archana Priyadarshi
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Matthew Crott
- Sydney University, Sydney, New South Wales, Australia
| | | | - Mihaela Culcer
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
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Ni Chathasaigh CM, Smiles L, Curley AE, O'Currain E. Newborn face mask ventilation training using a standardised intervention and respiratory function monitor: a before and after manikin study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2023-326416. [PMID: 38272657 DOI: 10.1136/archdischild-2023-326416] [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: 10/06/2023] [Accepted: 01/07/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE The International Liaison Committee on Resuscitation has recommended improvements in training for neonatal resuscitation, highlighting the potential role of respiratory function monitors (RFMs). Our objective was to determine whether a manikin-based, standardised face mask ventilation training intervention using an RFM with a simple visual display reduced face mask leak. DESIGN Multicentre, before and after study. Participants and instructors were blinded to the RFM display during both assessment periods. PARTICIPANTS Healthcare professionals working or training in a hospital providing maternity and neonatal services. INTERVENTION All participants underwent a training intervention on positive pressure ventilation using a modified, leak-free manikin and RFM. The intervention consisted of a demonstration of optimal face mask ventilation technique, training in RFM interpretation with corrective strategies for common scenarios and a period of deliberate practice. Each participant performed 30 s of positive pressure ventilation blinded to the RFM display before and after training. MAIN OUTCOME MEASURES The primary outcome was face mask leak (%) measured after training. Secondary outcome measures included expired tidal volume, inflating pressures and ventilation rate. Adjustments made to technique during training were an important qualitative outcome. RESULTS Four hundred and fourteen participants were recruited over a 13-month period from April 2022, and 412 underwent analysis. Median (IQR) face mask leak before training was 31% (10-69%) compared with 10% (6-18%) after training (p<0.0001). Improvements were noted across all other ventilation parameters. CONCLUSION Standardised face mask ventilation training using an RFM with simple visual feedback led to a significant reduction in leak.
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Affiliation(s)
- Caitriona M Ni Chathasaigh
- The National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Linda Smiles
- The National Maternity Hospital, Dublin, Ireland
| | - Anna E Curley
- The National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Eoin O'Currain
- The National Maternity Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Tran KH, Ramsie M, Law B, Schmölzer G. Comparison of positive pressure ventilation devices during compliance changes in a neonatal ovine model. Pediatr Res 2024:10.1038/s41390-024-03028-3. [PMID: 38218928 DOI: 10.1038/s41390-024-03028-3] [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] [Received: 10/20/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND To compare tidal volume (VT) delivery with compliance at 0.5 and 1.5 mL/cmH2O using four different ventilation (PPV) devices (i.e., self-inflating bag (SIB), T-Piece resuscitator, Next Step (a novel Neonatal Resuscitator), and Fabian ventilator (conventional neonatal ventilator) using a neonatal piglet model. DESIGN/METHODS Randomized experimental animal study using 10 mixed-breed neonatal piglets (1-3 days; 1.8-2.4 kg). Piglets were anesthetized, intubated, instrumented, and randomized to receive positive pressure ventilation (PPV) for one minute with a SIB with or without a respiratory function monitor (RFM), T-Piece resuscitator with or without an RFM, Next Step, and Fabian Ventilator with both compliance levels. Compliance changes were achieved by placing a wrap around the piglets' chest and tightened it. Our primary outcome was targeted VT delivery of 5 mL/kg at 0.5 and 1.5 mL/cmH2O lung compliance. RESULTS At 0.5 mL/cmH2O compliance, the mean(SD) expired VT with the Next Step was 5.1(0.2) mL/kg compared to the Fabian 4.8(0.5) mL/kg, SIB 8.9(3.6) mL/kg, SIB + RFM 4.5(1.8) mL/kg, T-Piece 7.4(4.3) mL/kg, and T-Piece+RFM 6.4(3.1) mL/kg. At 1.5 mL/cmH2O compliance, the mean(SD) expired VT with the Next Step was 5.2(0.6) mL/kg compared to the Fabian 4.4(0.7) mL/kg, SIB 12.1(5.3) mL/kg, SIB + RFM 9.4(3.9) mL/kg, T-Piece 8.6(1.5) mL/kg, and T-Piece+RFM 6.5 (1.6) mL/kg. CONCLUSION The Next Step provides consistent VT during PPV, which is comparable to a mechanical ventilator. IMPACT Current guidelines recommend fixed peak inflation pressure in resuscitation, linked to lung and brain injury. The Next Step Neonatal Resuscitator, a cost-effective device, offers volume-targeted positive pressure ventilation with consistent tidal volumes. With two different compliances, the Next Step Neonatal Resuscitator delivered a consistent tidal volume which was similar to a mechanical ventilator. The Next Step Neonatal Resuscitator outperformed self-inflating bags and T-Pieces in delivering targeted tidal volumes. The Next Step Neonatal Resuscitator could be an alternative ventilation device for neonatal resuscitation.
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Affiliation(s)
- Kim Hoang Tran
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marwa Ramsie
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Brenda Law
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Georg Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB, Canada.
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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7
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Taha S, Simpson RB, Sharkey D. The critical role of technologies in neonatal care. Early Hum Dev 2023; 187:105898. [PMID: 37944264 DOI: 10.1016/j.earlhumdev.2023.105898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Neonatal care has made significant advances in the last few decades. As a result, mortality and morbidity in high-risk infants, such as extremely preterm infants or those infants with birth-related brain injury, has reduced significantly. Many of these advances have been facilitated or delivered through development of medical technologies allowing clinical teams to be better supported with the care they deliver or provide new therapies and diagnostics to improve management. The delivery of neonatal intensive care requires the provision of medical technologies that are easy to use, reliable, accurate and ideally developed for the unique needs of the newborn population. Many technologies have been developed and commercialised following adult trials without ever being studied in neonatal patients despite the unique characteristics of this population. Increasingly, funders and industry are recognising this major challenge which has resulted in initiatives to develop new ideas from concept through to clinical care. This review explores some of the key medical technologies used in neonatal care and the evidence to support their adoption to improve outcomes. A number of devices have yet to realise their full potential and will require further development to optimise and find their ideal target population and clinical benefit. Examples of emerging technologies, which may soon become more widely used, are also discussed. As neonatal care relies more on medical technologies, we need to be aware of the impact on care pathways, especially from a human factors approach, the associated costs and subsequent benefits to patients alongside the supporting evidence.
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Affiliation(s)
- Syed Taha
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Rosalind B Simpson
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
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Pereira-Fantini PM, Kenna KR, Fatmous M, Sett A, Douglas E, Dahm S, Sourial M, Fang H, Greening DW, Tingay DG. Impact of tidal volume strategy at birth on initiating lung injury in preterm lambs. Am J Physiol Lung Cell Mol Physiol 2023; 325:L594-L603. [PMID: 37727901 DOI: 10.1152/ajplung.00159.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023] Open
Abstract
Tidal ventilation is essential in supporting the transition to air-breathing at birth, but excessive tidal volume (VT) is an important factor in preterm lung injury. Few studies have assessed the impact of specific VT levels on injury development. Here, we used a lamb model of preterm birth to investigate the role of different levels of VT during positive pressure ventilation (PPV) in promoting aeration and initiating early lung injury pathways. VT was delivered as 1) 7 mL/kg throughout (VTstatic), 2) begun at 3 mL/kg and increased to a final VT of 7 mL/kg over 3 min (VTinc), or 3) commenced at 7 mL/kg, decreased to 3 mL/kg, and then returned to 7 mL/kg (VTalt). VT, inflating pressure, lung compliance, and aeration were similar in all groups from 4 min, as was postmortem histology and lung lavage protein concentration. However, transient decrease in VT in the VTalt group caused increased ventilation heterogeneity. Following TMT-based quantitative mass spectrometry proteomics, 1,610 proteins were identified in the lung. Threefold more proteins were significantly altered with VTalt compared with VTstatic or VTinc strategies. Gene set enrichment analysis identified VTalt specific enrichment of immune and angiogenesis pathways and VTstatic enrichment of metabolic processes. Our finding of comparable lung physiology and volutrauma across VT groups challenges the paradigm that there is a need to rapidly aerate the preterm lung at birth. Increased lung injury and ventilation heterogeneity were identified when initial VT was suddenly decreased during respiratory support at birth, further supporting the benefit of a gentle VT approach.NEW & NOTEWORTHY There is little evidence to guide the best tidal volume (VT) strategy at birth. In this study, comparable aeration, lung mechanics, and lung morphology were observed using static, incremental, and alternating VT strategies. However, transient reduction in VT was associated with ventilation heterogeneity and inflammation. Our results suggest that rapidly aerating the preterm lung may not be as clinically critical as previously thought, providing clinicians with reassurance that gently supporting the preterm lung maybe permissible at birth.
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Affiliation(s)
- Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly R Kenna
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Monique Fatmous
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Services, Joan Kirner Women's and Children's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Ellen Douglas
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sophia Dahm
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Magdy Sourial
- Translational Research Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Haoyun Fang
- Molecular Proteomics, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David W Greening
- Molecular Proteomics, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Victoria, Australia
- Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Victoria, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Gunawardana S, Arattu Thodika FMS, Murthy V, Bhat P, Williams EE, Dassios T, Milner AD, Greenough A. Respiratory function monitoring during early resuscitation and prediction of outcomes in prematurely born infants. J Perinat Med 2023; 51:950-955. [PMID: 36800988 DOI: 10.1515/jpm-2022-0538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/25/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVES Over the last decade, there has been increased use of end-tidal carbon dioxide (ETCO2) and oxygen saturation (SpO2) monitoring during resuscitation of prematurely born infants in the delivery suite. Our objectives were to test the hypotheses that low end-tidal carbon dioxide (ETCO2) levels, low oxygen saturations (SpO2) and high expiratory tidal volumes (VTE) during the early stages of resuscitation would be associated with adverse outcomes in preterm infants. METHODS Respiratory recordings made in the first 10 min of resuscitation in the delivery suite of 60 infants, median GA 27 (interquartile range 25-29) weeks were analysed. The results were compared of infants who did or did not die or did or did not develop intracerebral haemorrhage (ICH) or bronchopulmonary dysplasia (BPD). RESULTS Twenty-five infants (42%) developed an ICH and 23 (47%) BPD; 11 (18%) died. ETCO2 at approximately 5 min after birth was lower in infants who developed an ICH, this remained significant after adjusting for gestational age, coagulopathy and chorioamnionitis (p=0.03). ETCO2 levels were lower in infants who developed ICH or died compared to those that survived without ICH, which remained significant after adjustment for gestational age, Apgar score at 10 min, chorioamnionitis and coagulopathy (p=0.004). SpO2 at approximately 5 min was lower in the infants who died compared to those who survived which remained significant after adjusting for the 5-min Apgar score and chorioamnionitis (p=0.021). CONCLUSIONS ETCO2 and SpO2 levels during early resuscitation in the delivery suite were associated with adverse outcomes.
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Affiliation(s)
- Shannon Gunawardana
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Fahad M S Arattu Thodika
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Vadivelam Murthy
- Neonatal Intensive Care Centre, Barts Health NHS Trust, London, UK
| | - Prashanth Bhat
- Neonatal Intensive Care Centre, Brighton and Sussex University Hospital, Sussex, UK
| | - Emma E Williams
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Anthony D Milner
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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10
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Shah D, Tracy M, Hinder M, Badawi N. Quantitative end-tidal carbon dioxide at initiation of resuscitation may help guide the ventilation of infants born at less than 30 weeks gestation. Acta Paediatr 2023; 112:652-658. [PMID: 36541873 DOI: 10.1111/apa.16639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
AIM Estimation of end-tidal carbon dioxide (EtCO2 ) with capnography can guide mask ventilation in infants born at less than 30 weeks of gestation. Chemical-sensitive colorimetric devices to detect CO2 are widely used at resuscitation. We aimed to quantify EtCO2 in the first breaths following initiation of mask ventilation at birth and correlated need for endotracheal intubation. METHODS Infants <30 weeks gestation receiving mask ventilation were randomised into two groups of mask-hold technique (one-person vs. two-person). Data on EtCO2 in the first 30 breaths, time to achieve 5 mmHg, 10 mmHg and 15 mmHg CO2 using a respiratory function monitor was determined. RESULTS Twenty-five infants with a mean gestation of 27.3 (±3 weeks) and mean birth weight 920.4 (±188.3 g) were analysed. The median EtCO2 was 5.6 mmHg in the first 10 breaths, whereas it was 12.6 mmHg for 11-20 breaths and 18 mmHg for 21-30 breaths. There was no significant difference in maximum median EtCO2 for the first 20 breaths, although EtCO2 was significantly lower in infants who were intubated (32.0 vs. 15.0, p = 0.018). CONCLUSION EtCO2 monitoring in infants <30 weeks gestation at birth is feasible and reflective of alveolar ventilation. EtCO2 may help guide ventilation of preterm infants at birth.
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Affiliation(s)
- Dharmesh Shah
- Neonatal Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Mark Tracy
- Neonatal Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Murray Hinder
- Neonatal Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Cerebral Palsy Research Institute, Cerebral Palsy Alliance, University of Sydney, Sydney, New South Wales, Australia
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11
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Escrig-Fernández R, Zeballos-Sarrato G, Gormaz-Moreno M, Avila-Alvarez A, Toledo-Parreño JD, Vento M. The Respiratory Management of the Extreme Preterm in the Delivery Room. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020351. [PMID: 36832480 PMCID: PMC9955623 DOI: 10.3390/children10020351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
The fetal-to-neonatal transition poses an extraordinary challenge for extremely low birth weight (ELBW) infants, and postnatal stabilization in the delivery room (DR) remains challenging. The initiation of air respiration and the establishment of a functional residual capacity are essential and often require ventilatory support and oxygen supplementation. In recent years, there has been a tendency towards the soft-landing strategy and, subsequently, non-invasive positive pressure ventilation has been generally recommended by international guidelines as the first option for stabilizing ELBW in the delivery room. On the other hand, supplementation with oxygen is another cornerstone of the postnatal stabilization of ELBW infants. To date, the conundrum concerning the optimal initial inspired fraction of oxygen, target saturations in the first golden minutes, and oxygen titration to achieve desired stability saturation and heart rate values has not yet been solved. Moreover, the retardation of cord clamping together with the initiation of ventilation with the patent cord (physiologic-based cord clamping) have added additional complexity to this puzzle. In the present review, we critically address these relevant topics related to fetal-to-neonatal transitional respiratory physiology, ventilatory stabilization, and oxygenation of ELBW infants in the delivery room based on current evidence and the most recent guidelines for newborn stabilization.
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Affiliation(s)
- Raquel Escrig-Fernández
- Department of Neonatology, Hospital Universitari i Politècnic La Fe, 106 Fernando Abril Martorell Avenue, 46026 Valencia, Spain
- Correspondence:
| | | | - María Gormaz-Moreno
- Department of Neonatology, Hospital Universitari i Politècnic La Fe, 106 Fernando Abril Martorell Avenue, 46026 Valencia, Spain
| | - Alejandro Avila-Alvarez
- Division of Neonatology, Pediatric Department, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, 15006 A Coruña, Spain
| | - Juan Diego Toledo-Parreño
- Department of Neonatology, Hospital Universitari i Politècnic La Fe, 106 Fernando Abril Martorell Avenue, 46026 Valencia, Spain
| | - Máximo Vento
- Department of Neonatology, Hospital Universitari i Politècnic La Fe, 106 Fernando Abril Martorell Avenue, 46026 Valencia, Spain
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12
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Cavigioli F, Bresesti I, Di Peri A, Cerritelli F, Gazzolo D, Gavilanes AWD, Kramer B, Te Pas A, Lista G. Tidal volume optimization and heart rate response during stabilization of very preterm infants. Pediatr Pulmonol 2023; 58:550-555. [PMID: 36324233 DOI: 10.1002/ppul.26229] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/22/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
AIM To verify the added value of respiratory function monitor (RFM) to assess ventilation and the heart rate (HR) changes during stabilization of preterm infants. METHODS Preterm infants <32 weeks' gestation, bradycardic at birth and in need for positive pressure ventilation (PPV) were included. The first 15 min of stabilization was monitored with RFM. Three time points were identified according to HR values (T0 the start of mask PPV; T1 the HR rise >100 bpm; T2 the delivery of the last PPV). For each inflation, PIP, PEEP, MAP, expired tidal volume/kg (Vte/kg), and mean dynamic compliance (Cdyn) were analyzed. RESULTS PIP and MAP values were significantly higher at T1 (27.09 ± 5.37 and 17.47 ± 3.85 cmH2 O) and at T2 (24.7 ± 3.86 and 15.2 ± 3.78 cmH2 O) compared to T0 (24.05 ± 2.27 and 15.85 ± 2.77 cmH2 O). PEEP at T1 was significantly higher (6.27 ± 2.17 cmH2 O) compared to T2 (5.61 ± 1.50 cmH2 O). Vte/kg showed significantly lower T0 values (3.57 ± 2.14 ml/kg) compared to T1 (6.18 ± 2.51 ml/kg) and T2 (6.89 ± 2.40 ml/kg). There was a significant effect of time on Cdyn. CONCLUSIONS A clear correspondence between HR rise and adequate Vte/kg during stabilization of very preterm infants was highlighted. RFM might be useful to tailor ventilation, following real-time changes of lung compliance.
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Affiliation(s)
| | - Ilia Bresesti
- NICU "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonio Di Peri
- NICU "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | | | - Diego Gazzolo
- Neonatal Intensive Care Unit, "G. D'Annunzio" University, Chieti, Italy
| | - Antonio W D Gavilanes
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Boris Kramer
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arjan Te Pas
- Division of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gianluca Lista
- NICU "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
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13
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar J, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Pediatrics 2023; 151:189896. [PMID: 36325925 DOI: 10.1542/peds.2022-060463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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14
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Shah D, Tracy MB, Hinder MK, Badawi N. One-person versus two-person mask ventilation in preterm infants at birth: a pilot randomised controlled trial. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001768. [PMID: 36746525 PMCID: PMC9906374 DOI: 10.1136/bmjpo-2022-001768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mask leak and airway obstruction are common with mask ventilation in newborn infants, leading to suboptimal ventilation. We aimed to perform a pilot study measuring respiratory mechanics during one-person and two-person mask ventilation in preterm infants at birth. METHODS Infants less than 30 weeks' gestation were eligible for the study. In the two-person method, one person holds the mask in place and the other provides positive pressure ventilation compared with the standard one-person mask hold. A respiratory function monitor was used in line with a T-piece resuscitator to measure mask leak and airway obstruction. Deferred consent was obtained. RESULTS Twenty-five infants were recruited. The mean (SD) birth weight was 920.4 g (188.3), and mean (SD) gestational age was 27.3 weeks (3.0). Percentage mask leak was higher in the one-person mask method (26.4±18.5) compared with the two-person mask method (17.6±9.3) (p=0.018). The mean (SD) expired tidal volume (VTe, mL) in breaths with leak was 3.9 (1.57) in the one-person method compared with 3.05 (1.0) the two-person method (p=0.31). A significantly lower mean (SD) end-tidal carbon dioxide (EtCO2, mm Hg) was measured at 25.3 (9.9) in breaths with mask leak, compared with 30.8 (12.1) in breaths without leak. The breaths with airway obstruction had lower mean EtCO2 (25.9 vs 30.8, p=0.003) and lower mean VTe (1.71 vs 6.95, p<0.001). CONCLUSION Mask leak and airway obstruction are common in resuscitation of preterm infants at birth. The use of the two-person mask technique is effective and it could be a useful option if mask ventilation with the one-person method is not effective. TRIAL REGISTRATION NUMBER ACTRN12614000245695.
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Affiliation(s)
- Dharmesh Shah
- Newborn Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia .,Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
| | - Mark B Tracy
- Newborn Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia.,Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
| | - Murray Kenneth Hinder
- Newborn Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia.,Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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15
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Kuypers KLAM, van Zanten HA, Heesters V, Kamlin O, Springer L, Lista G, Cavigioli F, Vento M, Núñez-Ramiro A, Kuester H, Horn S, Weinberg DD, Foglia EE, Morley CJ, Davis PG, Te Pas AB. Resuscitators' opinions on using a respiratory function monitor during neonatal resuscitation. Acta Paediatr 2023; 112:63-68. [PMID: 36177808 PMCID: PMC10092741 DOI: 10.1111/apa.16559] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to assess the resuscitators' opinions of the usefulness and clinical value of using a respiratory function monitor (RFM) when resuscitating extremely preterm infants with positive pressure ventilation. METHODS The link to an online survey was sent to 106 resuscitators from six countries who were involved in a multicentre trial that compared the percentage of inflations within a predefined target range with and without the RFM. The resuscitators were asked to assess the usefulness and clinical value of the RFM. The survey was online for 4 months after the trial ended in May 2019. RESULTS The survey was completed by 74 (70%) resuscitators of which 99% considered the RFM to be helpful during neonatal resuscitation and 92% indicated that it influenced their decision-making. The majority (76%) indicated that using the RFM improved their practice and made resuscitation more effective, even when the RFM was not available. Inadequate training was the key issue that limited the effectiveness of the RFM: 45% felt insufficiently trained, and 78% felt more training in using and interpreting the RFM would have been beneficial. CONCLUSION Resuscitators considered the RFM to be helpful to guide neonatal resuscitation, but sufficient training was required to achieve the maximum benefit.
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Affiliation(s)
- Kristel L A M Kuypers
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Henriëtte A van Zanten
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Veerle Heesters
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Omar Kamlin
- Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Laila Springer
- Department of Neonatology, University Children's Hospital, Tübingen, Germany
| | - Gianluca Lista
- Department of Neonatology, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Francesco Cavigioli
- Department of Neonatology, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Maximo Vento
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Antonio Núñez-Ramiro
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Helmut Kuester
- Neonatology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Sebastian Horn
- Neonatology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Danielle D Weinberg
- Division of Neonatology, Department of Paediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Paediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colin J Morley
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - Peter G Davis
- Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
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16
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Ong YKG, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM, Cartledge S, Dawson JA, Elgohary MM, Ersdal HL, Finan E, Flaatten HI, Flores GE, Fuerch J, Garg R, Gately C, Goh M, Halamek LP, Handley AJ, Hatanaka T, Hoover A, Issa M, Johnson S, Kamlin CO, Ko YC, Kule A, Leone TA, MacKenzie E, Macneil F, Montgomery W, O’Dochartaigh D, Ohshimo S, Palazzo FS, Picard C, Quek BH, Raitt J, Ramaswamy VV, Scapigliati A, Shah BA, Stewart C, Strand ML, Szyld E, Thio M, Topjian AA, Udaeta E, Vaillancourt C, Wetsch WA, Wigginton J, Yamada NK, Yao S, Zace D, Zelop CM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2022; 146:e483-e557. [PMID: 36325905 DOI: 10.1161/cir.0000000000001095] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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17
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Respiratory function monitoring during neonatal resuscitation: A systematic review. Resusc Plus 2022; 12:100327. [PMID: 36425449 PMCID: PMC9678959 DOI: 10.1016/j.resplu.2022.100327] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Abstract
Aim Positive pressure ventilation via a facemask is critical in neonatal resuscitation, but frequently results in mask leak, obstruction, and inadequate respiratory support. This systematic review aimed to determine whether the display of respiratory function monitoring improved resuscitation or clinical outcomes. Methods Randomized controlled trials comparing outcomes when respiratory function monitoring was displayed versus not displayed for newborns requiring positive pressure ventilation at birth were selected and from databases (last search August 2022), and assessed for risk of bias using Cochrane Risk of Bias Tools for randomized control trials. The study was registered in the Prospective Register of Systematic Reviews. Grading of Recommendations, Assessment, Development and Evaluations was used to assess the certainty of evidence. Treatment recommendations were approved by the Neonatal Life Support Task Force of the International Liaison Committee on Resuscitation. Results reported primary and secondary outcomes and included resuscitation and clinical outcomes. Results Of 2294 unique articles assessed for eligibility, three randomized controlled trials were included (observational studies excluded) (n = 443 patients). For predefined resuscitation and clinical outcomes, these studies either did not report the primary outcome (time to heart rate ≥ 100 bpm from birth), had differing reporting methods (achieving desired tidal volumes, significant mask leak) or did not find significant differences (intubation rate, air leaks, death before hospital discharge, severe intraventricular hemorrhage, chronic lung disease). Limitations included limited sample size for critical outcomes, inconsistent definitions amongst studies and unreported long-term outcomes. Conclusion Although respiratory function monitoring has been utilized in clinical care, there is currently insufficient evidence to suggest its benefit for newborn infants receiving respiratory support for resuscitation at birth. Registration PROSPERO CRD42021278169 (registered November 27, 2021). Funding The International Liaison Committee on Resuscitation provided support that included access to software platforms and teleconferencing.
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2022; 181:208-288. [PMID: 36336195 DOI: 10.1016/j.resuscitation.2022.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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de Medeiros SM, Mangat A, Polglase GR, Sarrato GZ, Davis PG, Schmölzer GM. Respiratory function monitoring to improve the outcomes following neonatal resuscitation: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2022; 107:589-596. [PMID: 35058279 DOI: 10.1136/archdischild-2021-323017] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Animal and observational human studies report that delivery of excessive tidal volume (VT) at birth is associated with lung and brain injury. Using a respiratory function monitor (RFM) to guide VT delivery might reduce injury and improve outcomes. OBJECTIVE To determine whether use of an RFM in addition to clinical assessment versus clinical assessment alone during mask ventilation in the delivery room reduces in-hospital mortality and morbidity of infants <37 weeks' gestation. STUDY SELECTION Randomised controlled trials (RCTs) comparing RFM in addition to clinical assessment versus clinical assessment alone during mask ventilation in the delivery room of infants born <37 weeks' gestation. DATA ANALYSIS Risk of bias was assessed using Covidence Collaboration tool and pooled into a meta-analysis using a random-effects model. The primary outcome was death prior to discharge. MAIN OUTCOME Death before hospital discharge. RESULTS Three RCTs enrolling 443 infants were combined in a meta-analysis. The pooled analysis showed no difference in rates of death before discharge with an RFM versus no RFM, relative risk (RR) 95% (CI) 0.98 (0.64 to 1.48). The pooled analysis suggested a significant reduction for brain injury (a combination of intraventricular haemorrhage and periventricular leucomalacia) (RR 0.65 (0.48 to 0.89), p=0.006) and for intraventricular haemorrhage (RR 0.69 (0.50 to 0.96), p=0.03) in infants receiving positive pressure ventilation with an RFM versus no RFM. CONCLUSION In infants <37 weeks, an RFM in addition to clinical assessment compared with clinical assessment during mask ventilation resulted in similar in-hospital mortality, significant reduction for any brain injury and intraventricular haemorrhage. Further trials are required to determine whether RFMs should be routinely available for neonatal resuscitation.
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Affiliation(s)
- Sarah Marie de Medeiros
- Centre for the Studies of Asphyxia and Resuscitation, Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Avneet Mangat
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Peter G Davis
- Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada .,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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20
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Foglia EE, Shah BA, Szyld E. Positive pressure ventilation at birth. Semin Perinatol 2022; 46:151623. [PMID: 35697527 DOI: 10.1016/j.semperi.2022.151623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To review the current state of the art of positive pressure ventilation (PPV) during resuscitation FINDINGS: The frequency of PPV during delivery room resuscitation varies across settings and gestational age subgroups. Goal targets and parameters for delivery room PPV remain undefined. The T-piece resuscitator provides the most consistent pressures during PPV and may improve clinical outcomes. The laryngeal mask may be an important alternative interface for PPV, but more data are needed to identify the optimal role of the supraglottic airway during PPV. No objective monitors of PPV have conclusively demonstrated improved outcomes to date. CONCLUSION More information, including real-world data from population-based studies, is needed to provide data-driven guidelines for positive pressure ventilation during neonatal transition after birth.
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Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia PA USA.
| | - Birju A Shah
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
| | - Edgardo Szyld
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
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21
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Technology in the delivery room supporting the neonatal healthcare provider's task. Semin Fetal Neonatal Med 2022; 27:101333. [PMID: 35400603 DOI: 10.1016/j.siny.2022.101333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Very preterm infants are a unique and highly vulnerable group of patients that have a narrow physiological margin within which interventions are safe and effective. The increased understanding of the foetal to neonatal transition marks the intricacy of the rapid and major physiological changes that take place, making delivery room stabilisation and resuscitation an increasingly complex and sophisticated activity for caregivers to perform. While modern, automated technologies are progressively implemented in the neonatal intensive care unit (NICU) to enhance the caregivers in providing the right care for these patients, the technology in the delivery room still lags far behind. Diligent translation of well-known and promising technological solutions from the NICU to the delivery room will allow for better support of the caregivers in performing their tasks. In this review we will discuss the current technology used for stabilisation of preterm infants in the delivery room and how this could be optimised in order to further improve care and outcomes of preterm infants in the near future.
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22
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Suzuki K, Takatori F. Development of Neonatal Flow Sensor for Neonatal Resuscitation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4987-4990. [PMID: 36086522 DOI: 10.1109/embc48229.2022.9871129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Globally, an estimated 2.4 million newborns died in the first month of life in 2019. With quality care at birth and treat immediately after birth millions of newborn deaths are expected to be averted. In 2019, most neonatal deaths were due to preterm birth and intrapartum related complications (birth asphyxia, lack of respiration at birth). For these newborns, healthcare providers provide positive pressure ventilation. However, the lungs of newborns are stiff and small, and proper ventilation can be difficult to achieve. Flow sensors can improve the technique because they can convey ventilation parameters. In this study, we have developed a flow sensor that can be used for neonatal resuscitation. The results showed that the sensor had low flow resistance (0.18kPa@10L/min), the measurement accuracy at low flow rates was higher than commercially available flow sensors, was robust to noise when intubation tube was connected, and did not increase the dead space. In the future, we will examine display and usability, and develop devices useful for resuscitation of newborns.
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23
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Visual attention during pediatric resuscitation with feedback devices: a randomized simulation study. Pediatr Res 2022; 91:1762-1768. [PMID: 34290385 PMCID: PMC9270220 DOI: 10.1038/s41390-021-01653-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/09/2021] [Accepted: 06/30/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to investigate the effect of feedback devices on visual attention and the quality of pediatric resuscitation. METHODS This was a randomized cross-over simulation study at the Medical University of Vienna. Participants were students and neonatal providers performing four resuscitation scenarios with the support of feedback devices randomized. The primary outcome was the quality of resuscitation. Secondary outcomes were total dwell time (=total duration of visit time) on areas of interest and the workload of participants. RESULTS Forty participants were analyzed. Overall, chest compression (P < 0.001) and ventilation quality were significantly better (P = 0.002) when using a feedback device. Dwell time on the feedback device was 40.1% in the ventilation feedback condition and 48.7% in the chest compression feedback condition. In both conditions, participants significantly reduced attention from the infant's chest and mask (72.9 vs. 32.6% and 21.9 vs. 12.7%). Participants' subjective workload increased by 3.5% (P = 0.018) and 8% (P < 0.001) when provided with feedback during a 3-min chest compression and ventilation scenario, respectively. CONCLUSIONS The quality of pediatric resuscitation significantly improved when using real-time feedback. However, attention shifted from the manikin and other equipment to the feedback device and subjective workload increased, respectively. IMPACT Cardiopulmonary resuscitation with feedback devices results in a higher quality of resuscitation and has the potential to lead to a better outcome for patients. Feedback devices consume attention from resuscitation providers. Feedback devices were associated with a shift of visual attention to the feedback devices and an increased workload of participants. Increased workload for providers and benefits for resuscitation quality need to be balanced for the best effect.
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24
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Batey N, Henry C, Garg S, Wagner M, Malhotra A, Valstar M, Smith T, Sharkey D. The newborn delivery room of tomorrow: emerging and future technologies. Pediatr Res 2022:10.1038/s41390-022-01988-y. [PMID: 35241791 DOI: 10.1038/s41390-022-01988-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/10/2022] [Accepted: 02/01/2022] [Indexed: 11/08/2022]
Abstract
Advances in neonatal care have resulted in improved outcomes for high-risk newborns with technologies playing a significant part although many were developed for the neonatal intensive care unit. The care provided in the delivery room (DR) during the first few minutes of life can impact short- and long-term neonatal outcomes. Increasingly, technologies have a critical role to play in the DR particularly with monitoring and information provision. However, the DR is a unique environment and has major challenges around the period of foetal to neonatal transition that need to be overcome when developing new technologies. This review focuses on current DR technologies as well as those just emerging and further over the horizon. We identify what key opinion leaders in DR care think of current technologies, what the important DR measures are to them, and which technologies might be useful in the future. We link these with key technologies including respiratory function monitors, electoral impedance tomography, videolaryngoscopy, augmented reality, video recording, eye tracking, artificial intelligence, and contactless monitoring. Encouraging funders and industry to address the unique technological challenges of newborn care in the DR will allow the continued improvement of outcomes of high-risk infants from the moment of birth. IMPACT: Technological advances for newborn delivery room care require consideration of the unique environment, the variable patient characteristics, and disease states, as well as human factor challenges. Neonatology as a speciality has embraced technology, allowing its rapid progression and improved outcomes for infants, although innovation in the delivery room often lags behind that in the intensive care unit. Investing in new and emerging technologies can support healthcare providers when optimising care and could improve training, safety, and neonatal outcomes.
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Affiliation(s)
- Natalie Batey
- Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Caroline Henry
- Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shalabh Garg
- Department of Neonatal Medicine, James Cook University Hospital, Middlesbrough, UK
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital and Department of Paediatrics, Monash University, Melbourne, Australia
| | - Michel Valstar
- School of Computer Science, University of Nottingham, Nottingham, UK
| | - Thomas Smith
- School of Computer Science, University of Nottingham, Nottingham, UK
| | - Don Sharkey
- Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK.
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25
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Kaufmann M, Mense L, Springer L, Dekker J. Tactile stimulation in the delivery room: past, present, future. A systematic review. Pediatr Res 2022:10.1038/s41390-022-01945-9. [PMID: 35124690 DOI: 10.1038/s41390-022-01945-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 11/08/2022]
Abstract
In current resuscitation guidelines, tactile stimulation is recommended for infants with insufficient respiratory efforts after birth. No recommendations are made regarding duration, onset, and method of stimulation. Neither is mentioned how tactile stimulation should be applied in relation to the gestational age. The aim was to review the physiological mechanisms of respiratory drive after birth and to identify and structure the current evidence on tactile stimulation during neonatal resuscitation. A systematic review of available data was performed using PubMed, covering the literature up to April 2021. Two independent investigators screened the extracted references and assessed their methodological quality. Six studies were included. Tactile stimulation management, including the onset of stimulation, overall duration, and methods as well as the effect on vital parameters was analyzed and systematically presented. Tactile stimulation varies widely between, as well as within different centers and no consensus exists which stimulation method is most effective. Some evidence shows that repetitive stimulation within the first minutes of resuscitation improves oxygenation. Further studies are warranted to optimize strategies to support spontaneous breathing after birth, assessing the effect of stimulating various body parts respectively within different gestational age groups.
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Affiliation(s)
- M Kaufmann
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Medical Faculty, TU Dresden, Dresden, Germany.
| | - L Mense
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Medical Faculty, TU Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Medical Faculty, TU Dresden, Dresden, Germany
| | - L Springer
- Division of Neonatology, Department of Paediatrics, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - J Dekker
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
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26
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Rød I, Jørstad AK, Aagaard H, Rønnestad A, Solevåg AL. Advanced Clinical Neonatal Nursing Students' Transfer of Performance: From Skills Training With Real-Time Feedback on Ventilation to a Simulated Neonatal Resuscitation Scenario. Front Pediatr 2022; 10:866775. [PMID: 35509829 PMCID: PMC9058113 DOI: 10.3389/fped.2022.866775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Advanced clinical neonatal nurses are expected to have technical skills including bag-mask ventilation. Previous studies on neonatal bag-mask ventilation skills training focus largely on medical students and/or physicians. The aim of this study was to investigate whether advanced clinical neonatal nursing students' bag-mask ventilation training with real-time feedback resulted in transfer of bag-mask ventilation performance to a simulated setting without feedback on ventilation. MATERIALS AND METHODS Students in advanced clinical neonatal nursing practiced bag-mask ventilation on a premature manikin (Premature Anne, Laerdal Medical, Stavanger, Norway) during skills training. A flow sensor (Neo Training, Monivent AB, Gothenburg, Sweden) was placed between the facemask and the self-inflating bag (Laerdal Medical), and visual feedback on mask leak (%), expiratory tidal volume (VT e in ml/kg), ventilation rate and inflation pressure was provided. Two months later, the students participated in a simulated neonatal resuscitation scenario. The same variables were recorded, but not fed back to the students. We compared ventilation data from skills- and simulation training. A structured questionnaire was used to investigate the students' self-perceived neonatal ventilation competence before and after the skills- and simulation training. RESULTS Mask leakage and ventilation rate was higher, and VT e lower and highly variable in the simulated scenario compared with skills training (all p < 0.001). There was no statistically significant difference in inflation pressure (p = 0.92). The fraction of ventilations with VT e within the target range was lower during simulation (21%) compared to skills training (30%) (p < 0.001). There was no difference in the students' self-perceived competence in bag-mask ventilation before vs. after skills- and simulation training. CONCLUSION Skills training with real-time feedback on mask leak, ventilation rate, tidal volume, and inflation pressure did not result in objective or subjective improvements in bag-mask ventilation in a simulated neonatal resuscitation situation. Incorrect VT e delivery was common even when feedback was provided. It would be of interest to study whether more frequent training, and training both with and without feedback, could improve transfer of performance to a simulated resuscitation setting.
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Affiliation(s)
- Irene Rød
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
| | | | - Hanne Aagaard
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
| | - Arild Rønnestad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anne Lee Solevåg
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway.,Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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27
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Tidal volumes and pressures delivered by the NeoPuff T-piece resuscitator during resuscitation of term newborns. Resuscitation 2021; 170:222-229. [PMID: 34915085 DOI: 10.1016/j.resuscitation.2021.12.006] [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: 10/22/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 12/16/2022]
Abstract
AIM T-piece resuscitators are commonly used for respiratory support during newborn resuscitation. This study aimed to describe delivered pressures and tidal volumes when resuscitating term newborns immediately after birth, using the NeoPuff T-piece resuscitator. METHOD Observational study from June 2019 through March 2021 at Stavanger University Hospital, Norway, including term newborns ventilated with a T-piece resuscitator after birth, with consent to participate. Ventilation parameters of the first 100 inflations from each newborn were recorded by respiration monitors and divided into an early (inflation 1-20) and a late (inflation 21-100) phase. RESULTS Of the 7730 newborns born, 232 term newborns received positive pressure ventilation. Of these, 129 newborns were included. In the early and the late phase, the median (interquartile range) peak inflating pressure was 30 (28-31) and 30 (27-31) mbar, and tidal volume was 4.5 (1.6-7.8) and 5.7 (2.2-9.8) ml/kg, respectively. Increased inflation times were associated with an increase in volume before plateauing at an inflation time of 0.41 s in the early phase and 0.50 s in the late phase. Inflation rates exceeding 32 per minute in the early phase and 41 per minute in the late phase were associated with lower tidal volumes. CONCLUSION There was a substantial variation in tidal volumes despite a relatively stable peak inflating pressure. Delivered tidal volumes were at the lower end of the recommended range. Our results indicate that an inflation time of approximately 0.5 s and rates around 30-40 per minute are associated with the highest delivered tidal volumes.
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28
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Novel Neonatal Simulator Provides High-Fidelity Ventilation Training Comparable to Real-Life Newborn Ventilation. CHILDREN-BASEL 2021; 8:children8100940. [PMID: 34682205 PMCID: PMC8535021 DOI: 10.3390/children8100940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 01/08/2023]
Abstract
Face mask ventilation of apnoeic neonates is an essential skill. However, many non-paediatric healthcare personnel (HCP) in high-resource childbirth facilities receive little hands-on real-life practice. Simulation training aims to bridge this gap by enabling skill acquisition and maintenance. Success may rely on how closely a simulator mimics the clinical conditions faced by HCPs during neonatal resuscitation. Using a novel, low-cost, high-fidelity simulator designed to train newborn ventilation skills, we compared objective measures of ventilation derived from the new manikin and from real newborns, both ventilated by the same group of experienced paediatricians. Simulated and clinical ventilation sequences were paired according to similar duration of ventilation required to achieve success. We found consistencies between manikin and neonatal positive pressure ventilation (PPV) in generated peak inflating pressure (PIP), mask leak and comparable expired tidal volume (eVT), but positive end-expiratory pressure (PEEP) was lower in manikin ventilation. Correlations between PIP, eVT and leak followed a consistent pattern for manikin and neonatal PPV, with a negative relationship between eVT and leak being the only significant correlation. Airway obstruction occurred with the same frequency in the manikin and newborns. These findings support the fidelity of the manikin in simulating clinical conditions encountered during real newborn ventilation. Two limitations of the simulator provide focus for further improvements.
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29
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Mangat A, Bruckner M, Schmölzer GM. Face mask versus nasal prong or nasopharyngeal tube for neonatal resuscitation in the delivery room: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:561-567. [PMID: 33504574 DOI: 10.1136/archdischild-2020-319460] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/17/2020] [Accepted: 01/10/2021] [Indexed: 11/04/2022]
Abstract
IMPORTANCE The current neonatal resuscitation guidelines recommend positive pressure ventilation via face mask or nasal prongs at birth. Using a nasal interface may have the potential to improve outcomes for newborn infants. OBJECTIVE To determine whether nasal prong/nasopharyngeal tube versus face mask during positive pressure ventilation of infants born <37 weeks' gestation in the delivery room reduces in-hospital mortality and morbidity. DATA SOURCES MEDLINE (through PubMed), Google Scholar and EMBASE, Clinical Trials.gov and the Cochrane Central Register of Controlled Trials through August 2019. STUDY SELECTION Randomised controlled trials comparing nasal prong/nasopharyngeal tube versus face mask during positive pressure ventilation of infants born <37 weeks' gestation in the delivery room. DATA ANALYSIS Risk of bias was assessed using the Covidence Collaboration Tool, results were pooled into a meta-analysis using a random effects model. MAIN OUTCOME In-hospital mortality. RESULTS Five RCTs enrolling 873 infants were combined into a meta-analysis. There was no statistical difference in in-hospital mortality (risk ratio (RR 0.98, 95% CI 0.63 to 1.52, p=0.92, I2=11%), rate of chest compressions in the delivery room (RR 0.37, 95% CI 0.10 to 1.33, p=0.13, I2=28%), rate of intraventricular haemorrhage (RR 1.54, 95% CI 0.88 to 2.70, p=0.13, I2=0%) or delivery room intubations in infants ventilated with a nasal prong/tube (RR 0.63, 95% CI 0.39,1.02, p=0.06, I2=52%). CONCLUSION In infants born <37 weeks' gestation, in-hospital mortality and morbidity were similar following positive pressure ventilation during initial stabilisation with a nasal prong/tube or a face mask.
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Affiliation(s)
- Avneet Mangat
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Marlies Bruckner
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Steiermark, Austria
| | - Georg M Schmölzer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Steiermark, Austria .,Neonatology, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Steiermark, Austria
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30
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Donaldsson S, Drevhammar T, Li Y, Bartocci M, Rettedal SI, Lundberg F, Odelberg-Johnson P, Szczapa T, Thordarson T, Pilypiene I, Thorkelsson T, Soderstrom L, Chijenas V, Jonsson B. Comparison of Respiratory Support After Delivery in Infants Born Before 28 Weeks' Gestational Age: The CORSAD Randomized Clinical Trial. JAMA Pediatr 2021; 175:911-918. [PMID: 34125148 PMCID: PMC8424478 DOI: 10.1001/jamapediatrics.2021.1497] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Establishing stable breathing is a key event for preterm infants after birth. Delivery of pressure-stable continuous positive airway pressure and avoiding face mask use could be of importance in the delivery room. OBJECTIVE To determine whether using a new respiratory support system with low imposed work of breathing and short binasal prongs decreases delivery room intubations or death compared with a standard T-piece system with a face mask. DESIGN, SETTING, AND PARTICIPANTS In this unblinded randomized clinical trial, mothers threatening preterm delivery before week 28 of gestation were screened. A total of 365 mothers were enrolled, and 250 infants were randomized before birth and 246 liveborn infants were treated. The trial was conducted in 7 neonatal intensive care units in 5 European countries from March 2016 to May 2020. The follow-up period was 72 hours after intervention. INTERVENTIONS Infants were randomized to either the new respiratory support system with short binasal prongs (n = 124 infants) or the standard T-piece system with face mask (n = 122 infants). The intervention was providing continuous positive airway pressure for 10 to 30 minutes and positive pressure ventilation, if needed, with the randomized system. MAIN OUTCOMES AND MEASURES The primary outcome was delivery room intubation or death within 30 minutes of birth. Secondary outcomes included respiratory and safety variables. RESULTS Of 246 liveborn infants treated, the mean (SD) gestational age was 25.9 (1.3) weeks, and 127 (51.6%) were female. A total of 41 infants (33.1%) receiving the new respiratory support system were intubated or died in the delivery room compared with 55 infants (45.1%) receiving standard care. The adjusted odds ratio was statistically significant after adjusting for stratification variables (adjusted odds ratio, 0.53; 95% CI, 0.30-0.94; P = .03). No significant differences were seen in secondary outcomes or safety variables. CONCLUSIONS AND RELEVANCE In this study, using the new respiratory support system reduced delivery room intubation in extremely preterm infants. Stabilizing preterm infants with a system that has low imposed work of breathing and binasal prongs as interface is safe and feasible. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02563717.
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Affiliation(s)
- Snorri Donaldsson
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Drevhammar
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Anesthesiology and ICU, Östersund Hospital, Östersund, Sweden
| | - Yinghua Li
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Marco Bartocci
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Fredrik Lundberg
- Department of Neonatology, Linköping University Hospital, Linköping, Sweden
| | | | - Tomasz Szczapa
- Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Thordur Thordarson
- Department of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingrida Pilypiene
- Department of Neonatology, Vilnius University Hospital, Vilnius, Lithuania
| | - Thordur Thorkelsson
- Department of Neonatology, The National University Hospital of Iceland, Reykjavík, Iceland
| | - Lars Soderstrom
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
| | | | - Baldvin Jonsson
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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31
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Liley HG, Zestic J. Reaching for improvement in newborn resuscitation. Resuscitation 2021; 167:407-409. [PMID: 34400270 DOI: 10.1016/j.resuscitation.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Helen G Liley
- Faculty of Medicine and Mater Research, The University of Queensland, Australia.
| | - Jelena Zestic
- School of Psychology, Cognitive Engineering Research Group, The University of Queensland, Australia
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A multi-centre randomised controlled trial of respiratory function monitoring during stabilisation of very preterm infants at birth. Resuscitation 2021; 167:317-325. [PMID: 34302924 DOI: 10.1016/j.resuscitation.2021.07.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022]
Abstract
AIM To determine whether the use of a respiratory function monitor (RFM) during PPV of extremely preterm infants at birth, compared with no RFM, leads to an increase in percentage of inflations with an expiratory tidal volume (Vte) within a predefined target range. METHODS Unmasked, randomised clinical trial conducted October 2013 - May 2019 in 7 neonatal intensive care units in 6 countries. Very preterm infants (24-27 weeks of gestation) receiving PPV at birth were randomised to have a RFM screen visible or not. The primary outcome was the median proportion of inflations during manual PPV (face mask or intubated) within the target range (Vte 4-8 mL/kg). There were 42 other prespecified monitor measurements and clinical outcomes. RESULTS Among 288 infants randomised (median (IQR) gestational age 26+2 (25+3-27+1) weeks), a total number of 51,352 inflations were analysed. The median (IQR) percentage of inflations within the target range in the RFM visible group was 30.0 (18.0-42.2)% vs 30.2 (14.8-43.1)% in the RFM non-visible group (p = 0.721). There were no differences in other respiratory function measurements, oxygen saturation, heart rate or FiO2. There were no differences in clinical outcomes, except for the incidence of intraventricular haemorrhage (all grades) and/or cystic periventricular leukomalacia (visible RFM: 26.7% vs non-visible RFM: 39.0%; RR 0.71 (0.68-0.97); p = 0.028). CONCLUSION In very preterm infants receiving PPV at birth, the use of a RFM, compared to no RFM as guidance for tidal volume delivery, did not increase the percentage of inflations in a predefined target range. TRIAL REGISTRATION Dutch Trial Register NTR4104, clinicaltrials.gov NCT03256578.
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Heo JS, Kim SY, Park HW, Choi YS, Park CW, Cho GJ, Oh AY, Jang EK, Kim HS, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 8. Neonatal resuscitation. Clin Exp Emerg Med 2021; 8:S96-S115. [PMID: 34034452 PMCID: PMC8171175 DOI: 10.15441/ceem.21.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/05/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Su Yeong Kim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Ah Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyung Jang
- Office of Patient Safety, Yonsei University Severance Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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34
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Hinder M, Tracy M. Newborn resuscitation devices: The known unknowns and the unknown unknowns. Semin Fetal Neonatal Med 2021; 26:101233. [PMID: 33773952 DOI: 10.1016/j.siny.2021.101233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infant resuscitation devices used at birth must be capable of delivering adequate and consistent ventilation in a controlled and predictable manner to a wide patient weight range, and combinations of transitional lung states. Manual inflation resuscitation devices delivering positive pressure lung inflation at birth can be classified broadly into two types: 1) flow generating, ie silicone self-inflating bags (SIB) also known as bag valve mask (BVM) and 2) flow dependent, ie anaesthetic flow inflating bag (FIB) and t-piece resuscitator (TPR) systems (eg: Neopuff, GE Panda and Draeger Resuscitaires). Globalization, lower production costs, and an expanding market need for devices, has led to a proliferation of brands (both reusable and single use) within a class type. T-piece resuscitators have become the dominant device particularly in high income countries. There remains a paucity of information on the performance characteristics of these devices and their ability to provide the required respiratory parameters for effective and safe ventilation across the full-expected weight range and lung states to which they will be applied. This review aims to inform current clinical practise on the biomechanical efficiency, reliability and efficacy of the most common devices used to apply PPV to newborns and infants ≤10 kgs.
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Affiliation(s)
- Murray Hinder
- The Westmead Hospital Neonatal Intensive Care Unit, Australia; The University of Sydney, Department of Paediatrics and Child Health, Australia
| | - Mark Tracy
- The Westmead Hospital Neonatal Intensive Care Unit, Australia; The University of Sydney, Department of Paediatrics and Child Health, Australia.
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European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation 2021; 161:291-326. [PMID: 33773829 DOI: 10.1016/j.resuscitation.2021.02.014] [Citation(s) in RCA: 223] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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36
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Abstract
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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37
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Tidal volume measurements in the delivery room in preterm infants requiring positive pressure ventilation via endotracheal tube-feasibility study. J Perinatol 2021; 41:1930-1935. [PMID: 34112962 PMCID: PMC8191447 DOI: 10.1038/s41372-021-01113-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/05/2021] [Accepted: 05/18/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Current delivery room (DR) resuscitation utilizes pressure-limited devices without tidal volume (TV) measurements. Clinicians use chest expansion as a surrogate, which is a poor indicator of TV. TV in early life can be highly variable due to rapidly changing lung compliance. Our objectives were to assess feasibility of measuring TV in DR, and to report the generated TV in intubated patients. STUDY DESIGN Prospective, observational, feasibility study in infants <32 weeks GA and intubated in DR. TV was measured using a respiratory function monitor. RESULT Ten infants with mean GA 23.9(±1.5) weeks and mean BW 618.5(±155) gram were included. Total of 178 min (mean 17.8 min/patient) with 8175 individual breaths (mean 817.5 breaths/patient) were analyzed. Goal TV of 4-6 ml/kg was provided 23.5% of times with high TV (>6 ml/kg) provided 47.7% of times. CONCLUSION TV measurement in DR is feasible. It is associated with high intra and inter-patient variability.
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38
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Baixauli-Alacreu S, Padilla-Sánchez C, Hervás-Marín D, Lara-Cantón I, Solaz-García A, Alemany-Anchel MJ, Vento M. Expired Tidal Volume and Respiratory Rate During Postnatal Stabilization of Newborn Infants Born at Term via Cesarean Delivery. THE JOURNAL OF PEDIATRICS: X 2021. [DOI: 10.1016/j.ympdx.2020.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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39
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Mileder LP, Derler T, Baik-Schneditz N, Schwaberger B, Urlesberger B, Pichler G. Optimizing noninvasive respiratory support during postnatal stabilization: video-based analysis of airway maneuvers and their effects. J Matern Fetal Neonatal Med 2020; 35:3991-3997. [PMID: 33172322 DOI: 10.1080/14767058.2020.1846176] [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: 10/23/2022]
Abstract
OBJECTIVE Noninvasive respiratory support during postnatal transition may be challenging. Thus, we aimed to analyze frequency and effects of maneuvers to improve noninvasive respiratory support in neonates immediately after birth. MATERIALS AND METHODS We included neonates born between September 2009 and January 2015 who were video recorded as part of prospective observational studies and required noninvasive respiratory support during the first 15 min after birth. Maneuvers to improve respiratory support were assessed by video analysis. Vital parameter measurement using pulse oximetry and near-infrared spectroscopy was supplemented by respiratory function monitoring. RESULTS One-hundred forty-three of 653 eligible neonates (21.9%) required respiratory support. Video recordings were analyzed in 76 preterm and 58 term neonates, showing airway maneuvers in 105 of them (78.4%). Repositioning of the face mask was the most common maneuver (56.9%). We observed a median of three maneuvers (0-22) in preterm and a median of two maneuvers (0-13) in term neonates (p = .01). Regional cerebral tissue oxygen saturation was significantly higher during the 60 s after the first airway maneuver. CONCLUSION Maneuvers to improve respiratory support are commonly required during neonatal resuscitation, with a higher incidence in preterm neonates. The first airway maneuver was associated with an improvement of cerebral tissue oxygenation.
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Affiliation(s)
- Lukas P Mileder
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Tanja Derler
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Nariae Baik-Schneditz
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Schwaberger
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gerhard Pichler
- Research Unit for Neonatal Micro- and Macrocirculation, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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40
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Chao KY, Lin YW, Chiang CE, Tseng CW, Mu SC. Sustained inflation: The lung recruitment maneuvers for neonates. Paediatr Respir Rev 2020; 36:142-150. [PMID: 32386887 DOI: 10.1016/j.prrv.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/11/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022]
Abstract
Establishing effective respiration is vital in the transition from fetal to neonatal life. Respiratory support mainly facilitates and creates functional residual capacity and maintains adequate gas exchange. Sustained inflation (SI) delivers prolonged inflation and rapidly creates and establishes the functional residual capacity. The use of SI in preterm infants in the delivery room is still controversial. The optimum settings of SI remain unknown. Animal studies and clinical reports have demonstrated the advantages and disadvantages of SI. In this article, the current literature was reviewed to examine the efficacy of SI in infants.
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Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Lin
- Department of Nursing, Fu Jen Catholic University Hospital, Fu Jen University, New Taipei City, Taiwan
| | - Chen-En Chiang
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Wei Tseng
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Medical College, Fu Jen Catholic University, New Taipei City, Taiwan.
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41
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Yang KC, Te Pas AB, Weinberg DD, Foglia EE. Corrective steps to enhance ventilation in the delivery room. Arch Dis Child Fetal Neonatal Ed 2020; 105:605-608. [PMID: 32152191 DOI: 10.1136/archdischild-2019-318579] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/03/2020] [Accepted: 02/18/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The clinical impact of ventilation corrective steps for delivery room positive pressure ventilation (PPV) is not well studied. We aimed to characterise the performance and effect of ventilation corrective steps (MRSOPA (Mask adjustment, Reposition airway, Suction mouth and nose, Open mouth, Pressure increase and Alternative airway)) during delivery room resuscitation of preterm infants. DESIGN Prospective observational study of delivery room PPV using video and respiratory function monitor recordings. SETTING Tertiary academic delivery hospital. PATIENTS Preterm infants <32 weeks gestation. MAIN OUTCOME MEASURE Mean exhaled tidal volume (Vte) of PPV inflations before and after MRSOPA interventions, categorised as inadequate (<4 mL/kg); appropriate (4-8 mL/kg), or excessive (>8 mL/kg). Secondary outcomes were leak (>30%) and obstruction (Vte <1 mL/kg), and infant heart rate. RESULTS There were 41 corrective interventions in 30 infants, with a median duration of 15 (IQR 7-29) s. The most frequent intervention was a combination of Mask/Reposition and Suction/Open. Mean Vte was inadequate before 16/41 interventions and became adequate following 6/16. Mean Vte became excessive after 6/41 interventions. Mask leak, present before 13/41 interventions, was unchanged after 4 and resolved after 9. Obstruction was present before five interventions and was subsequently resolved only once. MRSOPA interventions introduced leak in two cases and led to obstruction in one case. The heart rate was <100 beats per minute before 31 interventions and rose to >100 beats per minute after 14/31 of these. CONCLUSIONS Ventilation correction interventions improve tidal volume delivery in some cases, but lead to ineffective or excessive tidal volumes in others. Mask leak and obstruction can be induced by MRSOPA manoeuvres.
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Affiliation(s)
- Kesi C Yang
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Arjan B Te Pas
- Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Danielle D Weinberg
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth E Foglia
- Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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O'Currain E, Davis PG, Thio M. Educational Perspectives: Toward More Effective Neonatal Resuscitation: Assessing and Improving Clinical Skills. Neoreviews 2020; 20:e248-e257. [PMID: 31261077 DOI: 10.1542/neo.20-5-e248] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Newborn deaths following birth asphyxia remain a significant global problem, and effective resuscitation by well-trained professionals may reduce mortality and morbidity. Clinicians are often responsible for teaching newborn resuscitation to trainees. Multiple educational methods are used to teach these skills, but data supporting their efficacy are limited. Mask ventilation and chest compressions are considered the basics of resuscitation. These technical motor skills are critically important but difficult to teach and often not objectively assessed. Teaching more advanced skills such as neonatal intubation is challenging, because teaching opportunities and working hours of learners have declined. Videolaryngoscopy appears to be an effective teaching tool that allows instruction during clinical practice. There is also emerging recognition that effective resuscitation requires more than individual clinical skills. The importance of teamwork and leadership is now recognized, and teamwork training should be incorporated because it improves these nontechnical skills. Simulation training has become increasingly popular as a method of teaching both technical and nontechnical skills. However, there are unanswered questions about the validity, fidelity, and content of simulation. Formal resuscitation programs usually incorporate a mixture of teaching modalities and appear to reduce neonatal mortality and morbidity in low- and middle-income countries. Emerging teaching techniques such as tele-education, video debriefing, and high-frequency training warrant further investigation.
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Affiliation(s)
- Eoin O'Currain
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,School of Medicine, University College Dublin, Dublin, Ireland.,Pediatric Infant & Perinatal Emergency Retrieval, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Marta Thio
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,Pediatric Infant & Perinatal Emergency Retrieval, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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43
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King A, Blank D, Bhatia R, Marzbanrad F, Malhotra A. Tools to assess lung aeration in neonates with respiratory distress syndrome. Acta Paediatr 2020; 109:667-678. [PMID: 31536658 DOI: 10.1111/apa.15028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/26/2019] [Accepted: 09/17/2019] [Indexed: 12/31/2022]
Abstract
AIM Respiratory distress syndrome is a common condition among preterm neonates, and assessing lung aeration assists in diagnosing the disease and helping to guide and monitor treatment. We aimed to identify and analyse the tools available to assess lung aeration in neonates with respiratory distress syndrome. METHODS A systematic review and narrative synthesis of studies published between January 1, 2004, and August 26, 2019, were performed using the OVID Medline, PubMed, Embase and Scopus databases. RESULTS A total of 53 relevant papers were retrieved for the narrative synthesis. The main tools used to assess lung aeration were respiratory function monitoring, capnography, chest X-rays, lung ultrasound, electrical impedance tomography and respiratory inductive plethysmography. This paper discusses the evidence to support the use of these tools, including their advantages and disadvantages, and explores the future of lung aeration assessments within neonatal intensive care units. CONCLUSION There are currently several promising tools available to assess lung aeration in neonates with respiratory distress syndrome, but they all have their limitations. These tools need to be refined to facilitate convenient and accurate assessments of lung aeration in neonates with respiratory distress syndrome.
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Affiliation(s)
- Arrabella King
- Department of Paediatrics Monash University Melbourne Vic. Australia
| | - Douglas Blank
- Monash Newborn Monash Children's Hospital Melbourne Vic. Australia
- The Ritchie Centre Hudson Institute of Medical Research Melbourne Vic. Australia
| | - Risha Bhatia
- Department of Paediatrics Monash University Melbourne Vic. Australia
- Monash Newborn Monash Children's Hospital Melbourne Vic. Australia
| | - Faezeh Marzbanrad
- Department of Electrical and Computer Systems Engineering Monash University Melbourne Vic. Australia
| | - Atul Malhotra
- Department of Paediatrics Monash University Melbourne Vic. Australia
- Monash Newborn Monash Children's Hospital Melbourne Vic. Australia
- The Ritchie Centre Hudson Institute of Medical Research Melbourne Vic. Australia
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44
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Focus is in the gaze of the beholder. Pediatr Res 2020; 87:434-435. [PMID: 31706256 PMCID: PMC7035968 DOI: 10.1038/s41390-019-0671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/21/2019] [Indexed: 11/08/2022]
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Abstract
Approximately 1 in 10 newborns will require basic resuscitation interventions at birth. Some infants progress to require more advanced measures including the provision of positive pressure ventilation, chest compressions, intubation and administration of volume/cardiac medications. Although advanced resuscitation is infrequent, it is crucial that personnel adequately trained in these techniques are available to provide such resuscitative measures. In 2000, Louis Halmalek et al. called for a "New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment." This was one of the first articles to highlight simulation as a method of teaching newborn resuscitation. The last decades have seen an exponential growth in the area of simulation in newborn care, in particular in newborn resuscitation and stabilization. Simulation is best defined as an instructional strategy "used to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner." Simulation training has now become an important point of how we structure training and deliver improved healthcare to patients. Some of the key aspects of simulation training include feedback, deliberate practice, outcome measurement, retention of skills and curriculum integration. The term "Train to win" is often used in sporting parlance to define how great teams succeed. The major difference between sports teams is that generally their game day comes once a week, whereas in newborn resuscitation every day is potentially "game day." In this review we aim to summarize the current evidence on the use of simulation based education and training in neonatal resuscitation, with particular emphasis on the evidence supporting its effectiveness. We will also highlight recent advances in the development of simulation based medical education in the context of newborn resuscitation to ensure we "train to win."
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Affiliation(s)
- Aisling A Garvey
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland.,INFANT Research Centre, Cork, Ireland
| | - Eugene M Dempsey
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland.,INFANT Research Centre, Cork, Ireland
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End-tidal carbon dioxide levels during resuscitation and carbon dioxide levels in the immediate neonatal period and intraventricular haemorrhage. Eur J Pediatr 2020; 179:555-559. [PMID: 31848749 PMCID: PMC7080666 DOI: 10.1007/s00431-019-03543-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/18/2022]
Abstract
Abnormal levels of end-tidal carbon dioxide (EtCO2) during resuscitation in the delivery suite are associated with intraventricular haemorrhage (IVH) development. Our aim was to determine whether carbon dioxide (CO2) levels in the first 3 days after birth reflected abnormal EtCO2 levels in the delivery suite, and hence, a prolonged rather than an early insult resulted in IVH. In addition, we determined if greater EtCO2level fluctuations during resuscitation occurred in infants who developed IVH. EtCO2 levels during delivery suite resuscitation and CO2 levels on the neonatal unit were evaluated in 58 infants (median gestational age 27.3 weeks). Delta EtCO2 was the difference between the highest and lowest level of EtCO2. Thirteen infants developed a grade 3-4 IVH (severe group). There were no significant differences in CO2 levels between those who did and did not develop an IVH (or severe IVH) on the NICU. The delta EtCO2 during resuscitation differed between infants with any IVH (6.2 (5.4-7.5) kPa) or no IVH (3.8 (2.7-4.3) kPA) (p < 0.001) after adjusting for differences in gestational age. Delta EtCO2 levels gave an area under the ROC curve of 0.940 for prediction of IVH.Conclusion: The results emphasize the importance of monitoring EtCO2 levels in the delivery suite.What is Known:• Abnormal levels of carbon dioxide (CO2) in the first few days after birth and abnormal end-tidal CO2levels (EtCO2) levels during resuscitation are associated in preterm infants with the risk of developing intraventricular haemorrhage (IVH).What is New:• There were no significant differences in NICU CO2levels between those who developed an IVH or no IVH.• There was a poor correlation between delivery suite ETCO2levels and NICU CO2levels.• Large fluctuations in EtCO2during resuscitation in the delivery suite were highly predictive of IVH development in preterm infants.
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Abstract
Immediately after birth through spontaneous breaths, infants' clear lung liquid replacing it with air, and gradually establishing a functional residual capacity to achieve gas exchange. Most infants start breathing independently after birth and ~3% of infants who require positive pressure ventilation. When newborns fail to start breathing the current neonatal resuscitation guidelines recommend initiatingpositive pressure ventilationusing a face mask and a ventilation device. Adequate ventilation is the cornerstone of successful neonatal resuscitation; therefore, it is mandatory that anybody involved in neonatal resuscitation is trained in mask ventilation techniques. One of the main problems with mask ventilation is that it is very subjective with direct feedback lacking and not uncommonly, the resuscitator does not realise that their technique is unsatisfactory. Many studies have shown that monitoring tidal volume and leak around the mask or endotracheal tube enables the resuscitator to identify the problem and adjust their technique to reduce the leak and deliver and appropriate tidal volume. This chapter discusses the currently available monitoring devices used during stabilization/resuscitation in the delivery room.
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Affiliation(s)
- Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Colin J Morley
- Department of Obstetrics and Gynaecology, University of Cambridge, United Kingdom
| | - Omar C O F Kamlin
- Neonatal Services, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Abstract
Fetal to neonatal transition after birth is a complex, well-coordinated process involving multiple organ systems. Any significant derangement in this process increases the risk of death and other adverse outcomes, underlying the importance of continuous monitoring to promptly detect and correct these derangements by effective resuscitative support. In recent years, there has been increasing efforts to move from subjective and discontinuous monitoring to more objective and continuous monitoring of different physiological parameters. Some of them like pulse oximetry for arterial oxygen saturation and electrocardiography for heart rate monitoring are now part of resuscitation guidelines whereas others like respiratory function monitoring, near infrared spectroscopy, or amplitude integrated electroencephalography are being evaluated. In this review, we describe some of the physiological parameters that can be monitored during delivery room emergencies and review the evidence for some of the monitoring technologies currently being evaluated.
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Affiliation(s)
- Deepak Jain
- University of Miami Miller School of Medicine, United States
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Kamlin COF, Schmölzer GM, Dawson JA, McGrory L, O’Shea J, Donath SM, Lorenz L, Hooper SB, Davis PG. A randomized trial of oropharyngeal airways to assist stabilization of preterm infants in the delivery room. Resuscitation 2019; 144:106-114. [DOI: 10.1016/j.resuscitation.2019.08.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/20/2019] [Accepted: 08/30/2019] [Indexed: 11/17/2022]
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O'Currain E, Thio M, Dawson JA, Donath SM, Davis PG. Respiratory monitors to teach newborn facemask ventilation: a randomised trial. Arch Dis Child Fetal Neonatal Ed 2019; 104:F582-F586. [PMID: 30636691 DOI: 10.1136/archdischild-2018-316118] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The International Liaison Committee on Resuscitation has found that there is a need for high-quality randomised trials of training interventions that improve the effectiveness of resuscitation skills. The objective of this study was to determine whether using a respiratory function monitor (RFM) during mask ventilation training with a manikin reduces facemask leak. DESIGN Stratified, parallel-group, randomised controlled trial. Outcome assessors were blinded to group allocation. SETTING Thirteen hospitals in Australia, including non-tertiary sites. PARTICIPANTS Consecutive sample of healthcare professionals attending a structured newborn resuscitation training course. INTERVENTIONS An RFM providing real-time, objective, leak, flow and volume information was attached to the facemask during 1.5 hours of newborn ventilation and simulation training using a manikin. Participants were randomised to have the RFM display visible (intervention) or masked (control), using a computer-generated randomisation sequence. MAIN OUTCOME MEASURES The primary outcome was facemask leak measured after neonatal facemask ventilation training. Tidal volume was an important secondary outcome measure. RESULTS Participants were recruited from May 2016 to November 2017. Of 402 eligible participants, two refused consent. Four hundred were randomised, 200 to each group, of whom 194 in each group underwent analysis. The median (IQR) facemask leak was 23% (8%-41%) in the RFM visible group compared with 35% (14%-67%) in the masked group, p<0.0001, difference (95% CI) in medians 12 (4 to 22). CONCLUSIONS The display of information from an RFM improved the effectiveness of newborn facemask ventilation training. TRIAL REGISTRATION NUMBER ACTRN12616000542493, pre-results.
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Affiliation(s)
- Eoin O'Currain
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,School of Medicine, University College Dublin, Dublin, Ireland.,Paediatric Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Marta Thio
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,Paediatric Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Anne Dawson
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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