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Dunne EA, O'Donnell CPF, Nakstad B, McCarthy LK. Thermoregulation for very preterm infants in the delivery room: a narrative review. Pediatr Res 2024; 95:1448-1454. [PMID: 38253875 PMCID: PMC11126394 DOI: 10.1038/s41390-023-02902-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/28/2023] [Accepted: 11/02/2023] [Indexed: 01/24/2024]
Abstract
Abnormal temperature in preterm infants is associated with increased morbidity and mortality. Infants born prematurely are at risk of abnormal temperature immediately after birth in the delivery room (DR). The World Health Organization (WHO) recommends that the temperature of newly born infants is maintained between 36.5-37.5oC after birth. When caring for very preterm infants, the International Liaison Committee on Resuscitation (ILCOR) recommends using a combination of interventions to prevent heat loss. While hypothermia remains prevalent, efforts to prevent it have increased the incidence of hyperthermia, which may also be harmful. Delayed cord clamping (DCC) for preterm infants has been recommended by ILCOR since 2015. Little is known about the effect of timing of DCC on temperature, nor have there been specific recommendations for thermal care before DCC. This review article focuses on the current evidence and recommendations for thermal care in the DR, and considers thermoregulation in the context of emerging interventions and future research directions. IMPACT: Abnormal temperature is common amongst very preterm infants after birth, and is an independent risk factor for mortality. The current guidelines recommend a combination of interventions to prevent heat loss after birth. Despite this, abnormal temperature is still a problem, across all climates and economies. New and emerging delivery room practice (i.e., delayed cord clamping, mobile resuscitation trolleys, early skin to skin care) may have an effect on infant temperature. This article reviews the current evidence and recommendations, and considers future research directions.
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Affiliation(s)
- Emma A Dunne
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Colm P F O'Donnell
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Britt Nakstad
- Division of Pediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Lisa K McCarthy
- Department of Neonatology, The National Maternity Hospital, Holles Street, Dublin, Ireland.
- School of Medicine, University College Dublin, Dublin, Ireland.
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Goodwin L, Kirby K, McClelland G, Beach E, Bedson A, Benger JR, Deave T, Osborne R, McAdam H, McKeon-Carter R, Miller N, Taylor H, Voss S. Inequalities in birth before arrival at hospital in South West England: a multimethods study of neonatal hypothermia and emergency medical services call-handler advice. BMJ Open 2024; 14:e081106. [PMID: 38684256 PMCID: PMC11057285 DOI: 10.1136/bmjopen-2023-081106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES To examine inequalities in birth before arrival (BBA) at hospitals in South West England, understand which groups are most likely to experience BBA and how this relates to hypothermia and outcomes (phase A). To investigate opportunities to improve temperature management advice given by emergency medical services (EMS) call-handlers during emergency calls regarding BBA in the UK (phase B). DESIGN A two-phase multimethod study. Phase A analysed anonymised data from hospital neonatal records between January 2018 and January 2021. Phase B analysed anonymised EMS call transcripts, followed by focus groups with National Health Service (NHS) staff and patients. SETTING Six Hospital Trusts in South West England and two EMS providers (ambulance services) in South West and North East England. PARTICIPANTS 18 multidisciplinary NHS staff and 22 members of the public who had experienced BBA in the UK. RESULTS 35% (64/184) of babies conveyed to hospital were hypothermic on arrival. When compared with national data on all births in the South West, we found higher percentages of women with documented safeguarding concerns at booking, previous live births and 'late bookers' (booking their pregnancy >13 weeks gestation). These women may, therefore, be more likely to experience BBA. Preterm babies, babies to first-time mothers and babies born to mothers with disability or safeguarding concerns at booking were more likely to be hypothermic following BBA. Five main themes emerged from qualitative data on call-handler advice: (1) importance placed on neonatal temperature; (2) advice on where the baby should be placed following birth; (3) advice on how to keep the baby warm; (4) timing of temperature management advice and (5) clarity and priority of instructions. CONCLUSIONS Findings identified factors associated with BBA and neonatal hypothermia following BBA. Improvements to EMS call-handler advice could reduce the number of babies arriving at hospital hypothermic.
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Affiliation(s)
- Laura Goodwin
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Kim Kirby
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Research, Audit and Quality Improvement Department, South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | | | - Emily Beach
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Adam Bedson
- South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | | | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Ria Osborne
- Research, Audit & Improvement, South Western Ambulance Service NHS Foundation Trust, Exeter, UK
| | - Helen McAdam
- Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | | | - Nick Miller
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah Voss
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
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Wainaina J, Ogero M, Mumelo L, Wairoto K, Mbevi G, Tuti T, Mwaniki P, Irimu G, English M, Aluvaala J. Hypothermia amongst neonatal admissions in Kenya: a retrospective cohort study assessing prevalence, trends, associated factors, and its relationship with all-cause neonatal mortality. Front Pediatr 2024; 12:1272104. [PMID: 38601273 PMCID: PMC11004247 DOI: 10.3389/fped.2024.1272104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/26/2024] [Indexed: 04/12/2024] Open
Abstract
Background Reports on hypothermia from high-burden countries like Kenya amongst sick newborns often include few centers or relatively small sample sizes. Objectives This study endeavored to describe: (i) the burden of hypothermia on admission across 21 newborn units in Kenya, (ii) any trend in prevalence of hypothermia over time, (iii) factors associated with hypothermia at admission, and (iv) hypothermia's association with inpatient neonatal mortality. Methods A retrospective cohort study was conducted from January 2020 to March 2023, focusing on small and sick newborns admitted in 21 NBUs. The primary and secondary outcome measures were the prevalence of hypothermia at admission and mortality during the index admission, respectively. An ordinal logistic regression model was used to estimate the relationship between selected factors and the outcomes cold stress (36.0°C-36.4°C) and hypothermia (<36.0°C). Factors associated with neonatal mortality, including hypothermia defined as body temperature below 36.0°C, were also explored using logistic regression. Results A total of 58,804 newborns from newborn units in 21 study hospitals were included in the analysis. Out of these, 47,999 (82%) had their admission temperature recorded and 8,391 (17.5%) had hypothermia. Hypothermia prevalence decreased over the study period while admission temperature documentation increased. Significant associations were found between low birthweight and very low (0-3) APGAR scores with hypothermia at admission. Odds of hypothermia reduced as ambient temperature and month of participation in the Clinical Information Network (a collaborative learning health platform for healthcare improvement) increased. Hypothermia at admission was associated with 35% (OR 1.35, 95% CI 1.22, 1.50) increase in odds of neonatal inpatient death. Conclusions A substantial proportion of newborns are admitted with hypothermia, indicating a breakdown in warm chain protocols after birth and intra-hospital transport that increases odds of mortality. Urgent implementation of rigorous warm chain protocols, particularly for low-birth-weight babies, is crucial to protect these vulnerable newborns from the detrimental effects of hypothermia.
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Affiliation(s)
- John Wainaina
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Morris Ogero
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Livingstone Mumelo
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Kefa Wairoto
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - George Mbevi
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Timothy Tuti
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Paul Mwaniki
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Irimu
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Oxford, United Kingdom
| | - Jalemba Aluvaala
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Smith B. Thermoregulation of the Extremely Low Birth Weight Neonate. Neonatal Netw 2024; 43:12-18. [PMID: 38267092 DOI: 10.1891/nn-2023-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
The birth of an extremely low birth weight (ELBW) neonate is complex because of their immaturity. Respiratory and hemodynamic stabilization often takes precedence in the immediate delivery period. While establishing effective breathing and circulation is vital to the survival of the neonate, it is crucial to understand that other adverse outcomes can occur during the resuscitation and transport of the ELBW neonate. Impaired thermoregulation is one of the most detrimental adverse outcomes during the golden hour period and later in the neonatal intensive care unit. Hypothermia is an independent risk factor for increased morbidity and mortality and can impact multiple body systems, making management even more challenging. This article discusses the physiology of thermoregulation while exploring interventions to maintain normothermia in the ELBW neonate, ultimately improving long-term outcomes.
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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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Goodwin L, Voss S, McClelland G, Beach E, Bedson A, Black S, Deave T, Miller N, Taylor H, Benger J. Temperature measurement of babies born in the pre-hospital setting: analysis of ambulance service data and qualitative interviews with paramedics. J Accid Emerg Med 2022; 39:826-832. [PMID: 35914922 DOI: 10.1136/emermed-2021-211970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 07/19/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Birth before arrival at hospital (BBA) is associated with unfavourable perinatal outcomes and increased mortality. An important risk factor for mortality following BBA is hypothermia, and emergency medical services (EMS) providers are well placed to provide warming strategies. However, research from the UK suggests that EMS providers (paramedics) do not routinely record neonatal temperature following BBA. This study aimed to determine the proportion of cases in which neonatal temperature is documented by paramedics attending BBAs in the South West of England and to explore the barriers to temperature measurement by paramedics. METHODS A two-phase multi-method study. Phase I involved an analysis of anonymised data from electronic patient care records between 1 February 2017 and 31 January 2020 in a single UK ambulance service, to determine 1) the frequency of BBAs attended and 2) the percentage of these births where a neonatal temperature was recorded, and what proportion of these were hypothermic. Phase II involved interviews with 20 operational paramedics from the same ambulance service, to explore their experiences of, and barriers and facilitators to, neonatal temperature measurement and management following BBA. RESULTS There were 1582 'normal deliveries' attended by paramedics within the date range. Neonatal temperatures were recorded in 43/1582 (2.7%) instances, of which 72% were below 36.5°C. Data from interviews suggested several barriers and potential facilitators to paramedic measurement of neonatal temperature. Barriers included unavailable or unsuitable equipment, prioritisation of other care activities, lack of exposure to births, and uncertainty regarding responsibilities and roles. Possible facilitators included better equipment, physical prompts, and training and awareness-raising around the importance of temperature measurement. CONCLUSIONS This study demonstrates a lack of neonatal temperature measurement by paramedics in the South West following BBA, and highlights barriers and facilitators that could serve as a basis for developing an intervention to improve neonatal temperature measurement.
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Affiliation(s)
- Laura Goodwin
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Sarah Voss
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Graham McClelland
- Research and Development, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK.,Stroke Research Group, Newcastle University School of Population and Health Sciences, Newcastle upon Tyne, UK
| | - Emily Beach
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Adam Bedson
- EPRR/Specialist Practice, South Western Ambulance Service NHS Foundation Trust, Taunton, Somerset, UK
| | - Sarah Black
- Research and Audit, South Western Ambulance Service NHS Foundation Trust, Exeter, Devon, UK
| | - Toity Deave
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Nick Miller
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Hazel Taylor
- Research Design Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jonathan Benger
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
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Chang TP, Elkin R, Boyle TP, Nishisaki A, Walsh B, Benary D, Auerbach M, Camacho C, Calhoun A, Stapleton SN, Whitfill T, Wood T, Fayyaz J, Gross IT, Thomas AA. Characterizing preferred terms for geographically distant simulations: distance, remote and telesimulation. Simul Healthc 2022. [DOI: 10.54531/drkq7209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulationists lack standard terms to describe new practices accommodating pandemic restrictions. A standard language around these new simulation practices allows ease of communication among simulationists in various settings.
We explored consensus terminology for simulation accommodating geographic separation of participants, facilitators or equipment. We used an iterative process with participants of two simulation conferences, with small groups and survey ranking.
Small groups (n = 121) and survey ranking (n = 54) were used with
This research has deepened our understanding of how simulationists interpret this terminology, including the derived themes: (1) physical distance/separation, (2) overarching nature of the term and (3) implications from existing terms. We further deepen the conceptual discussion on healthcare simulation aligned with the search of the terminologies. We propose there are nuances that prevent an early consensus recommendation. A taxonomy of descriptors specifying the conduct of
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Affiliation(s)
- Todd P Chang
- 1Division of Emergency Medicine & Transport, Children’s Hospital Los Angeles/Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rachel Elkin
- 2Division of Pediatric Emergency Medicine, New York-Presbyterian Morgan Stanley Children’s Hospital-Columbia University Irving Medical Center/Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Tehnaz P Boyle
- 3Division of Pediatric Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Akira Nishisaki
- 4Division of Pediatric Critical Care, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Walsh
- 5Division of Emergency Medicine, Boston Children’s Hospital, Harvard University, Boston, MA, USA
| | - Doreen Benary
- 6Division of Pediatric Emergency Medicine, NYU Langone Medical Center, New York University, New York, NY, USA
| | - Marc Auerbach
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cheryl Camacho
- 8Simulation and Outreach Education, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Aaron Calhoun
- 9Division of Critical Care, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Stephanie N Stapleton
- 10Department of Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Travis Whitfill
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Trish Wood
- 11Starship Child Health, Auckland, New Zealand
| | - Jabeen Fayyaz
- 12Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Isabel T Gross
- 13Division of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Anita A Thomas
- 14Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA, USA
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Rossi L, Lumbreras AEV, Vagni S, Dell’Anno M, Bontempo V. Nutritional and Functional Properties of Colostrum in Puppies and Kittens. Animals (Basel) 2021; 11:ani11113260. [PMID: 34827992 PMCID: PMC8614261 DOI: 10.3390/ani11113260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The post-natal period is a crucial time for all animal species. During the course of their first two weeks of life, puppies and kittens face several risks to their health due to their scarce energy storage and weak immune system. Colostrum is the first production of the mammary glands that plays a pivotal role for puppies and kittens. Colostrum is an important source of immunoglobulins and key nutrients such as lipids and carbohydrates, which are fundamental for the health of newborns. Puppies and kittens must ingest a sufficient amount of colostrum within a few hours of birth to ensure their survival. On the other hand, there are some particular compounds that are not strictly essential, but their presence may play an important role in nutrition and health. As there are no recent studies on companion animals, we have reported published articles describing animal studies in different species to review the nutrition of newborn mammals, with particular emphasis on companion animals. Abstract The present review aims toward a better understanding of the nutrition of newborn puppies and kittens. The post-natal period is very sensitive in dogs and cats, as in other animal species. During the first two weeks of life, puppies and kittens are at high risk of dehydration, hypothermia, and hypoglycemia, as well as infectious diseases as they start to acquire the physiological functions of the adult. Neonatal hepatic glycogen storage is low, and newborns depend on colostrum intake to survive. Colostrum provides immunoglobulins and other important substances such as lipids and carbohydrates. Immunoglobulins are central to the immunological link that occurs when the mother transfers passive immunity. The mechanism of transfer varies among mammalian species, but in this review, we focused our attention on dogs and cats. Furthermore, there are components of colostrum which, although their presence is not absolutely necessary, play an important role in nutrition. These components have received considerable interest because of their presumed safety and potential nutritional and therapeutic effects both in humans and animals; however, unfortunately, there are few recent studies in companion animals. Here, we have gathered the published articles that describe studies involving different species of animals, emphasizing companion animals. In particular, the purpose of this narrative of the nutritional and functional proprieties of queens’ and bitches’ colostrum.
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Schwaberger B, Urlesberger B, Schmölzer GM. Delivery Room Care for Premature Infants Born after Less than 25 Weeks' Gestation-A Narrative Review. CHILDREN-BASEL 2021; 8:children8100882. [PMID: 34682147 PMCID: PMC8534639 DOI: 10.3390/children8100882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022]
Abstract
Premature infants born after less than 25 weeks' gestation are particularly vulnerable at birth and stabilization in the delivery room (DR) is challenging. After birth, infants born after <25 weeks' gestation develop respiratory and hemodynamic instability due to their immature physiology and anatomy. Successful stabilization at birth has the potential to reduce morbidities and mortalities, while suboptimal DR care could increase long-term sequelae. This article reviews current neonatal resuscitation guidelines and addresses challenges during DR stabilization in extremely premature infants born after <25 weeks' gestation at the threshold of viability.
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Affiliation(s)
- Bernhard Schwaberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria; (B.S.); (B.U.)
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria; (B.S.); (B.U.)
| | - Georg M. Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T5H 3V9, Canada
- Correspondence: ; Tel.: +1-780-735-4660
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Young A, Azeez F, Godad SP, Shetty P, Sharma A. A multimodal quality improvement approach to promote normothermia in very preterm infants. Acta Paediatr 2021; 110:2745-2752. [PMID: 34185925 DOI: 10.1111/apa.16009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
AIM To achieve the National Neonatal Audit Programme (NNAP) standard of 90% normothermia among preterm infants born under 30 weeks of gestation. METHODS Project SHIP (Stopping Hypothermia In Premmies) was a quality improvement programme to improve admission normothermia. Phase 1 of the project implemented low-fidelity simulations during 2011-2016. In Phase 2 (2017), a multimodal approach to quality improvement was used, including in situ simulations, videos of simulated scenarios, an allocated team member for thermal care, a clear protocol for thermal care, a coordinating 'lollipop man' role and monthly performance feedback. Additionally, continuous temperature monitoring using servo-control during stabilisation was introduced during Phase 2. Phase 3 (2018-2019) focused on embedding practice and maintaining performance. RESULTS Phase 1 initiatives resulted in improvement of normothermia rates from 58% to 75%. However, the results plateaued. During Phase 2, the hypothermia rate fell from 16% to 3%. During Phase 3, this improvement in the hypothermia rate was sustained, achieving the standard of 90% normothermia in 2018 and falling just short in 2019 due to an increased hyperthermia rate. CONCLUSION A multimodal quality improvement approach achieved sustained improvement in normothermia. Continuous temperature monitoring during stabilisation allows resuscitating teams to plan interventions to treat hypothermia and hyperthermia.
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Affiliation(s)
- Aneurin Young
- Department of Neonatal Medicine and Surgery NIHR Southampton Biomedical Research Centre Princess Anne Hospital Southampton Southampton UK
| | - Fameesh Azeez
- Department of Neonatal Medicine and Surgery Princess Anne Hospital Southampton Southampton UK
| | - Santan Pawalu Godad
- Department of Neonatal Medicine and Surgery Princess Anne Hospital Southampton Southampton UK
| | - Preethish Shetty
- Department of Paediatrics Royal Hampshire County Hospital Winchester UK
| | - Alok Sharma
- Department of Neonatal Medicine and Surgery Princess Anne Hospital Southampton Southampton UK
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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: 214] [Impact Index Per Article: 71.3] [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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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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Singh J, Dalal P, Gathwala G. Clinical profile and predictors of mortality among the referred neonates at a tertiary care centre in north India: a prospective observational study. Trop Doct 2020; 50:221-227. [PMID: 32380904 DOI: 10.1177/0049475520921675] [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] [Indexed: 11/16/2022]
Abstract
The National Family Health Survey (NFHS-4) shows encouraging improvement in infant and under-five mortality rates in India. However, the neonatal mortality rate (NMR) still remains high as India contributes to about one-fifth of global deaths. This prospective study was conducted from 15 January to 30 April 2016 to examine the clinical profile and predictors of mortality among referred neonates at our centre. Among 301 neonates, prematurity (40%) was the most common indication for referral followed by need for ventilation (38%) and birth asphyxia (28%). Approximately 73% neonates were referred within 24 h of birth. Ninety (29.9%) neonates died; of these, 63% died within 24 h of presentation. Prematurity, birth asphyxia, hypothermia, shock at presentation and extreme low birth weight were the most significant predictors of mortality. Adequate training of peripheral health personnel, dedicated teams for neonatal referral and strengthening of peripheral sick newborn care units (SNCUs) seem to be promising interventions for favourable outcome.
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Affiliation(s)
- Jasbir Singh
- Senior Resident, Department of Pediatrics, PGIMS, Rohtak, Haryana, India
| | - Poonam Dalal
- Professor, Department of Pediatrics, PGIMS, Rohtak, Haryana, India
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Merazzi D, Bresesti I, Tagliabue P, Valsecchi MG, De Lorenzo P, Lista G. Body temperature at nursery admission in a cohort of healthy newborn infants: results from an observational cross-sectional study. Ital J Pediatr 2020; 46:46. [PMID: 32293526 PMCID: PMC7157981 DOI: 10.1186/s13052-020-0810-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exposure to hypothermia is somehow unavoidable when a baby comes to life. This is the reason why any possible effort should be made by every caregiver involved during birth, from labour to transfer into the maternity ward, to reduce it. Hypothermia has widely shown to be related to several neonatal problems, and the risks are more relevant when the babies are born prematurely. METHOD An observational study was conducted in April 2016 to assess the current practises to avoid hypothermia at birth in 20 Italian neonatal units. Each unit introduced local improvements in clinical practice and the same observational study was repeated 1 year later. RESULTS A total of 4722 babies were analysed. An overall increase in adherence to local and international recommendations emerged from our study. Significant differences between 2016 and 2017 were found in regard to neonatal temperature at nursery entry (36.3 °C vs 36.5 °C, respectively, p < 0.0001), delayed cord clamping practice > 60″ (48.1% vs 68.1%, respectively, p < 0.0001) and skin-to-skin practice > 60' (56.3% vs 60.9, respectively, p = 0.03). Statistical correlations with the risk of hypothermia were found for delivery room (OR 0.88 (CI 95%0.83-0.94), p < 0.0001) and maternal temperature (OR 0.57 (CI 95% 0.48-0.67), p < 0.0001). CONCLUSION Periodical assessment of the delivery room practice has shown to be effective in improving adherence to the international recommendations. Relationship between neonatal hypothermia and several other variables including the delivery room and mother temperature underlines how neonatal thermoregulation starts immediately after birth. Hence, a multi-disciplinary approach is needed to provide the optimal environment for a safe birth.
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Affiliation(s)
| | - Ilia Bresesti
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.,Division of Pediatrics, "L. Sacco" Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Paolo Tagliabue
- Division of Neonatology, "S. Gerardo" Hospital, MBBM Foundation, Monza, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paola De Lorenzo
- Center of Biostatistics for Clinical Epidemiology and Pediatric Clinic, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Gianluca Lista
- Division of Neonatology, "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.
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Donnellan D, Moore Z, Patton D, O'Connor T, Nugent L. The effect of thermoregulation quality improvement initiatives on the admission temperature of premature/very low birth-weight infants in neonatal intensive care units: A systematic review. J SPEC PEDIATR NURS 2020; 25:e12286. [PMID: 31909894 DOI: 10.1111/jspn.12286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/12/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this review was to ascertain the impact of thermoregulation quality improvement initiatives (QIs) on the admission temperatures of premature/very-low-birth-weight infants in neonatal intensive care units (NICUs). METHODS A systematic search of databases Cumulative Index to Nursing and Allied Health Literature, Medline, Embase, and the Cochrane library was carried out. Specific inclusion and exclusion criteria were adhered to, with no publication date limitations added. The chosen studies were examined for quality, data were extracted and analysed, before a narrative synthesis was performed. The last search occurred on January 7, 2019, with PRISMA flow diagrams completed for identified studies. RESULTS Ten studies of varying methodology design were included in this review. Variations of thermoregulation interventions were included in the 10 studies. Nevertheless, all of them demonstrated that admission temperature rates can be significantly improved by implementing a thermoregulation QI. The multidisciplinary team and ongoing education were seen as much needed components to the overall sustainability, and continuing success of the QI's. PRACTICAL IMPLICATIONS This systematic review determines that thermoregulation QIs can positively impact the admission temperatures of premature/very-low-birth-weight infants in the NICU. Prevention of hypothermia is aimed at reducing the risks of developing major neonatal morbidities. The pooling of the results from the 10 studies helps in the sharing of outcome measures and thus, improving quantitative synthesis. More frequent monitoring of the axillary temperature would help in preventing hypothermia and hyperthermia occurring. Ongoing education and staff training are essential for managing thermoregulation successfully. Examining the compliance rates to such quality initiatives, and the variations in interventions would benefit from further research to ensure better standardisation of clinical practice.
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Affiliation(s)
- Denise Donnellan
- Neonatal Intensive Care Unit, University Hospital Galway, Galway, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom O'Connor
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
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McClelland G, Burrow E, McAdam H. Babies born in the pre-hospital setting attended by ambulance clinicians in the north east of England. Br Paramed J 2019; 4:43-48. [PMID: 33447150 PMCID: PMC7783920 DOI: 10.29045/14784726.2019.12.4.3.43] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: The majority of births in the United Kingdom happen in hospital or at stand-alone midwife led centres, or with the support of midwives in a planned fashion outside of hospital. The unplanned birth of a baby in the pre-hospital setting is a rare event which may result in an ambulance being called, so attendance at a birth is a rare event for ambulance clinicians. A service evaluation was conducted to report which clinical observations were recorded on babies born in the pre-hospital setting who were attended by ambulance clinicians from the North East Ambulance Service (NEAS) over a one-year period. Methods: A retrospective service evaluation was conducted using routinely collected data. All electronic patient care records covering a one-year period between 1 October 2017 and 30 September 2018 with a primary impression of ‘childbirth’ were examined. Results: This evaluation identified 168 individual pre-hospital childbirth cases attended by NEAS clinicians during the evaluation timeframe. The majority (85%) of babies were born to multiparous mothers with a median gestation of 39 weeks. Very few clinical observations were recorded on the babies (respiratory rate 23%, heart rate 21%, temperature 10%, APGAR 8%, blood sugar 1%) and no babies had all five of these observations documented. Only 5% of babies had any complications documented. Conclusion: This study showed that NEAS ambulance clinicians rarely attend babies born in the pre-hospital setting and that complications were infrequently recorded. There was a lack of observations recorded on the babies, which is an issue due to the clear link between easily measurable characteristics such as temperature and mortality and morbidity.
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Affiliation(s)
- Graham McClelland
- North East Ambulance Service NHS Foundation Trust: ORCID iD: http://orcid.org/0000-0002-4502-5821
| | - Emma Burrow
- North East Ambulance Service NHS Foundation Trust
| | - Helen McAdam
- North East Ambulance Service NHS Foundation Trust
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Kinoshita D, Hada S, Fujita R, Matsunaga N, Sakaki H, Ohki Y. Maximal sterile barrier precautions independently contribute to decreased central line-associated bloodstream infection in very low birth weight infants: A prospective multicenter observational study. Am J Infect Control 2019; 47:1365-1369. [PMID: 31266662 DOI: 10.1016/j.ajic.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The use of peripherally inserted central catheters (PICCs) in neonates differs among various institutions and countries because there are no random controlled trials or large observational studies regarding maximal sterile barrier (MSB) precautions in neonatal intensive care units. Our objective was to investigate the association of MSB implementation with central line-associated bloodstream infection (CLABSI) in very low birth weight infants. METHODS This was a prospective multicenter observational study in Japan of infants with birth weight less than 1501 grams and in whom a PICC was placed for the first time between October 2014 and March 2017. Risk factors for CLABSI, both related and unrelated to MSB, were assessed by the mixed-effects Cox proportional hazards model, with the neonatal center variable as the random effect. RESULTS In total, 33,713 catheter-days among 2383 infants were included. We observed 70 cases of CLABSI. MSB precautions were implemented in 13.9% of insertions and were associated with a lower CLABSI risk (adjusted hazard ratio, 0.20; 95% confidence interval, 0.05-0.84). CONCLUSIONS We found that MSB implementation during PICC insertion in infants with birth weight less than 1501 grams independently contributed to a decrease in CLABSI risk.
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Affiliation(s)
- Daisuke Kinoshita
- Neonatal Infection Control and Prevention Searching Group in Japan; Department of Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
| | - Satoshi Hada
- Neonatal Infection Control and Prevention Searching Group in Japan; Department of Neonatology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Retsu Fujita
- Neonatal Infection Control and Prevention Searching Group in Japan; Innovation and Research Support Center, Graduate school of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Nobuaki Matsunaga
- Neonatal Infection Control and Prevention Searching Group in Japan; Department of Pediatrics, Juntendo University Hospital, Tokyo, Japan
| | - Haruyo Sakaki
- Neonatal Infection Control and Prevention Searching Group in Japan; Department of Nursing, Nishisaitama-chuo National Hospital, Saitama, Japan
| | - Yasushi Ohki
- Neonatal Infection Control and Prevention Searching Group in Japan; Department of Pediatrics, Kiryu Kosei General Hospital, Gunma, Japan
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Lee NH, Nam SK, Lee J, Jun YH. Clinical impact of admission hypothermia in very low birth weight infants: results from Korean Neonatal Network. KOREAN JOURNAL OF PEDIATRICS 2019; 62:386-394. [PMID: 31122009 PMCID: PMC6801200 DOI: 10.3345/kjp.2019.00206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/22/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5°C-37.5°C. PURPOSE We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities. METHODS A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean Neonatal Network. From registered infants born between January 2013 and December 2015, 5,343 VLBW infants born at less than 33 weeks of gestation were reviewed. RESULTS The mean admission temperature was 36.1°C±0.6°C, with a range of 31.9°C to 38.4°C. Approximately 74.1% of infants had an admission hypothermia of <36.5°C. Lower birth weight, intubation in the delivery room and Apgar score <7 at 5 minutes were significantly related to admission hypothermia. The mortality was the lowest at 36.5°C-37.5°C and adjusted odd ratios for all deaths increased to 1.38 (95% confidence interval [CI], 1.04-1.83), 1.44 (95% CI, 1.05-1.97) and 1.86 (95% CI, 1.22-2.82) for infants with admission temperatures of 36.0°C-36.4°C, 35.0°C-35.9°C, and <35.0°C, respectively. Admission hypothermia was also associated with high likelihoods of bronchopulmonary dysplasia, pulmonary hypertension, proven sepsis, pulmonary hemorrhage, air-leak, seizure, grade 3 or higher intraventricular hemorrhage and advanced retinopathy of prematurity requiring laser therapy. CONCLUSION A large portion of preterm infants in Korea had hypothermia at NICU admission, which was associated with high mortality and several important morbidities. More aggressive interventions aimed at reducing hypothermia are required in this high-risk population.
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Affiliation(s)
- Na Hyun Lee
- Department of Pediatrics, Inha University Hospital, Incheon, Korea
| | - Soo Kyung Nam
- Department of Pediatrics, Inha University Hospital, Incheon, Korea
| | - Juyoung Lee
- Department of Pediatrics, Inha University Hospital, Incheon, Korea.,Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Yong Hoon Jun
- Department of Pediatrics, Inha University Hospital, Incheon, Korea.,Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
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Abstract
A high incidence of postnatal hypothermia has been reported in high-as well low-resource countries and it remains an independent predictor of neonatal morbidity and mortality, especially in very preterm infants in all settings. The temperature of newly born infants should be maintained between 36.5 and 37.5 °C after birth through admission and stabilization. Interventions to achieve this may include environmental temperature 23-25 °C, use of radiant warmers, exothermic mattresses, woollen or plastic caps, plastic wraps, humidified and heated gases. Skin-to-skin contact has been used, especially in low-resource settings. The combinations of these interventions applied to quality improvement initiatives, including staff training, use of checklists, and continuous feedback with the staff involved in the management of the neonate, are key factors to prevent heat loss from delivery room to admission to the neonatal intensive care unit. The admission temperature should be recorded as a predictor of outcomes as well as a quality indicator.
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Affiliation(s)
- Daniele Trevisanuto
- Department of Women's and Children's Health, Azienda Ospedaliera di Padova, University of Padua, Padua, Italy.
| | - Daniela Testoni
- Division of Neonatal Medicine, Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria Fernanda B de Almeida
- Division of Neonatal Medicine, Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, Brazil
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20
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Social touch during development: Long-term effects on brain and behavior. Neurosci Biobehav Rev 2018; 95:202-219. [PMID: 30278194 DOI: 10.1016/j.neubiorev.2018.09.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 01/07/2023]
Abstract
In this paper, our goal is to explore what is known about the role of social touch during development. We first address the neural substrates of social touch and the role of tactile experience in neural development. We discuss natural variation in early exposure to social touch, followed by a discussion on experimental manipulations of social touch during development and "natural experiments", such as early institutionalization. We then consider the role of other developmental and experiential variables that predict social touch in adults. Throughout, we propose and consider new theoretical models of the role of social touch during development on later behavior and neurobiology.
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Caldas JPDS, Millen FDC, Camargo JFD, Castro PAC, Camilo ALDF, Marba STM. Effectiveness of a measure program to prevent admission hypothermia in very low‐birth weight preterm infants. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Effectiveness of a measure program to prevent admission hypothermia in very low-birth weight preterm infants. J Pediatr (Rio J) 2018; 94:368-373. [PMID: 28886399 DOI: 10.1016/j.jped.2017.06.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a thermoregulation bundle for preventing admission hypothermia in very low-birth weight preterm infants. METHODS Interventional study with retrospective evaluation of data undertaken in a tertiary neonatal unit including all very low-birth weight preterm infants (<1500g) born at and admitted to the unit. Two periods were compared: before intervention (PI; 01/01/2012 to 02/28/2014_ and after intervention (PII; 04/01/2014 to 11/30/2016). The intervention started in March 2014. At PI procedures in the delivery room were: placement in a crib with a radiant heat source, doors always closed, polyethylene body plastic bag, double cap (plastic and cotton mesh), room temperature between 24 to 27°C and transport to neonatal unit in a pre-heated incubator (36-37.0°C). At PII, there was a reinforcement on not opening the plastic bag during the entire resuscitation process, even at an advanced stage, and the anthropometric measures and routine care were performed in the neonatal unit. Maternal, delivery, and neonatal variables were compared. Admission hypothermia was considered when admission axillary temperature was <36.0°C. Periodic results were shown to the team every six months and results were discussed. RESULTS The incidence of admission hypothermia was reduced significantly in PII (37.2 vs. 14.2%, p<0.0001) and admission temperature medians were higher (36.1 vs. 36.5°C, p<0.001). At PII, there was an increase in the number of infants transported with oxygen (49.5 vs. 75.5%, p<0.0001). No differences were observed regarding birth weight and gestational age. CONCLUSION There was a very important reduction in admission hypothermia incidence and a higher median admission temperature after continued protocol implementation.
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23
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Wilson E, Zeitlin J, Piedvache A, Misselwitz B, Christensson K, Maier RF, Norman M, Edstedt Bonamy AK. Cohort study from 11 European countries highlighted differences in the use and efficacy of hypothermia prevention strategies after very preterm birth. Acta Paediatr 2018; 107:958-966. [PMID: 29356061 DOI: 10.1111/apa.14230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/18/2017] [Accepted: 01/16/2018] [Indexed: 01/22/2023]
Abstract
AIM This study investigated the different strategies used in 11 European countries to prevent hypothermia, which continues to affect a large proportion of preterm births in the region. METHODS We examined the association between the reported use of hypothermia prevention strategies in delivery rooms and body temperatures on admission to neonatal intensive care units (NICUs) in 5861 infants born at 22 + 0 to 31 +6 weeks of gestation. The use of plastic bags, wraps, caps, exothermic heat and mattresses was investigated. RESULTS The proportion of infants born in units that systematically used one or more hypothermia prevention strategies was 88.2% and 50.9% of those infants were hypothermic on admission to NICUs. Of the 9.6% born in units without systematic hypothermia prevention, 73.2% were hypothermic. Only 2.2% of infants were born in units with no reported prevention strategies. Lower gestational age increased the probability of hypothermia. No significant differences were found between the various hypothermia prevention strategies. Hyperthermia was seen in 4.8% of all admitted infants. CONCLUSION Very preterm infants had lower risks of hypothermia on NICU admission if the unit used systematic prevention strategies. All the strategies had similar effects, possibly due to implementation rather than a strategy's specific efficacy.
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Affiliation(s)
- Emilija Wilson
- Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - Jennifer Zeitlin
- INSERM; Obstetrical, Perinatal and Paediatric Epidemiology Research Team; Centre for Epidemiology and Biostatistics (U1153); Paris-Descartes University; Paris France
| | - Aurélie Piedvache
- INSERM; Obstetrical, Perinatal and Paediatric Epidemiology Research Team; Centre for Epidemiology and Biostatistics (U1153); Paris-Descartes University; Paris France
| | | | - Kyllike Christensson
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Rolf F. Maier
- Children's Hospital; Philipps University; Marburg Germany
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Stockholm Sweden
- Department of Neonatal Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Anna-Karin Edstedt Bonamy
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Clinical Epidemiology Unit; Department of Medicine Solna; Karolinska Institutet; Stockholm Sweden
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24
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Hu XJ, Wang L, Zheng RY, Lv TC, Zhang YX, Cao Y, Huang GY. Using polyethylene plastic bag to prevent moderate hypothermia during transport in very low birth weight infants: a randomized trial. J Perinatol 2018; 38:332-336. [PMID: 29282354 DOI: 10.1038/s41372-017-0028-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 08/29/2017] [Accepted: 09/21/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Hypothermia remains a significant problem among very low birth weight (VLBW) infants. The use of occlusive polyethylene plastic bags immediately after birth has been proven to be effective for preterm infants to reduce hypothermia. This study aims to determine whether placing VLBW infants in plastic bags during transport reduces hypothermia. STUDY DESIGN Study infants were randomly assigned to a standard thermoregulation protocol or to a standard thermoregulation protocol with placement of the torso and lower extremities inside a polyethylene plastic bag during transport. The primary outcome measures were axillary temperature before and after transport and the occurrence of moderate hypothermia upon neonatal intensive care unit admission. RESULT The 108 VLBW infants recruited into the study were randomized to the plastic bag (n = 54) group or to standard group (n = 54) and had similar baseline characteristics. VLBW infants in the plastic bag group had a lower rate of moderate hypothermia (3.7 vs 27.8%; risk ratio 0.10; confidence interval 0.02-0.46; P < 0.001) and higher axillary temperatures (36.4 ± 0.4 °C vs 35.9 ± 0.9 °C; P = 0.001) upon NICU admission compared to infants receiving standard care. CONCLUSION Placing VLBW infants in polyethylene plastic bags during transport reduces the occurrence of hypothermia, especially moderate hypothermia.
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Affiliation(s)
- Xiao-Jing Hu
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Li Wang
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Ru-Yi Zheng
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Tian-Chan Lv
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Yu-Xia Zhang
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Yun Cao
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Guo-Ying Huang
- Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China. .,Shanghai Key Laboratory of Birth Defects, Shanghai, China.
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O'Brien EA, Colaizy TT, Brumbaugh JE, Cress GA, Johnson KJ, Klein JM, Bell EF. Body temperatures of very low birth weight infants on admission to a neonatal intensive care unit. J Matern Fetal Neonatal Med 2018; 32:2763-2766. [PMID: 29478358 DOI: 10.1080/14767058.2018.1446076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Hypothermia occurs frequently in the first minutes after birth in preterm infants. Hyperthermia also occurs, often as a consequence of efforts to provide thermal support. Both hypothermia and hyperthermia are potentially harmful. Our objective was to examine the distribution of admission temperatures of very low birth weight (VLBW) infants, the effect of gestational age on admission temperatures, and the time required for correction of low temperatures. METHODS Admission axillary temperatures were retrieved from the medical records for all VLBW infants born in our hospital during a 5-year period. The temperatures were classified as severe (<35.0 °C), moderate (35.0-35.9 °C), or mild (36.0-36.4 °C) hypothermia, normothermia (36.5-37.4 °C), or hyperthermia (≥37.5 °C). The relationship between gestational age and admission temperature was examined. In addition, we analyzed the time required for normalization of low temperatures. RESULTS Overall, 12% of infants were severely hypothermic, 40% moderately hypothermic, 27% mildly hypothermic, 19% normothermic, and 2% hyperthermic. Gestational age was inversely related to hypothermia risk and to the time required for recovery to normothermia. CONCLUSION Admission hypothermia is common among VLBW infants and is affected by gestational age.
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Affiliation(s)
- Emily A O'Brien
- a Physician Assistant Program, Midwestern University , Downers Grove , IL , USA
| | - Tarah T Colaizy
- b Department of Pediatrics , University of Iowa , Iowa City , IA , USA
| | - Jane E Brumbaugh
- c Department of Pediatrics and Adolescent Medicine , Mayo Clinic , Rochester , MN , USA
| | - Gretchen A Cress
- b Department of Pediatrics , University of Iowa , Iowa City , IA , USA
| | - Karen J Johnson
- b Department of Pediatrics , University of Iowa , Iowa City , IA , USA
| | - Jonathan M Klein
- b Department of Pediatrics , University of Iowa , Iowa City , IA , USA
| | - Edward F Bell
- b Department of Pediatrics , University of Iowa , Iowa City , IA , USA
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McCall EM, Alderdice F, Halliday HL, Vohra S, Johnston L. Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2018; 2:CD004210. [PMID: 29431872 PMCID: PMC6491068 DOI: 10.1002/14651858.cd004210.pub5] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Newborn admission temperature is a strong predictor of outcomes across all gestations. Hypothermia immediately after birth remains a worldwide issue and, if prolonged, is associated with harm. Keeping preterm infants warm is difficult even when recommended routine thermal care guidelines are followed in the delivery room. OBJECTIVES To assess the efficacy and safety of interventions designed for prevention of hypothermia in preterm and/or low birth weight infants applied within 10 minutes after birth in the delivery room, compared with routine thermal care or any other single/combination of intervention(s) also designed for prevention of hypothermia in preterm and/or low birth weight infants applied within 10 minutes after birth in the delivery room. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 5), MEDLINE via PubMed (1966 to 30 June 2016), Embase (1980 to 30 June 2016), and CINAHL (1982 to 30 June 2016). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Trials using randomised or quasi-randomised allocations to test interventions designed to prevent hypothermia (apart from 'routine' thermal care) applied within 10 minutes after birth in the delivery room for infants at < 37 weeks' gestation and/or birth weight ≤ 2500 grams. DATA COLLECTION AND ANALYSIS We used Cochrane Neonatal methods when performing data collection and analysis. MAIN RESULTS Twenty-five studies across 15 comparison groups met the inclusion criteria, categorised as: barriers to heat loss (18 studies); external heat sources (three studies); and combinations of interventions (four studies).Barriers to heat loss Plastic wrap or bag versus routine carePlastic wraps improved core body temperature on admission to the neonatal intensive care unit (NICU) or up to two hours after birth (mean difference (MD) 0.58°C, 95% confidence interval (CI) 0.50 to 0.66; 13 studies; 1633 infants), and fewer infants had hypothermia on admission to the NICU or up to two hours after birth (typical risk ratio (RR) 0.67, 95% CI 0.62 to 0.72; typical risk reduction (RD) -0.25, 95% CI -0.29 to -0.20; number needed to treat for an additional beneficial outcome (NNTB) 4, 95% CI 4 to 5; 10 studies; 1417 infants). Risk of hyperthermia on admission to the NICU or up to two hours after birth was increased in infants in the wrapped group (typical RR 3.91, 95% CI 2.05 to 7.44; typical RD 0.04, 95% CI 0.02 to 0.06; number needed to treat for an additional harmful outcome (NNTH) 25, 95% CI 17 to 50; 12 studies; 1523 infants), but overall, fewer infants receiving plastic wrap were outside the normothermic range (typical RR 0.75, 95% CI 0.69 to 0.81; typical RD -0.20, 95% CI -0.26 to -0.15; NNTH 5, 95% CI 4 to 7; five studies; 1048 infants).Evidence was insufficient to suggest that plastic wraps or bags significantly reduce risk of death during hospital stay or other major morbidities, with the exception of reducing risk of pulmonary haemorrhage.Evidence of practices regarding permutations on this general approach is still emerging and has been based on the findings of only one or two small studies.External heat sourcesEvidence is emerging on the efficacy of external heat sources, including skin-to-skin care (SSC) versus routine care (one study; 31 infants) and thermal mattress versus routine care (two studies; 126 infants).SSC was shown to be effective in reducing risk of hypothermia when compared with conventional incubator care for infants with birth weight ≥ 1200 and ≤ 2199 grams (RR 0.09, 95% CI 0.01 to 0.64; RD -0.56, 95% CI -0.84 to -0.27; NNTB 2, 95% CI 1 to 4). Thermal (transwarmer) mattress significantly kept infants ≤ 1500 grams warmer (MD 0.65°C, 95% CI 0.36 to 0.94) and reduced the incidence of hypothermia on admission to the NICU, with no significant difference in hyperthermia risk.Combinations of interventionsTwo studies (77 infants) compared thermal mattresses versus plastic wraps or bags for infants at ≤ 28 weeks' gestation. Investigators reported no significant differences in core body temperature nor in the incidence of hypothermia, hyperthermia, or core body temperature outside the normothermic range on admission to the NICU.Two additional studies (119 infants) compared plastic bags and thermal mattresses versus plastic bags alone for infants at < 31 weeks' gestation. Meta-analysis of these two studies showed improvement in core body temperature on admission to the NICU or up to two hours after birth, but an increase in hyperthermia. Data show no significant difference in the risk of having a core body temperature outside the normothermic range on admission to the NICU nor in the risk of other reported morbidities. AUTHORS' CONCLUSIONS Evidence of moderate quality shows that use of plastic wraps or bags compared with routine care led to higher temperatures on admission to NICUs with less hypothermia, particularly for extremely preterm infants. Thermal mattresses and SSC also reduced hypothermia risk when compared with routine care, but findings are based on two or fewer small studies. Caution must be taken to avoid iatrogenic hyperthermia, particularly when multiple interventions are used simultaneously. Limited evidence suggests benefit and no evidence of harm for most short-term morbidity outcomes known to be associated with hypothermia, including major brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotising enterocolitis, and nosocomial infection. Many observational studies have shown increased mortality among preterm hypothermic infants compared with those who maintain normothermia, yet evidence is insufficient to suggest that these interventions reduce risk of in-hospital mortality across all comparison groups. Hypothermia may be a marker for illness and poorer outcomes by association rather than by causality. Limitations of this review include small numbers of identified studies; small sample sizes; and variations in methods and definitions used for hypothermia, hyperthermia, normothermia, routine care, and morbidity, along with lack of power to detect effects on morbidity and mortality across most comparison groups. Future studies should: be adequately powered to detect rarer outcomes; apply standardised morbidity definitions; focus on longer-term outcomes, particularly neurodevelopmental outcomes.
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Affiliation(s)
- Emma M McCall
- Queen's University BelfastSchool of Nursing and MidwiferyMedical Biology Centre97 Lisburn RoadBelfastNorthern IrelandUK
| | - Fiona Alderdice
- Nuffield Department of Population Health, University of OxfordNational Perinatal Epidemiology UnitOxfordUK
| | - Henry L Halliday
- Retired Honorary Professor of Child Health, Queen's University Belfast74 Deramore Park SouthBelfastNorthern IrelandUKBT9 5JY
| | - Sunita Vohra
- University of AlbertaDepartment of Pediatrics8B19 11111 Jasper AvenueEdmontonABCanadaT5K 0L4
| | - Linda Johnston
- University of TorontoLawrence S Bloomberg Faculty of NursingHealth Sciences Building155 College StreetTorontoOntarioCanadaM5T 2S8
- Soochow UniversityTaipeiTaiwan
- The University of MelbourneMelbourneAustralia
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Bensouda B, Mandel R, Mejri A, Lachapelle J, St-Hilaire M, Ali N. Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial. Neonatology 2018; 113:27-32. [PMID: 28934746 DOI: 10.1159/000480537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypothermia on admission to intensive care is associated with poor outcomes in preterm infants. The neonatal resuscitation program recommends the use of servo-control thermoregulation during resuscitation. Very little evidence exists to guide optimal temperature probe placement in the delivery room. OBJECTIVE The aim of this work was to determine, in moderately preterm infants, if temperature probe placement in the dorsal, thoracic, or axillary area during delivery room resuscitation would result in differing temperatures on admission to the neonatal intensive care unit (NICU). METHODS A randomised trial with 3 arms was conducted. In total, 122 inborn preterm infants born between 280/7 and 356/7 weeks of gestational age were recruited. The infants were randomly assigned to thermal probe placement in the left lower back, left upper thorax, or left axilla immediately after birth. Temperature was servo-controlled using an infant resuscitation table set to 36.5°C. The primary outcome was axillary temperature at admission to the NICU before transfer to a closed isolette, recorded with a digital thermometer. The secondary outcomes assessed were temperature within the target range (36.5-37.5°C), hypothermia (<36.5°C), and hyperthermia (>37.5°C). RESULTS All 122 infants were available for outcome analysis. The groups were comparable for birthweight, gestational age, and sex. The mean admission temperature was comparable between the 3 probe positions (mean, 95% CI): dorsum (36.7°C, 36.6-36.8), thorax (36.8°C, 36.7-36.9), and axilla (36.7°C, 36.6-36.9), p = 0.43. The proportion of infants with admission temperatures in the target range was comparable (87.2, 81.4, and 72.5% respectively), p = 0.44. CONCLUSION Dorsal, thoracic, or axillary temperature probe positioning during resuscitation yield similar admission temperatures in moderately preterm infants. Further studies are required in infants below 28 weeks of gestation to determine the best practice.
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Affiliation(s)
- Brahim Bensouda
- Pediatrics/Neonatology, Maisonneuve Rosemont Hospital, University of Montreal, Montreal, QC, Canada
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28
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Kubo KI, Deguchi K, Nagai T, Ito Y, Yoshida K, Endo T, Benner S, Shan W, Kitazawa A, Aramaki M, Ishii K, Shin M, Matsunaga Y, Hayashi K, Kakeyama M, Tohyama C, Tanaka KF, Tanaka K, Takashima S, Nakayama M, Itoh M, Hirata Y, Antalffy B, Armstrong DD, Yamada K, Inoue K, Nakajima K. Association of impaired neuronal migration with cognitive deficits in extremely preterm infants. JCI Insight 2017; 2:88609. [PMID: 28515367 DOI: 10.1172/jci.insight.88609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 04/18/2017] [Indexed: 12/23/2022] Open
Abstract
Many extremely preterm infants (born before 28 gestational weeks [GWs]) develop cognitive impairment in later life, although the underlying pathogenesis is not yet completely understood. Our examinations of the developing human neocortex confirmed that neuronal migration continues beyond 23 GWs, the gestational week at which extremely preterm infants have live births. We observed larger numbers of ectopic neurons in the white matter of the neocortex in human extremely preterm infants with brain injury and hypothesized that altered neuronal migration may be associated with cognitive impairment in later life. To confirm whether preterm brain injury affects neuronal migration, we produced brain damage in mouse embryos by occluding the maternal uterine arteries. The mice showed delayed neuronal migration, ectopic neurons in the white matter, altered neuronal alignment, and abnormal corticocortical axonal wiring. Similar to human extremely preterm infants with brain injury, the surviving mice exhibited cognitive deficits. Activation of the affected medial prefrontal cortices of the surviving mice improved working memory deficits, indicating that decreased neuronal activity caused the cognitive deficits. These findings suggest that altered neuronal migration altered by brain injury might contribute to the subsequent development of cognitive impairment in extremely preterm infants.
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Affiliation(s)
- Ken-Ichiro Kubo
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Kimiko Deguchi
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan.,Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Taku Nagai
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukiko Ito
- Department of Molecular Neuroscience, Medical Research Institute/School of Biomedical Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keitaro Yoshida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Toshihiro Endo
- Laboratory of Environmental Health Sciences, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Seico Benner
- Laboratory of Environmental Health Sciences, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Wei Shan
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ayako Kitazawa
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan.,Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Michihiko Aramaki
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Ishii
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Minkyung Shin
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Matsunaga
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Kanehiro Hayashi
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Masaki Kakeyama
- Laboratory of Environmental Health Sciences, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Laboratory for Systems Neuroscience & Preventive Medicine, Waseda University Faculty of Human Sciences, Tokorozawa, Japan
| | - Chiharu Tohyama
- Laboratory of Environmental Health Sciences, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Environmental Biology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kenji F Tanaka
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kohichi Tanaka
- Department of Molecular Neuroscience, Medical Research Institute/School of Biomedical Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sachio Takashima
- Division of Child Neurology, Yanagawa Institute of Developmental Disabilities, Yanagawa, Japan
| | - Masahiro Nakayama
- Department of Pathology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Masayuki Itoh
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yukio Hirata
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
| | - Barbara Antalffy
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Dawna D Armstrong
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Kiyofumi Yamada
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ken Inoue
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kazunori Nakajima
- Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
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Terrin G, Conte F, Scipione A, Aleandri V, Di Chiara M, Bacchio E, Messina F, De Curtis M. New architectural design of delivery room reduces morbidity in preterm neonates: a prospective cohort study. BMC Pregnancy Childbirth 2016; 16:63. [PMID: 27008185 PMCID: PMC4804574 DOI: 10.1186/s12884-016-0849-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background A multidisciplinary committee composed of a panel of experts, including a member of the American Academy of Pediatrics and American Institute of Architects, has suggested that the delivery room (DR) and the neonatal intensive care units (NICU) room should be directly interconnected. We aimed to investigate the impact of the architectural design of the DR and the NICU on neonatal outcome. Methods Two cohorts of preterm neonates born at < 32 weeks of gestational age, consecutively observed during 2 years, were compared prospectively before (Cohort 1: “conventional DR”) and after architectural renovation of the DR realized in accordance with specific standards (Cohort 2: “new concept of DR”). In Cohort 1, neonates were initially cared for a conventional resuscitation area, situated in the DR, and then transferred to the NICU, located on a separate floor of the same hospital. In Cohort 2 neonates were assisted at birth directly in the NICU room, which was directly connected to the DR via a pass-through door. The primary outcome of the study was morbidity, defined by the proportion of neonates with at least one complication of prematurity (i.e., late-onset sepsis, patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis). Secondary outcomes were mortality and duration of hospitalization. Statistical analysis was performed using standard methods by SPSS software. Results We enrolled 106 neonates (56 in Cohort 1 and 50 in Cohort 2). The main clinical and demographic characteristics of the 2cohorts were similar. Moderate hypothermia (body temperature ≤ 35.9 ° C) was more frequent in Cohort 1 (57 %) compared with Cohort 2 (24 %, p = 0.001). Morbidity was increased in Cohort 1 (73 %) compared with Cohort 2 (44 %, p = 0.002). No statistically significant differences in mortality and median duration of hospitalization were observed between the 2 cohorts of the study. Conclusions If realized according to the proposed architectural standards, renovation of DR and NICU may represent an opportunity to reduce morbidity in preterm neonates.
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Affiliation(s)
- Gianluca Terrin
- Department of Gynecology-Obstetrics and Perinatal Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Francesca Conte
- Department of Pediatrics, "Sapienza" University of Rome, Viale del Policlinico 155, Rome, 00161, Italy
| | - Antonella Scipione
- Department of Gynecology-Obstetrics and Perinatal Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Vincenzo Aleandri
- Department of Gynecology-Obstetrics and Perinatal Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.,Research Center on Evaluation of Quality in Medicine - CEQUAM, "Sapienza" University of Rome, Rome, Italy
| | - Maria Di Chiara
- Department of Gynecology-Obstetrics and Perinatal Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Erica Bacchio
- Department of Gynecology-Obstetrics and Perinatal Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Francesco Messina
- Department of Perinatal Medicine, Evangelical Hospital "V. Betania", Via Argine 604, Naples, 80147, Italy
| | - Mario De Curtis
- Department of Pediatrics, "Sapienza" University of Rome, Viale del Policlinico 155, Rome, 00161, Italy
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30
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Al-Naami B, Al-Hinnawi AR, Al-Kiswani A, Dahabreh A, Al-Assaf F, Kullab M. Toward Incorporating the Infant Weight Into Incubator's Automatic Temperature Control. J Med Device 2016. [DOI: 10.1115/1.4032633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A premature infant needs a stable thermal environment. This paper studies if the infant weight can be employed in the standard heat regulation system in incubators. This was done in two stages. First, a weight sensor was designed by means of using strain gauge in order to provide weight measurement. Later, a heat regulation circuit was designed and implemented by means of using a microcontroller. The humidity, environmental and skin temperature, and infant's weight are measured and used as inputs. The experiments showed that infant's weight can be successfully added to the control circuit in the incubator instrument. The results showed that infant's weight can productively contribute in temperature control with good confidence. The average standard error was equal to 0.48 °C. The results reveal that the infant's weight can contribute to increase quality assurance of incubators.
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Affiliation(s)
- Bassam Al-Naami
- Department of Biomedical Engineering, Hashemite University, P.O. Box 150459, Zarqa 13115, Jordan e-mail:
| | - Abdel-Razzak Al-Hinnawi
- Department of Medical Imaging, Hashemite University, P.O. Box 330127, Zarqa 13115, Jordan e-mail:
| | - Ahmad Al-Kiswani
- Department of Biomedical Engineering, Hashemite University, P.O. Box 150459, Zarqa 13115, Jordan
| | - Ala'a Dahabreh
- Department of Biomedical Engineering, Hashemite University, P.O. Box 150459, Zarqa 13115, Jordan
| | - Faris Al-Assaf
- Department of Biomedical Engineering, Hashemite University, P.O. Box 150459, Zarqa 13115, Jordan
| | - Mohd Kullab
- Department of Biomedical Engineering, Hashemite University, P.O. Box 150459, Zarqa 13115, Jordan
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Wlodaver A, Blunt M, Satnes K, Escobedo M, Hallford G, Szyld E. A retrospective comparison of VLBW outcomes before and after implementing new delivery room guidelines at a regional tertiary care center. J Perinatol 2016; 36:182-5. [PMID: 26633146 DOI: 10.1038/jp.2015.187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the impact of implemented protocol changes on delivery room interventions and very low birth weight (VLBW) health outcomes. STUDY DESIGN Retrospective study comparing birth characteristics, interventions and health outcomes of VLBW infants born in a tertiary care center before (calendar years 2008 to 2009) and after (calendar years 2012 to 2013) implementing new protocols using Chi-square analyses. RESULT Four hundred and nine were born before and 303 after changes were implemented. Postimplementation infants had more use of antenatal steroids (P=0.02), gestational age ⩽24 weeks (P=0.03) and birth weights between 501 and 750 g (P=0.04) and less oxygen administration (P=0.002), face mask ventilation (P=0.0001), surfactant use (P=0.0001), chest compressions (P=0.0001), intubation (P=0.002), epinephrine use (P=0.011), hypothermia (P=0.0001) and discharges home on supplemental oxygen (P=0.05). CONCLUSION Changes creating a new delivery team, adopting new delivery practice guidelines and updating delivery room equipment resulted in positive outcomes for delivery room practices and patient outcomes.
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Affiliation(s)
- A Wlodaver
- Department of Pediatrics, Neonatal-Perinatal Section, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Blunt
- Department of Pediatrics, Neonatal-Perinatal Section, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - K Satnes
- Department of Pediatrics, Neonatal-Perinatal Section, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Escobedo
- Department of Pediatrics, Neonatal-Perinatal Section, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - G Hallford
- Department of Pediatrics, Sections of Genetics and Neonatology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - E Szyld
- Department of Pediatrics, Neonatal-Perinatal Section, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Sick Neonate Score--A Simple Clinical Score for Predicting Mortality of Sick Neonates in Resource Restricted Settings. Indian J Pediatr 2016; 83:103-6. [PMID: 26365155 DOI: 10.1007/s12098-015-1884-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate an objective score to assess the condition of sick neonates at arrival and its use in predicting mortality. METHODS This descriptive study included 303 extramural neonates who were evaluated using a simple clinical score - Sick neonate score (SNS). All neonates were followed up till discharge or expiry. The score and its individual components were correlated with outcome. A receiver operating curve was plotted to determine the cutoff value for SNS in predicting mortality. RESULTS The common indications for neonatal transport were sepsis (30.7 %), birth asphyxia (17.5 %) and respiratory distress (15.2 %). Sixty neonates (20 %) expired and among them 76 % were hypothermic and 10 % hypoglycemic at admission. The average SNS for all neonates was 10 while it was 6 for those who expired. A cutoff value of SNS ≤ 8 predicted mortality with a sensitivity of 58.3 % and specificity of 52.7 %. CONCLUSIONS SNS is a useful scoring system to predict outcome of sick neonates in resource restricted settings.
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33
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Leng H, Wang H, Lin B, Cheng G, Wang L. Reducing Transitional Hypothermia in Outborn Very Low Birth Weight Infants. Neonatology 2016; 109:31-6. [PMID: 26485388 DOI: 10.1159/000438743] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 07/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transitional hypothermia (TH) is associated with increased morbidity and mortality in very low birth weight (VLBW) infants worldwide. OBJECTIVES To assess the effect of a quality improvement project (QIP) on outborn TH and the associated mortality/morbidity among VLBW neonates. METHODS We conducted a multi-intervention QIP to reduce TH (<36°C) among outborn VLBW neonates. This cohort study compared a historical group (group I, n = 86) to a prospective group (group II, established after QIP implementation, n = 86). The primary outcome was axillary temperature measured in the delivery room (DR) and upon admission to the neonatal intensive care unit (NICU). RESULTS The baseline characteristics of the two groups were similar. After introducing the QIP, the mean DR and NICU admission temperatures of the patients rose from 35.5 to 36.1°C and from 34.6 to 36.2°C, respectively (p < 0.01), and the percentage of patients with temperatures <36°C in the DR and NICU decreased from 80 to 40% and from 81 to 42% (p < 0.01), respectively. Meanwhile, the percentage of patients with a normal temperature in the DR and NICU rose from 20 to 58% and from 19 to 56% (p < 0.01), respectively, which was accompanied by significantly decreased mortality (p < 0.02) and other improvements. CONCLUSION Implementation of a QIP resulted in a decrease in the number of moderately hypothermic VLBW neonates and a sustained improvement in normothermia rates during DR stabilization and transfer to the NICU in outborn VLBW neonates.
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Affiliation(s)
- Haiqing Leng
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, PR China
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34
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Rech Morassutti F, Cavallin F, Zaramella P, Bortolus R, Parotto M, Trevisanuto D. Association of Rewarming Rate on Neonatal Outcomes in Extremely Low Birth Weight Infants with Hypothermia. J Pediatr 2015; 167:557-61.e1-2. [PMID: 26168772 DOI: 10.1016/j.jpeds.2015.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/20/2015] [Accepted: 06/03/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the possible association between rewarming rate and neonatal outcomes in extremely low birth weight infants (ELBWIs) with hypothermia. STUDY DESIGN All ELBWIs with hypothermia (temperature < 36.0°C) on neonatal intensive care unit (NICU) admission were retrospectively evaluated. Rewarming rate was analyzed as both a dichotomous (≥ 0.5°C/h rapid group; < 0.5°C/h slow group) and a continuous variable. Multivariable analysis was performed to explore the relation between rewarming rate and several outcomes, adjusting for clinically relevant confounders. RESULTS Hypothermia on NICU admission was present in 182 out of 744 ELBWIs (24.5%). The rewarming rate was slow in 109 subjects (59.9%) and rapid in 73 subjects (40.1%), with a median rewarming rate of 0.29°C/h (IQR 0.2-0.35) and 0.76°C/h (IQR 0.61-1.09), respectively (P < .0001). The median rewarming time was 340 minutes (IQR 250-480) and 170 minutes (IQR 110-230), respectively (P < .0001). After adjusting for clinically relevant confounders, we did not find significant associations between rewarming rate group (≥ 0.5°C/h vs < 0.5°C/h) and neonatal outcomes. When we considered the rewarming rate as continuous variable, a higher rewarming rate was identified as a protective factor for respiratory distress syndrome (OR 0.39, 95% CI 0.17-0.87; P = .02). CONCLUSIONS In ELBWIs with hypothermia upon NICU admission, there were no significant differences between rapid or slow rewarming rate and major neonatal outcomes. A higher rewarming rate was associated with a reduced incidence of respiratory distress syndrome.
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Affiliation(s)
- Francesca Rech Morassutti
- Department of Women's and Children's Health, School of Medicine, Padua University, Azienda Ospedaliera di Padova, Padua, Italy
| | | | - Patrizia Zaramella
- Department of Women's and Children's Health, School of Medicine, Padua University, Azienda Ospedaliera di Padova, Padua, Italy
| | - Renata Bortolus
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, Verona, Italy
| | - Matteo Parotto
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniele Trevisanuto
- Department of Women's and Children's Health, School of Medicine, Padua University, Azienda Ospedaliera di Padova, Padua, Italy.
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35
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Chang HY, Sung YH, Wang SM, Lung HL, Chang JH, Hsu CH, Jim WT, Lee CH, Hung HF. Short- and Long-Term Outcomes in Very Low Birth Weight Infants with Admission Hypothermia. PLoS One 2015; 10:e0131976. [PMID: 26193370 PMCID: PMC4507863 DOI: 10.1371/journal.pone.0131976] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/09/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neonatal hypothermia remains a common problem and is related to elevated morbidities and mortality. However, the long-term neurodevelopmental effects of admission hypothermia are still unknown. This study attempted to determine the short-term and long-term consequences of admission hypothermia in VLBW preterm infants. STUDY DESIGN This retrospective study measured the incidence and compared the outcomes of admission hypothermia in very low birth weight (VLBW) preterm infants in a tertiary-level neonatal intensive care unit. Infants were divided into the following groups: normothermia (36.5-37.5°C), mild hypothermia (36.0-36.4°C), moderate hypothermia (32.0-35.9°C), and severe hypothermia (< 32°C). We compared the distribution, demographic variables, short-term outcomes, and neurodevelopmental outcomes at 24 months of corrected age among groups. RESULTS We studied 341 infants: 79 with normothermia, 100 with mild hypothermia, 162 with moderate hypothermia, and 0 with severe hypothermia. Patients in the moderate hypothermia group had significantly lower gestational ages (28.1 wk vs. 29.7 wk, P < .02) and smaller birth weight (1004 g vs. 1187 g, P < .001) compared to patients in the normothermia group. Compared to normothermic infants, moderately hypothermic infants had significantly higher incidences of 1-min Apgar score < 7 (63.6% vs. 31.6%, P < .001), respiratory distress syndrome (RDS) (58.0% vs. 39.2%, P = .006), and mortality (18.5% vs. 5.1%, P = .005). Moderate hypothermia did not affect neurodevelopmental outcomes at 2 years' corrected age. Mild hypothermia had no effect on short-term or long-term outcomes. CONCLUSIONS Admission hypothermia was common in VLBW infants and correlated inversely with birth weight and gestational age. Although moderate hypothermia was associated with higher RDS and mortality rates, it may play a limited role among multifactorial causes of neurodevelopmental impairment.
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Affiliation(s)
- Hung-Yang Chang
- Department of Pediatrics, MacKay Memorial Hospital, Hsinchu Branch, Hsinchu, Taiwan
- Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Yi-Hsiang Sung
- Department of Pediatrics, MacKay Memorial Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Shwu-Meei Wang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Hou-Ling Lung
- Department of Pediatrics, MacKay Memorial Hospital, Hsinchu Branch, Hsinchu, Taiwan
| | - Jui-Hsing Chang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Chyong-Hsin Hsu
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Wai-Tim Jim
- Department of Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Ching-Hsiao Lee
- Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Hsiao-Fang Hung
- Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
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Abstract
Birth asphyxia accounts for about 23% of the approximately 4 million neonatal deaths each year worldwide (Black et al., Lancet, 2010, 375(9730):1969-87). The majority of newborn infants require little assistance to undergo physiologic transition at birth and adapt to extrauterine life. Approximately 10% of infants require some assistance to establish regular respirations at birth. Less than 1% need extensive resuscitative measures such as chest compressions and approximately 0.06% require epinephrine (Wyllie et al. Resuscitation, 2010, 81 Suppl 1:e260–e287). Transition at birth is mediated by significant changes in circulatory and respiratory physiology. Ongoing research in the field of neonatal resuscitation has expanded our understanding of neonatal physiology enabling the implementation of improved recommendations and guidelines on how to best approach newborns in need for intervention at birth. Many of these recommendations are extrapolated from animal models and clinical trials in adults. There are many outstanding controversial issues in neonatal resuscitation that need to be addressed. This article provides a comprehensive and critical literature review on the most relevant and current research pertaining to evolving new strategies in neonatal resuscitation. The key elements to a successful neonatal resuscitation include ventilation of the lungs while minimizing injury, the judicious use of oxygen to improve pulmonary blood flow, circulatory support with chest compressions, and vasopressors and volume that would hasten return of spontaneous circulation. Several exciting new avenues in neonatal resuscitation such as delayed cord clamping, sustained inflation breaths, and alternate vasopressor agents are briefly discussed. Finally, efforts to improve resuscitative efforts in developing countries through education of basic steps of neonatal resuscitation are likely to decrease birth asphyxia and neonatal mortality.
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Affiliation(s)
- Payam Vali
- Department of Pediatrics (Neonatology), University at Buffalo, Buffalo, NY, USA ; Division of Neonatology, Department of Pediatrics, Women and Children's Hospital of Buffalo, 219 Bryant St, Buffalo, NY 14222, USA
| | - Bobby Mathew
- Department of Pediatrics (Neonatology), University at Buffalo, Buffalo, NY, USA ; Women and Children's Hospital of Buffalo, 219 Bryant St, Buffalo, NY 14222, USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics (Neonatology), University at Buffalo, Buffalo, NY, USA ; Division of Neonatology, Department of Pediatrics, Women and Children's Hospital of Buffalo, 219 Bryant St, Buffalo, NY 14222, USA
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Rathod D, Adhisivam B, Bhat BV. Transport of sick neonates to a tertiary care hospital, South India: condition at arrival and outcome. Trop Doct 2014; 45:96-9. [PMID: 25537296 DOI: 10.1177/0049475514564270] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the transport of sick neonates to a tertiary care hospital and evaluate their condition at arrival and outcome. METHODS This descriptive study included 303 extramural neonates who were transported to a tertiary care hospital in south India. Demographic parameters, transport details and clinical features at arrival were recorded. All neonates were followed up till discharge or death. Transport and clinical variables were correlated with outcome. RESULTS Sepsis and birth asphyxia were the major indications for transport. Only 11% were transported by 108 ambulances (free government service). One-fifth of all neonates died and among them 76% were hypothermic and 10% hypoglycemic on admission. Prematurity, pregnancy induced hypertension (PIH), prolonged rupture of membranes (PROM), respiratory distress, grunting, bleeding, abdominal distension and a positive blood culture correlated with a poor outcome. CONCLUSION Stabilisation prior to transport is essential and the principles of neonatal transportation are independent of distance. Hypothermia and hypoglycaemia should be prevented in neonates during transport as they adversely affect the outcome.
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Affiliation(s)
- Deepak Rathod
- Junior Resident, Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - B Adhisivam
- Associate Professor, Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - B Vishnu Bhat
- Professor and Head, Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Total body polyethylene wraps for preventing hypothermia in preterm infants: a randomized trial. J Pediatr 2014; 165:261-266.e1. [PMID: 24837862 DOI: 10.1016/j.jpeds.2014.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/27/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether a polyethylene total body wrapping (covering both the body and head) is more effective than conventional treatment (covering up to the shoulders) in reducing perinatal thermal losses in very preterm infants. STUDY DESIGN This was a multicenter, prospective, randomized, parallel 1:1, unblinded, controlled trial of infants<29 weeks' gestation age, comprising two study groups: experimental group (total body group; both the body and head covered with a polyethylene occlusive bag, with the face uncovered) and control group (only the body, up to the shoulders, covered with a polyethylene occlusive bag). The primary outcome was axillary temperature on neonatal intensive care unit admission immediately after wrap removal. RESULTS One hundred randomly allocated infants (50 in the total body group and 50 controls) completed the study. Mean axillary temperature on neonatal intensive care unit admission was similar in the two groups (36.5±0.6°C total body vs 36.4±0.8°C controls; P=.53). The rate of moderate hypothermia (temperature<36°C) was 12% in the total body group and 20% in the control group (P=.41). Three subjects in each group (6.0%) had an axillary temperature>37.5°C on admission, and one subject in control group had an axillary temperature>38°C. CONCLUSION Total body wrapping is comparable with covering the body up to the shoulders in preventing postnatal thermal losses in very preterm infants.
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McCall E, Alderdice F, Halliday H, Johnston L, Vohra S. Challenges of Minimizing Heat Loss at Birth: A Narrative Overview of Evidence-Based Thermal Care Interventions. ACTA ACUST UNITED AC 2014. [DOI: 10.1053/j.nainr.2014.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Affiliation(s)
- Heui Seung Jo
- Department of Pediatrics, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
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