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Shah BA, Foulks A, Lapadula MC, McCoy M, Hallford G, Bedwell S, DeShea L, Szyld E. Laryngeal Mask Use in the Neonatal Population: A Survey of Practice Providers at a Regional Tertiary Care Center in the United States. Am J Perinatol 2023; 40:1551-1557. [PMID: 34729719 DOI: 10.1055/s-0041-1736662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the level of training, awareness, experience, and confidence of neonatal practice providers in the use of laryngeal mask (LM), and to identify the barriers in its implementation in the neonatal population. STUDY DESIGN Descriptive observational study utilizing an anonymous online questionnaire among healthcare providers at the Oklahoma Children's Hospital who routinely respond to newborn deliveries and have been trained in the Neonatal Resuscitation Program (NRP). Participants included physicians, trainees, nurse practitioners, nurses, and respiratory therapists. RESULTS Ninety-five participants completed the survey (27.5% response rate). The sample consisted of 77 NRP providers (81%), 11 instructors (12%), and 7 instructor mentors (7%). Among 72 respondents who had undergone LM training, 51 (54%) had hands-on manikin practice, 4 (4%) watched the American Academy of Pediatrics (AAP) NRP educational video, and 17 (18%) did both. Nurses (39 out of 46) were more likely to have completed LM training than were physicians (31 out of 47). With only 11 (12%) participants having ever placed a LM in a newly born infant, the median confidence for LM placement during neonatal resuscitation was 37 on a 0 to 100 scale. Frequently reported barriers for LM use in neonates were limited experience (81%), insufficient training (59%), preference for endotracheal tube (57%), and lack of awareness (56%). CONCLUSION While the majority of the neonatal practice providers were trained in LM placement, only a few had ever placed one in a live newborn, with a low degree of confidence overall. Future practice improvement should incorporate ongoing interdisciplinary LM education, availability of LM in the labor and delivery units, and promotion of awareness of LM as an alternative airway. KEY POINTS · LM is underutilized as an alternative airway.. · Insufficient experience and training limit LM use.. · Providers confidence with LM placement is low..
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Affiliation(s)
- Birju A Shah
- Neonatal-Perinatal Medicine, Oklahoma Children's Hospital, OU Health, Oklahoma City, Oklahoma
- Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Arlen Foulks
- Neonatal-Perinatal Medicine, Oklahoma Children's Hospital, OU Health, Oklahoma City, Oklahoma
- Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Maria C Lapadula
- Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mike McCoy
- Neonatal-Perinatal Medicine, Oklahoma Children's Hospital, OU Health, Oklahoma City, Oklahoma
| | - Gene Hallford
- Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Susan Bedwell
- Neonatal-Perinatal Medicine, Oklahoma Children's Hospital, OU Health, Oklahoma City, Oklahoma
- Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Lise DeShea
- Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Edgardo Szyld
- Neonatal-Perinatal Medicine, Oklahoma Children's Hospital, OU Health, Oklahoma City, Oklahoma
- Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Roberts CT, O'Shea JE. Alternatives to neonatal intubation. Semin Fetal Neonatal Med 2023; 28:101488. [PMID: 38000926 DOI: 10.1016/j.siny.2023.101488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Opportunities to learn and maintain competence in neonatal intubation have decreased. As many clinicians providing care to the newborn infant are not skilled in intubation, alternative strategies are critical. Most preterm infants breathe spontaneously, and require stabilisation rather than resuscitation at birth. Use of tactile stimulation, deferred cord clamping, and avoidance of hypoxia can help optimise breathing for these infants. Nasal devices appear a promising alternative to the face mask for early provision of respiratory support. In term and near-term infants, supraglottic airways may be the most effective initial approach to resuscitation. Use of supraglottic airways during resuscitation can be taught to a range of providers, and may reduce need for intubation. While face mask ventilation is an important skill, it is challenging to perform effectively. Identification of the best approach to training the use of these devices during neonatal resuscitation remains an important priority.
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Affiliation(s)
- Calum T Roberts
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia.
| | - Joyce E O'Shea
- Department of Paediatrics, Royal Hospital for Sick Children, Glasgow, Scotland, United Kingdom
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Peterson JLH, Ranganna R, Gottstein R. Simulation to Investigate Effective Airway Positioning in the Neonatal Patient. Clin Pediatr (Phila) 2023; 62:533-536. [PMID: 36411597 DOI: 10.1177/00099228221137157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jennifer L H Peterson
- Neonatal Intensive Care Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ranganath Ranganna
- Neonatal Intensive Care Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ruth Gottstein
- Neonatal Intensive Care Unit, Manchester University NHS Foundation Trust, Manchester, UK
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Diggikar S, Krishnegowda R, Nagesh KN, Lakshminrusimha S, Trevisanuto D. Laryngeal mask airway versus face mask ventilation or intubation for neonatal resuscitation in low-and-middle-income countries: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2023; 108:156-163. [PMID: 36520676 DOI: 10.1136/archdischild-2022-324472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/05/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess whether laryngeal mask airway (LMA) as compared with face mask (FM) or endotracheal intubation (ETT) is more effective in delivering positive pressure ventilation (PPV) during neonatal resuscitation in low-and-middle income countries (LMICs). STUDY DESIGN We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and searched Medline (PubMed interphase), Cumulative Index of Nursing and Allied Health Literature, Embase and Cochrane Registry between January 1990 and April 2022 for the studies that examined the effect of LMA in delivering PPV compared with the FM or ETT in infants during neonatal resuscitation. We included the studies conducted in LMIC only. We assessed the quality of all the included studies using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) recommendations. RESULTS Our search resulted in eight randomised studies Six studies compared LMA with FM and three studies compared LMA with ETT. When used as the primary device for providing PPV, the LMA as compared with FM resulted in a significant lower failure rate (relative risk (RR) 0.23, 95% CI 0.13 to 0.43) with moderate certainty of evidence (CoE) and lesser need for intubation (RR 0.21, 95% CI 0.07 to 0.58) with low CoE. There was no difference in the incidence of encephalopathy, neonatal admission, need for advanced resuscitations or death. No differences were observed between LMA and ETT. Studies comparing LMA to ETT were limited for any conceivable conclusion. CONCLUSION LMA is more effective than FM in delivering PPV with less failure rates and reduced need for intubation during neonatal resuscitation in term infants and in LMIC without any difference in the incidence of encephalopathy or death. Studies comparing LMA to ETT are scarce with important methodological limitations. PROSPERO REGISTRATION NUMBER CRD42021283478.
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Affiliation(s)
| | | | - Karthik N Nagesh
- Department of Pediatrics, Manipal Hospitals, Bangalore, Karnataka, India
| | | | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Universita degli Studi di Padova Dipartimento di Salute della Donna e del Bambino, Padova, Italy
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Lyra JC, Guinsburg R, de Almeida MFB, Variane GFT, Souza Rugolo LMSD. Use of laryngeal mask for neonatal resuscitation in Brazil: A national survey. Resusc Plus 2022; 13:100336. [PMID: 36582476 PMCID: PMC9792880 DOI: 10.1016/j.resplu.2022.100336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/06/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background The International Liaison Committee on Resuscitation suggests using the laryngeal mask airway (LMA) as an alternative to the face mask for performing positive pressure ventilation (PPV) in the delivery room in newborns ≥34 weeks. Because not much is known about the health professionals' familiarity in using LMA in Brazil, this study aimed to describe the health professionals' knowledge and practice of using LMA, who provide neonatal care in the country. Methods An online questionnaire containing 29 questions was sent to multi-healthcare professionals from different regions in the country through email and social media groups (WhatsApp®, Instagram®, Facebook®, and LinkedIn®). The participants anonymously answered the questions regarding their knowledge and expertise in using LMA to ventilate newborns in the delivery room. Results We obtained 749 responses from all the regions in Brazil, with 80% from health professionals working in public hospitals. Most respondents were neonatologists (73%) having > 15 years of clinical practice. Among the respondents, 92% recognized the usefulness of LMA for performing PPV in newborns, 59% did not have specific training in LMA insertion, and only 8% reported that they have already used LMA in the delivery room. In 90% of the hospitals, no written protocol was available to use LMA; and in 68% of the hospitals, LMA was not available for immediate use. Conclusion This nationwide survey showed that most professionals recognize the usefulness of LMA. However, the device is scarcely available and underused in the routine of ventilatory assistance for newborns in delivery rooms in Brazil.
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Affiliation(s)
- João Cesar Lyra
- Department of Pediatrics, UNESP – Univ Estadual Paulista, Sao Paulo State, Brazil,Corresponding author at: Department of Pediatrics, UNESP – Univ Estadual Paulista, Sao Paulo State, Distrito de Rubiao Junior – Av. Prof, Mario Rubens Guimaraes Montenegro s/n; Botucatu, Sao Paulo 18618-687, Brazil.
| | - Ruth Guinsburg
- Division of Neonatal Medicine - Escola Paulista de Medicina - Universidade Federal de São Paulo, Brazil
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Pejovic NJ, Cavallin F, Mpamize A, Lubulwa C, Höök SM, Byamugisha J, Nankunda J, Tylleskär T, Trevisanuto D. Respiratory monitoring during neonatal resuscitation using a supraglottic airway device vs. a face mask. Resuscitation 2021; 171:107-113. [PMID: 34695444 DOI: 10.1016/j.resuscitation.2021.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the respiratory function of asphyxiated infants resuscitated with i-gel supraglottic airway (SGA) vs. face mask (FM) in a low-resource setting. METHODS In this sub-study from the NeoSupra trial, respiratory function during the first 60 inflations was evaluated in 46 neonates (23 with SGA and 23 with FM) at the Mulago National Referral Hospital, Uganda. The primary outcome was the mask leak (%). The secondary outcomes included inspired (VTi) and expired (VTe) tidal volumes, and heart rate response to ventilation. RESULTS Median mask leak was 40% (IQR 22-52) with SGA and 39% (IQR 26-62) with FM (p = 0.38). Median VTe was 7.8 ml/kg (IQR 5.6-10.2) with SGA and 7.3 ml/kg (IQR 4.8-11.9) with FM (p = 0.84), while median VTi was 15.4 ml/kg (IQR 11-4-17.6) with SGA and 15.9 ml/kg (IQR 9.0-22.6) with FM (p = 0.68). A shorter time was needed to achieve heart rate > 100 bpm in SGA (median 13 s IQR 9-15) with respect to FM arm (median 61, IQR 33-140) (p = 0.0002). CONCLUSION Respiratory function was not statistically different between neonates resuscitated with SGA vs. FM. SGA was associated with faster heart rate recovery compared to FM in the subgroup of neonates with bradycardia. Further research is needed to investigate possible advantages of SGA on respiratory function at birth.
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Affiliation(s)
- Nicolas J Pejovic
- Centre for International Health, University of Bergen, Bergen, Norway; Neonatal Unit, Sachs' Children and Youth Hospital, Stockholm, Sweden; Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden.
| | | | | | | | - Susanna Myrnerts Höök
- Centre for International Health, University of Bergen, Bergen, Norway; Neonatal Unit, Sachs' Children and Youth Hospital, Stockholm, Sweden; Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden
| | - Josaphat Byamugisha
- Mulago National Referral Hospital, Kampala, Uganda; Dept. of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Uganda
| | - Jolly Nankunda
- Mulago National Referral Hospital, Kampala, Uganda; Dept. of Pediatrics and Child Health, College of Health Sciences, Makerere University, Uganda
| | - Thorkild Tylleskär
- Centre for International Health, University of Bergen, Bergen, Norway; Centre for Intervention Studies in Maternal and Child Health, University of Bergen, Bergen, Norway
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Pejovic NJ, Myrnerts Höök S, Byamugisha J, Alfvén T, Lubulwa C, Cavallin F, Nankunda J, Ersdal H, Blennow M, Trevisanuto D, Tylleskär T. A Randomized Trial of Laryngeal Mask Airway in Neonatal Resuscitation. N Engl J Med 2020; 383:2138-2147. [PMID: 33252870 DOI: 10.1056/nejmoa2005333] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Face-mask ventilation is the most common resuscitation method for birth asphyxia. Ventilation with a cuffless laryngeal mask airway (LMA) has potential advantages over face-mask ventilation during neonatal resuscitation in low-income countries, but whether the use of an LMA reduces mortality and morbidity among neonates with asphyxia is unknown. METHODS In this phase 3, open-label, superiority trial in Uganda, we randomly assigned neonates who required positive-pressure ventilation to be treated by a midwife with an LMA or with face-mask ventilation. All the neonates had an estimated gestational age of at least 34 weeks, an estimated birth weight of at least 2000 g, or both. The primary outcome was a composite of death within 7 days or admission to the neonatal intensive care unit (NICU) with moderate-to-severe hypoxic-ischemic encephalopathy at day 1 to 5 during hospitalization. RESULTS Complete follow-up data were available for 99.2% of the neonates. A primary outcome event occurred in 154 of 563 neonates (27.4%) in the LMA group and 144 of 591 (24.4%) in the face-mask group (adjusted relative risk, 1.16; 95% confidence interval [CI], 0.90 to 1.51; P = 0.26). Death within 7 days occurred in 21.7% of the neonates in the LMA group and 18.4% of those in the face-mask group (adjusted relative risk, 1.21; 95% CI, 0.90 to 1.63), and admission to the NICU with moderate-to-severe hypoxic-ischemic encephalopathy at day 1 to 5 during hospitalization occurred in 11.2% and 10.1%, respectively (adjusted relative risk, 1.27; 95% CI, 0.84 to 1.93). Findings were materially unchanged in a sensitivity analysis in which neonates with missing data were counted as having had a primary outcome event in the LMA group and as not having had such an event in the face-mask group. The frequency of predefined intervention-related adverse events was similar in the two groups. CONCLUSIONS In neonates with asphyxia, the LMA was safe in the hands of midwives but was not superior to face-mask ventilation with respect to early neonatal death and moderate-to-severe hypoxic-ischemic encephalopathy. (Funded by the Research Council of Norway and the Center for Intervention Science in Maternal and Child Health; NeoSupra ClinicalTrials.gov number, NCT03133572.).
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Affiliation(s)
- Nicolas J Pejovic
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Susanna Myrnerts Höök
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Josaphat Byamugisha
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Tobias Alfvén
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Clare Lubulwa
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Francesco Cavallin
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Jolly Nankunda
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Hege Ersdal
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Mats Blennow
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Daniele Trevisanuto
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
| | - Thorkild Tylleskär
- From the Center for International Health (N.J.P., S.M.H., T.T.) and the Center for Intervention Science in Maternal and Child Health (T.T.), University of Bergen, Bergen, and the Department of Anesthesiology and Intensive Care, Stavanger University Hospital (H.E.), and the Faculty of Health Sciences, University of Stavanger (H.E.), Stavanger - both in Norway; Sachs' Children and Youth Hospital (N.J.P., S.M.H., T.A.) and the Departments of Global Public Health (N.J.P., S.M.H., T.A.) and Clinical Science, Technology, and Intervention (M.B.), Karolinska Institutet, and the Department of Neonatal Medicine, Karolinska University Hospital (M.B.) - all in Stockholm; Mulago National Referral Hospital (J.B., C.L., J.N.) and the Departments of Obstetrics and Gynecology (J.B.) and Pediatrics and Child Health (J.N.), College of Health Sciences, Makerere University, Kampala, Uganda; and independent statistician, Solagna (F.C.), and the Department of Women's and Children's Health, Padua University, Padua (D.T.) - both in Italy
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Machumpurath S, O'Currain E, Dawson JA, Davis PG. Interfaces for non-invasive neonatal resuscitation in the delivery room: A systematic review and meta-analysis. Resuscitation 2020; 156:244-250. [PMID: 32858155 DOI: 10.1016/j.resuscitation.2020.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/13/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To perform a systematic review of trials comparing interfaces for delivering non-invasive PPV to a newborn in the delivery room (DR). METHODS MEDLINE, PUBMED, EMBASE, CINAHL and COCHRANE databases were searched on March 1, 2020 and 2826 articles were screened. The review was conducted using the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary outcomes were intubation in the DR and mortality. Secondary outcomes were chest compressions, intraventricular haemorrhage (IVH), necrotising enterocolitis (NEC) and mask leak. RESULTS Five randomized-control trials were eligible for inclusion. Sample size and gestational age varied amongst the trials, ranging from 56 to 617 infants and 24-39 weeks' respectively. Three trials compared nasal cannulae (NC) with face masks (FMs). Pooled analysis showed that NC were associated with a decreased use of chest compressions (RR 0.2 (95% CI 0.08-0.47). A reduction in rate of intubation in the DR was statistically significant only in the trial in which bi-nasal rather than single nasal cannulae were used (RR 0.10, 95% CI 0.02-0.44). However, there was no important difference in mortality (RR 0.72, 95% CI 0.47-1.13). Two trials compared different FM models (Laerdal versus Fisher & Paykel and Laerdal versus Resusi-sure) and both found no significant difference in primary and secondary outcomes. CONCLUSION There is little high-quality evidence to guide clinicians choosing an interface to provide PPV during newborn resuscitation. Nasal interfaces, particularly binasal cannulae, appear to offer some advantages over FMs but need further testing in larger, well designed trials. STUDY REGISTRATION PROSPERO CRD42020151870.
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Affiliation(s)
- Smitha Machumpurath
- The Royal Women's Hospital, 20 Flemington Rd., Melbourne, Victoria, Australia.
| | - Eoin O'Currain
- The Royal Women's Hospital, 20 Flemington Rd., Melbourne, Victoria, Australia; University College Dublin, Belfield, Dublin 4, Ireland
| | - Jennifer A Dawson
- The Royal Women's Hospital, 20 Flemington Rd., Melbourne, Victoria, Australia; Murdoch Children's Research Institute, 50 Flemington Rd., Parkville, Victoria, Australia
| | - Peter G Davis
- The Royal Women's Hospital, 20 Flemington Rd., Melbourne, Victoria, Australia; Murdoch Children's Research Institute, 50 Flemington Rd., Parkville, Victoria, Australia
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Haase B, Badinska AM, Koos B, Poets CF, Lorenz L. Do commonly available round facemasks fit near-term and term infants? Arch Dis Child Fetal Neonatal Ed 2020; 105:364-368. [PMID: 31542729 DOI: 10.1136/archdischild-2019-317531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE With inappropriately large facemasks, it is more difficult to create a seal on the face, potentially leading to ineffective ventilation during neonatal stabilisation. We investigated whether commonly available round facemasks are of appropriate size by measuring facial dimensions in near-term and term infants using two-dimensional (2D) and three-dimensional (3D) images. DESIGN Prospective single-centre observational study. SETTING Infants born in our centre at 34-41 weeks' gestation were eligible. INTERVENTION Patients were photographed with 2D and 3D technique. MAIN OUTCOME MEASURES Distances between nasion and gnathion were measured and compared with the outer diameter of various round facemasks. METHODS 2D and 3D images were performed using standard equipment. Correlations between gestational age and the above-mentioned distances were assessed using Pearson's r. RESULTS Images were taken from 102 infants with a mean (SD) gestational age of 37.9 (2.3) weeks. Mean distance between nasion and gnathion was 46.9 mm (5.1) in 2D and 49.9 mm (4.1) in 3D images, that is, on average 3 mm smaller in 2D than with 3D (p<0.01). Based on these measurements, round facemasks with an external diameter of 50 mm seemed fitting for most (61%) term infants and 42 mm masks for most (72%) near-term infants (GA 34-36 weeks). CONCLUSIONS Round facemasks with an external diameter of 60 mm are too large for almost all newborn infants, while 42/50 mm round facemasks are well fitting. Important anatomical structures were only visible using 3D images. CLINICAL TRIAL REGISTRATION NUMBER NCT03369028.
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Affiliation(s)
- Bianca Haase
- Department of Neonatology, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Ana Maria Badinska
- Department of Neonatology, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Bernd Koos
- Department of Orthodontics, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Christian F Poets
- Department of Neonatology, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Laila Lorenz
- Department of Neonatology, Universitätsklinikum Tübingen, Tübingen, Germany
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10
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Hunt KA, Murthy V, Bhat P, Fox GF, Campbell ME, Milner AD, Greenough A. Tidal volume monitoring during initial resuscitation of extremely prematurely born infants. J Perinat Med 2019; 47:665-670. [PMID: 31103996 DOI: 10.1515/jpm-2018-0389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/14/2019] [Indexed: 11/15/2022]
Abstract
Background Airway obstruction can occur during facemask (FM) resuscitation of preterm infants at birth. Intubation bypasses any upper airway obstruction. Thus, it would be expected that the occurrence of low expiratory tidal volumes (VTes) would be less in infants resuscitated via an endotracheal tube (ETT) rather than via an FM. Our aim was to test this hypothesis. Methods Analysis was undertaken of respiratory function monitoring traces made during initial resuscitation in the delivery suite to determine the peak inflating pressure (PIP), positive end expiratory pressure (PEEP), the VTe and maximum exhaled carbon dioxide (ETCO2) levels and the number of inflations with a low VTe (less than 2.2 mL/kg). Results Eighteen infants were resuscitated via an ETT and 11 via an FM, all born at less than 29 weeks of gestation. Similar inflation pressures were used in both groups (17.2 vs. 18.8 cmH2O, P = 0.67). The proportion of infants with a low median VTe (P = 0.6) and the proportion of inflations with a low VTe were similar in the groups (P = 0.10), as was the lung compliance (P = 0.67). Infants with the lowest VTe had the stiffest lungs (P < 0.001). Conclusion Respiratory function monitoring during initial resuscitation can objectively identify infants who may require escalation of inflation pressures.
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Affiliation(s)
- Katie A Hunt
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Vadivelam Murthy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Prashanth Bhat
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Grenville F Fox
- Neonatal Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Anthony D Milner
- The Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,The Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK.,NIHR Biomedical Centre at Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK.,NICU, 4Floor Golden Jubilee Wing, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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11
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Pejovic NJ, Myrnerts Höök S, Byamugisha J, Alfvén T, Lubulwa C, Cavallin F, Nankunda J, Ersdal H, Segafredo G, Blennow M, Trevisanuto D, Tylleskär T. Neonatal resuscitation using a supraglottic airway device for improved mortality and morbidity outcomes in a low-income country: study protocol for a randomized trial. Trials 2019; 20:444. [PMID: 31324213 PMCID: PMC6642595 DOI: 10.1186/s13063-019-3455-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 05/20/2019] [Indexed: 11/28/2022] Open
Abstract
Background Intrapartum-related death is the third leading cause of under-5 mortality. Effective ventilation during neonatal resuscitation has the potential to reduce 40% of these deaths. Face-mask ventilation performed by midwives is globally the most common method of resuscitating neonates. It requires considerable operator skills and continuous training because of its complexity. The i-gel® is a cuffless supraglottic airway which is easy to insert and provides an efficient seal that prevents air leakage; it has the potential to enhance performance in neonatal resuscitation. A pilot study in Uganda demonstrated that midwives could safely resuscitate newborns with the i-gel® after a short training session. The aim of the present trial is to investigate whether the use of a cuffless supraglottic airway device compared with face-mask ventilation during neonatal resuscitation can reduce mortality and morbidity in asphyxiated neonates. Methods A randomized phase III open-label superiority controlled clinical trial will be conducted at Mulago Hospital, Kampala, Uganda, in asphyxiated neonates in the delivery units. Prior to the intervention, health staff performing resuscitation will receive training in accordance with the Helping Babies Breathe curriculum with a special module for training on supraglottic airway insertion. A total of 1150 to 1240 babies (depending on cluster size) that need positive pressure ventilation and that have an expected gestational age of more than 34 weeks and an expected birth weight of more than 2000 g will be ventilated by daily unmasked randomization with a supraglottic airway device (i-gel®) (intervention group) or with a face mask (control group). The primary outcome will be a composite outcome of 7-day mortality and admission to neonatal intensive care unit (NICU) with neonatal encephalopathy. Discussion Although indications for the beneficial effect of a supraglottic airway device in the context of neonatal resuscitation exist, so far no large studies powered to assess mortality and morbidity have been carried out. We hypothesize that effective ventilation will be easier to achieve with a supraglottic airway device than with a face mask, decreasing early neonatal mortality and brain injury from neonatal encephalopathy. The findings of this trial will be important for low and middle-resource settings where the majority of intrapartum-related events occur. Trial registration ClinicalTrials.gov. Identifier: NCT03133572. Registered April 28, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3455-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicolas J Pejovic
- Centre for International Health, University of Bergen, Årstadveien 21, Box 7804, 5020, Bergen, Norway. .,Sachs' Children and Youth Hospital, Sjukhusbacken 10, 11883, Stockholm, Sweden. .,Karolinska Institutet Department of Public Health Sciences, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Susanna Myrnerts Höök
- Centre for International Health, University of Bergen, Årstadveien 21, Box 7804, 5020, Bergen, Norway.,Sachs' Children and Youth Hospital, Sjukhusbacken 10, 11883, Stockholm, Sweden.,Karolinska Institutet Department of Public Health Sciences, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Josaphat Byamugisha
- Mulago National Referral Hospital, Box 7272, Kampala, Uganda.,Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Box 7072, Kampala, Uganda
| | - Tobias Alfvén
- Sachs' Children and Youth Hospital, Sjukhusbacken 10, 11883, Stockholm, Sweden.,Karolinska Institutet Department of Public Health Sciences, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Clare Lubulwa
- Mulago National Referral Hospital, Box 7272, Kampala, Uganda
| | | | - Jolly Nankunda
- Mulago National Referral Hospital, Box 7272, Kampala, Uganda.,Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Box 7072, Kampala, Uganda
| | - Hege Ersdal
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4019, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Box 8600, 4036, Stavanger, Norway
| | - Giulia Segafredo
- Operational Research Unit, Doctors with Africa Cuamm, Via San Francesco 126, Padova, Italy
| | - Mats Blennow
- Department of Neonatal Medicine, Karolinska University Hospital, Eugeniavägen 3, 171 76, Stockholm, Sweden.,Karolinska Institutet Department of Clinical Science, Technology and Intervention, Alfred Nobels alle 8, 141 52, Huddinge, Sweden
| | - Daniele Trevisanuto
- Department of Woman and Child Health, Padua University, Via Giustiniani, 3, 35128, Padua, Italy
| | - Thorkild Tylleskär
- Centre for International Health, University of Bergen, Årstadveien 21, Box 7804, 5020, Bergen, Norway.,Centre for Intervention Science in Maternal and Child Health Centre for International Health, University of Bergen, Årstadveien 21, Box 7804, 5020, Bergen, Norway
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12
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Guinsburg R, Miyoshi MH, de Almeida MFB. T-piece resuscitators: a warning sign. Arch Dis Child Fetal Neonatal Ed 2019; 104:F116-F117. [PMID: 29954882 DOI: 10.1136/archdischild-2018-315372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/12/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Milton Harumi Miyoshi
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria Fernanda B de Almeida
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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13
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Kakkilaya V, Jubran I, Mashruwala V, Ramon E, Simcik VN, Marshall M, Brown LS, Jaleel MA, Kapadia VS. Quality Improvement Project to Decrease Delivery Room Intubations in Preterm Infants. Pediatrics 2019; 143:peds.2018-0201. [PMID: 30602545 PMCID: PMC6361361 DOI: 10.1542/peds.2018-0201] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Avoidance of delivery room intubation (DRI) reduces death or bronchopulmonary dysplasia (BPD) in preterm neonates. Our objective with this quality improvement project was to decrease DRI rates by improving face mask positive pressure ventilation (Fm-PPV) among infants born ≤29 weeks' gestation. METHODS Key drivers of change were identified from a retrospective review of resuscitation records. A resuscitation bundle to optimize Fm-PPV including the use of a small round mask and end-tidal CO2 detectors, increasing peak inspiratory pressure when indicated, and debriefing after each intubation were implemented in consecutive plan-do-study-act cycles. The DRI rate was tracked by using a control chart. Resuscitation practice and outcomes of pre-quality improvement cohort (QIC) (January 2014-September 2015) were compared with post-QIC (October 2015-December 2016). RESULTS Of the 314 infants who were resuscitated, 180 belonged to the pre-QIC and 134 to the post-QIC. The antenatal steroid administration rate was higher in the post-QIC (54% vs 88%). More infants in the post-QIC had resolution of bradycardia after Fm-PPV (56% vs 77%, P = .02). Infants in the post-QIC had lower DRI rates (58% vs 37%, P < .01), lower need for mechanical ventilation (85% vs 70%, P < .01), lower rates of BPD (26% vs 13%, P < .01), and severe retinopathy of prematurity (14% vs 5%, P = .01). Rates of DRI, BPD, and severe retinopathy of prematurity remained lower even after controlling for the potential confounders. CONCLUSIONS Implementation of a resuscitation bundle decreased the DRI rate and improved outcomes of preterm infants.
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Affiliation(s)
| | - Ihab Jubran
- University of Texas Southwestern Medical Center, Dallas, Texas; and
| | | | - Emma Ramon
- Parkland Hospital and Health Systems, Dallas, Texas
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14
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15
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Born not breathing: A randomised trial comparing two self-inflating bag-masks during newborn resuscitation in Tanzania. Resuscitation 2017; 116:66-72. [DOI: 10.1016/j.resuscitation.2017.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/30/2017] [Accepted: 04/06/2017] [Indexed: 11/24/2022]
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16
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van Vonderen JJ, Roest AA, Klumper FJ, Hooper SB, te Pas AB. The effect of breathing on ductus arteriosus blood flow directly after birth. Eur J Pediatr 2017; 176:1581-1585. [PMID: 28879564 PMCID: PMC5682873 DOI: 10.1007/s00431-017-2994-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 03/29/2017] [Accepted: 08/09/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED Spontaneous breathing at birth influences ductus arteriosus (DA) flow. This study quantifies the effect of breathing on DA shunting directly after birth. In healthy term infants born by elective cesarean section, simultaneous measurements of DA shunting and tidal volumes during spontaneous breathing were performed at 2-5, 5-8, and 10-13 min after birth. Eight infants with a mean (SD) gestational age of 40 (1) weeks and 3216 (616) grams were studied. Inspiratory tidal volume was 5.8 (3.3-7.7), 5.7 (4.0-7.1), and 5.2 (4.3-6.1) mL/kg at 2-5, 5-8, and 10-13 min. The velocity time integral of left-to-right shunting significantly increased during inspiration when compared to expiration (8.4 (5.2) vs. 3.7 (2.3) cm, 8.9 (4.4) vs. 5.6 (3.4) cm, and 14.0 (6.7) vs. 8.4 (6.9) cm; all p < 0.0001) at 2-5, 5-8, and 10-13 min, respectively. In contrast, right-to-left shunting was not different between inspiration and expiration at 2-5 and 10-13 min (11.1 (2.4) vs. 11.1 (2.6) cm and 10.7 (2.3) vs. 10.6 (3.0) cm; p > 0.05), but there was a small increase at 5-8 min (12.1 (2.4) vs. 10.8 (2.9) cm; p = 0.001) during expiration. CONCLUSION Directly after birth, ductal shunting is influenced by breathing effort, predominantly with an increase in left-to-right shunt due to inspiration. What is Known: • Spontaneous breathing at birth influences ductus arteriosus flow and pulmonary blood flow. • Crying causes a significant increase in left-to-right ductus arteriosus shunting. What is New: • Left-to-right ductus arteriosus shunting increases during inspiration compared to expiration. • Breathing is important for ductal shunting and contributes to pulmonary blood flow.
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Affiliation(s)
- Jeroen J. van Vonderen
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Arno A.W. Roest
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Frans J.C. Klumper
- Department of Gynecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Stuart B. Hooper
- The Ritchie Centre, MIMR-PHI, Monash University, Clayton, Victoria Australia
| | - Arjan B. te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC Leiden, the Netherlands
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Lorenz L, Maxfield DA, Dawson JA, Kamlin COF, McGrory L, Thio M, Donath SM, Davis PG. A new suction mask to reduce leak during neonatal resuscitation: a manikin study. Arch Dis Child Fetal Neonatal Ed 2016; 101:F464-7. [PMID: 26847369 DOI: 10.1136/archdischild-2015-309772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/11/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Leak around the face mask is a common problem during neonatal resuscitation. A newly designed face mask using a suction system to enhance contact between the mask and the infant's face might reduce leak and improve neonatal resuscitation. The aim of the study is to determine whether leak is reduced using the suction mask (Resusi-sure mask) compared with a conventional mask (Laerdal Silicone mask) in a manikin model. METHODS Sixty participants from different professional categories (neonatal consultants, fellows, registrars, nurses, midwives and students) used each face mask in a random order to deliver 2 min of positive pressure ventilation to a manikin. Delivered airway pressures were measured using a pressure line. Inspiratory and expiratory flows were measured using a flow sensor, and expiratory tidal volumes and mask leaks were derived from these values. RESULTS A median (IQR) leak of 12.1 (0.6-39.0)% was found with the conventional mask compared with 0.7 (0.2-4.6)% using the suction mask (p=0.002). 50% of the participants preferred to use the suction mask and 38% preferred to use the conventional mask. There was no correlation between leak and operator experience. CONCLUSIONS A new neonatal face mask based on the suction system reduced leak in a manikin model. Clinical studies to test the safety and effectiveness of this mask are needed.
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Affiliation(s)
- Laila Lorenz
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
| | - Dominic A Maxfield
- Department of Medicine, University of Newcastle-upon-Tyne, Newcastle, UK
| | - Jennifer A Dawson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia Clinical Services Stream, Murdoch Children Research Institute, Melbourne, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - C Omar F Kamlin
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia Clinical Services Stream, Murdoch Children Research Institute, Melbourne, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Lorraine McGrory
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia
| | - Marta Thio
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia PIPER-Neonatal Transport Service, The Royal Children's Hospital, Melbourne, Australia
| | - Susan M Donath
- Clinical Services Stream, Murdoch Children Research Institute, Melbourne, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia Clinical Services Stream, Murdoch Children Research Institute, Melbourne, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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18
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Mask ventilation with two different face masks in the delivery room for preterm infants: a randomized controlled trial. J Perinatol 2015; 35:464-8. [PMID: 25719544 DOI: 10.1038/jp.2015.8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/30/2014] [Accepted: 01/20/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND If an infant fails to initiate spontaneous breathing after birth, international guidelines recommend a positive pressure ventilation (PPV). However, PPV by face mask is frequently inadequate because of leak between the face and mask. Despite a variety of available face masks, none have been prospectively compared in a randomized fashion. We aimed to evaluate and compare leak between two commercially available round face masks (Fisher & Paykel (F&P) and Laerdal) in preterm infants <33 weeks gestational age in the delivery room. METHODS Infants born at the Royal Alexandra Hospital from April to September 2013 at <33 weeks gestational age who received mask PPV in the delivery room routinely had a flow sensor placed between the mask and T-piece resuscitator. Infants were randomly assigned to receive PPV with either a F&P or Laerdal face mask. All resuscitators were trained in the use of both face masks. We compared mask leak, airway pressures, tidal volume and ventilation rate between the two groups. RESULTS Fifty-six preterm infants (n=28 in each group) were enrolled; mean±s.d. gestational age 28±3 weeks; birth weight 1210±448 g; and 30 (52%) were male. Apgar scores at 1 and 5 min were 5±3 and 7±2, respectively. Infants randomized to the F&P face mask and Laerdal face mask had similar mask leak (30 (25-38) versus 35 (24-46)%, median (interquartile range), respectively, P=0.40) and tidal volume (7.1 (4.9-8.9) versus 6.6 (5.2-8.9) ml kg(-1), P=0.69) during PPV. There were no significant differences in ventilation rate, inflation time or airway pressures between groups. CONCLUSION The use of either face mask during PPV in the delivery room yields similar mask leak in preterm infants <33 weeks gestational age.
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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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20
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van Vonderen JJ, Witlox RS, Kraaij S, te Pas AB. Two-minute training for improving neonatal bag and mask ventilation. PLoS One 2014; 9:e109049. [PMID: 25279800 PMCID: PMC4184825 DOI: 10.1371/journal.pone.0109049] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/04/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To test effectivity of a two-minute training consisting of a few key-points in ventilation using the self-inflating bag (SIB). STUDY DESIGN Experienced and inexperienced caregivers were asked to mask ventilate a leak free manikin using the SIB before and after the training. Mask leak and pressures were measured using respiratory function monitoring. Pressures above 35 cm H2O were considered excessive. Parameters were compared using a Wilcoxon non-parametric test. RESULTS Before and after the short training, experienced caregivers had minimal median (IQR) mask leak (14 (3-75) vs. 3 (0-53)%; p<0.01). Inexperienced users had large leak which reduced from 51 (7-91)% before to 11 (2-71)% after training (p<0.01). Pressures above 35 cm H2O hardly occurred in experienced caregivers (0 (0-5) vs. 0 (0-0)%; ns). In inexperienced caregivers this frequently occurred but decreased considerably after training (94 (46-100) vs. 2 (0-70)%; p<0.01). CONCLUSION A two-minute training of bag and mask ventilation was effective. This training could be incorporated into any training program.
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Affiliation(s)
- Jeroen J. van Vonderen
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ruben S. Witlox
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sascha Kraaij
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arjan B. te Pas
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands
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