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Dalley A, Hodgson K, Dawson J, Tracy M, Davis P, Thio M. Introducing a novel respiratory function monitor for neonatal resuscitation training. Resusc Plus 2024; 17:100535. [PMID: 38234876 PMCID: PMC10792740 DOI: 10.1016/j.resplu.2023.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
Background A respiratory function monitor (RFM) gives immediate feedback, allowing clinicians to adjust face mask ventilation to correct leak or inappropriate tidal volumes. We audited the satisfaction of clinicians with a neonatal resuscitation training package, incorporating a novel RFM. Methods This was a mixed-methods study conducted at The Royal Women's Hospital, Melbourne, Australia. Clinicians were approached to complete a neonatal resuscitation training session. Participants watched a training video, then provided ventilation to term and preterm manikins first without, and then with, the RFM. Clinicians completed a survey after the session and undertook a follow-up session three months later. The primary outcome was participant satisfaction with the RFM. Secondary outcomes included participants' self-assessment of face mask leak and tidal volumes when using the RFM. Results Fifty clinicians completed both the initial and follow-up session. Participants reported high levels of satisfaction with the RFM for both term and preterm manikins: on a scale from 0, meaning "not at all", and 100, meaning "yes, for all resuscitations", the median response (interquartile range, IQR) was 82 (74-94) vs 81.5 (69-94.5). Levels of satisfaction were similar for less experienced and more experienced clinicians: median (IQR) 83 (77-93) vs 81 (71.5-95) respectively. When using the monitor, clinicians accurately self-assessed that they achieved leak below 30% and tidal volumes within the target range at least 80% of the time. Conclusion Clinicians of all experience levels had a high level of satisfaction with a training package including a novel RFM.
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Affiliation(s)
- A.M. Dalley
- Newborn Research Centre, The Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
| | - K.A. Hodgson
- Newborn Research Centre, The Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Paediatric Infant and Perinatal Emergency Retrieval, The Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - J.A. Dawson
- Newborn Research Centre, The Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - M.B. Tracy
- Westmead Hospital, Department of Neonatology, Cnr Hawkesbury Road and Darcy Road, Westmead, New South Wales 2145, Australia
- The University of Sydney, City Road Level 2 & 3, Sydney, New South Wales 2006, Australia
| | - P.G. Davis
- Newborn Research Centre, The Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - M. Thio
- Newborn Research Centre, The Royal Women’s Hospital, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Level 7, 20 Flemington Road, Parkville, Victoria 3052, Australia
- Paediatric Infant and Perinatal Emergency Retrieval, The Royal Children’s Hospital, 50 Flemington Road, Parkville, Victoria 3052, Australia
- Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia
- Gandel Simulation Service, The Royal Women’s Hospital & The University of Melbourne, 20 Flemington Road, Parkville, Victoria 3052, Australia
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2
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Foglia EE, Shah BA, DeShea L, Lander K, Kamath-Rayne BD, Herrick HM, Zaichkin J, Lee S, Bonafide C, Song C, Hallford G, Lee HC, Kapadia V, Leone T, Josephsen J, Gupta A, Strand ML, Beasley WH, Szyld E. Laryngeal mask use during neonatal resuscitation at birth: A United States-based survey of neonatal resuscitation program providers and instructors. Resusc Plus 2024; 17:100515. [PMID: 38094660 PMCID: PMC10716019 DOI: 10.1016/j.resplu.2023.100515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 04/11/2024] Open
Abstract
Aim Neonatal resuscitation guidelines promote the laryngeal mask (LM) interface for positive pressure ventilation (PPV), but little is known about how the LM is used among Neonatal Resuscitation Program (NRP) Providers and Instructors. The study aim was to characterize the training, experience, confidence, and perspectives of NRP Providers and Instructors regarding LM use during neonatal resuscitation at birth. Methods A voluntary anonymous survey was emailed to all NRP Providers and Instructors. Survey items addressed training, experience, confidence, and barriers for LM use during resuscitation. Associations between respondent characteristics and outcomes of both LM experience and confidence were assessed using logistic regression. Results Between 11/7/22-12/12/22, there were 5,809 survey respondents: 68% were NRP Providers, 55% were nurses, and 87% worked in a hospital setting. Of these, 12% had ever placed a LM during newborn resuscitation, and 25% felt very or completely confident using a LM. In logistic regression, clinical or simulated hands-on training, NRP Instructor role, professional role, and practice setting were all associated with both LM experience and confidence.The three most frequently identified barriers to LM use were insufficient experience (46%), preference for other interfaces (25%), and failure to consider the LM during resuscitation (21%). One-third (33%) reported that LMs are not available where they resuscitate newborns. Conclusion Few NRP providers and instructors use the LM during neonatal resuscitation. Strategies to increase LM use include hands-on clinical training, outreach promoting the advantages of the LM compared to other interfaces, and improving availability of the LM in delivery settings.
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Affiliation(s)
- Elizabeth E. Foglia
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Birju A. Shah
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lise DeShea
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Kathryn Lander
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
| | - Beena D. Kamath-Rayne
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
| | - Heidi M. Herrick
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Sura Lee
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Christopher Bonafide
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Clara Song
- Southern California Permanente Medical Group, Anaheim, CA, United States
| | - Gene Hallford
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Henry C. Lee
- Division of Neonatology, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Vishal Kapadia
- Division of Neonatology, Department of Pediatrics, UT Southwestern, Dallas, TX, United States
| | - Tina Leone
- Division of Neonatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Justin Josephsen
- Division of Neonatology, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Arun Gupta
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marya L. Strand
- Division of Neonatology, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - William H. Beasley
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Edgardo Szyld
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - for the American Academy of Pediatrics Delivery Room Intervention, Evaluation DRIVE Network
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
- Positive Pressure, PLLC, Shelton, WA, United States
- Southern California Permanente Medical Group, Anaheim, CA, United States
- Division of Neonatology, University of California San Diego School of Medicine, La Jolla, CA, United States
- Division of Neonatology, Department of Pediatrics, UT Southwestern, Dallas, TX, United States
- Division of Neonatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
- Division of Neonatology, Saint Louis University School of Medicine, St. Louis, MO, United States
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
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3
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Edwards G, O'Shea JE. Is telemedicine suitable for remotely supporting non-tertiary units in providing emergency care to unwell newborns? Arch Dis Child 2023; 109:5-10. [PMID: 37438088 DOI: 10.1136/archdischild-2022-325057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/08/2023] [Indexed: 07/14/2023]
Abstract
Although the majority of term infants will breathe spontaneously at birth, the requirement for advanced resuscitation can be unpredictable, as can the precipitous delivery of an extremely preterm infant in a non-tertiary neonatal unit. Infants born in hospitals without a tertiary neonatal intensive care unit have a higher mortality which is a disparity that has been difficult to resolve.Telemedicine, the use of videoconferencing software to connect those at the scene of a resuscitation to a remote clinician, can allow for real-time two-way communication between a local unit and a tertiary neonatal specialist. It has been present for some time in neonatology to provide secure video messaging with families and its use in neonatal acute care and resuscitation has been growing in recent years.We sought to perform a review of the current evidence available on the use of telemedicine in neonatal resuscitation. Studies demonstrate improved quality of resuscitation, improved adherence to resuscitation guidelines and positive experiences reported by local and tertiary teams. Suitable technology needs to be available to establish a rapid and secure video connection, as does adequate availability of experienced neonatologists to provide remote guidance. Telemedicine is an exciting and emerging tool which is being developed as a standard of care in units which have piloted it.
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Affiliation(s)
- Gemma Edwards
- Neonatal Unit, Princess Royal Maternity Hospital, Glasgow, UK
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4
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Cavigioli F, Bresesti I, Di Peri A, Cerritelli F, Gazzolo D, Gavilanes AWD, Kramer B, Te Pas A, Lista G. Tidal volume optimization and heart rate response during stabilization of very preterm infants. Pediatr Pulmonol 2023; 58:550-555. [PMID: 36324233 DOI: 10.1002/ppul.26229] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/22/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
AIM To verify the added value of respiratory function monitor (RFM) to assess ventilation and the heart rate (HR) changes during stabilization of preterm infants. METHODS Preterm infants <32 weeks' gestation, bradycardic at birth and in need for positive pressure ventilation (PPV) were included. The first 15 min of stabilization was monitored with RFM. Three time points were identified according to HR values (T0 the start of mask PPV; T1 the HR rise >100 bpm; T2 the delivery of the last PPV). For each inflation, PIP, PEEP, MAP, expired tidal volume/kg (Vte/kg), and mean dynamic compliance (Cdyn) were analyzed. RESULTS PIP and MAP values were significantly higher at T1 (27.09 ± 5.37 and 17.47 ± 3.85 cmH2 O) and at T2 (24.7 ± 3.86 and 15.2 ± 3.78 cmH2 O) compared to T0 (24.05 ± 2.27 and 15.85 ± 2.77 cmH2 O). PEEP at T1 was significantly higher (6.27 ± 2.17 cmH2 O) compared to T2 (5.61 ± 1.50 cmH2 O). Vte/kg showed significantly lower T0 values (3.57 ± 2.14 ml/kg) compared to T1 (6.18 ± 2.51 ml/kg) and T2 (6.89 ± 2.40 ml/kg). There was a significant effect of time on Cdyn. CONCLUSIONS A clear correspondence between HR rise and adequate Vte/kg during stabilization of very preterm infants was highlighted. RFM might be useful to tailor ventilation, following real-time changes of lung compliance.
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Affiliation(s)
| | - Ilia Bresesti
- NICU "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonio Di Peri
- NICU "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | | | - Diego Gazzolo
- Neonatal Intensive Care Unit, "G. D'Annunzio" University, Chieti, Italy
| | - Antonio W D Gavilanes
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Boris Kramer
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arjan Te Pas
- Division of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gianluca Lista
- NICU "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy
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5
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Foglia EE, Davis PG, Guinsburg R, Kapadia V, Liley HG, Rüdiger M, Schmölzer GM, Strand ML, Wyckoff MH, Wyllie J, Weiner GM. Recommended Guideline for Uniform Reporting of Neonatal Resuscitation: The Neonatal Utstein Style. Pediatrics 2023; 151:190463. [PMID: 36632729 DOI: 10.1542/peds.2022-059631] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 01/13/2023] Open
Abstract
Clinical research on neonatal resuscitation has accelerated over recent decades. However, an important methodologic limitation is that there are no standardized definitions or reporting guidelines for neonatal resuscitation clinical studies. To address this, the International Liaison Committee on Resuscitation Neonatal Life Support Task Force established a working group to develop the first Utstein-style reporting guideline for neonatal resuscitation. The working group modeled this approach on previous Utstein-style guidelines for other populations. This reporting guideline focuses on resuscitation of newborns immediately after birth for respiratory failure, bradycardia, severe bradycardia, or cardiac arrest. We identified 7 relevant domains: setting, patient, antepartum, birth/preresuscitation, resuscitation process, postresuscitation process, and outcomes. Within each domain, relevant data elements were identified as core versus supplemental. Core data elements should be collected and reported for all neonatal resuscitation studies, while supplemental data elements may be collected and reported using standard definitions when possible. The Neonatal Utstein template includes both core and supplemental elements across the 7 domains, and the associated Data Table provides detailed information and reporting standards for each data element. The Neonatal Utstein reporting guideline is anticipated to assist investigators engaged in neonatal resuscitation research by standardizing data definitions. The guideline will facilitate data pooling in meta-analyses, enhancing the strength of neonatal resuscitation treatment recommendations and subsequent guidelines.
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Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter G Davis
- Newborn Research Center, the Royal Women's Hospital and the University of Melbourne, Victoria, Australia
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Mario Rüdiger
- Saxony Center for Fetal-Neonatal Health.,Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Medizinische Fakultät TU Dresden, Dresden, Germany
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Marya L Strand
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan Wyllie
- Department of Paediatrics and Neonatology, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Gary M Weiner
- Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Bäcke P, Thies-Lagergren L, Blomqvist YT. Neonatal resuscitation after birth: Swedish midwives' experiences of and perceptions about separation of mothers and their newborn babies. Eur J Midwifery 2023; 7:10. [PMID: 37213413 PMCID: PMC10193297 DOI: 10.18332/ejm/162319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/13/2023] [Accepted: 04/03/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION This study aimed to investigate midwives' experiences of and perceptions about mother-baby separation during resuscitation of the baby following birth. METHODS A qualitative study was conducted using an author-designed questionnaire. Fifty-four midwives from two Swedish birth units with different working methods regarding neonatal resuscitation - at the mother's bedside in the birth room or in a designated resuscitation room outside the birth room - completed the questionnaire. Data were analyzed using qualitative content analysis. RESULTS Most midwives had experience of removing a newborn baby in need of critical care from the birth room, thus separating the mother and baby. The midwives identified the difficulties and challenges involved in carrying out emergency care in the birth room after birth and had divergent opinions about what they considered possible in these birth situations. They agreed on the benefits, for both mother and baby, in performing emergency care in the birth room and avoiding a separation altogether, if possible. CONCLUSIONS There are good opportunities to reduce separation of mother and baby after birth; training, knowledge, education and the right environmental conditions are important factors in successfully implementing new ways of working. It is possible to work towards reducing separation and this work should continue and strive to eliminate separation as far as possible.
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Affiliation(s)
- Pyrola Bäcke
- Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Li Thies-Lagergren
- Midwifery Research – Reproductive, Perinatal and Sexual Health, Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ylva Thernström Blomqvist
- Neonatal Intensive Care Unit, University Hospital, Uppsala, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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7
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Kuypers KLAM, van Zanten HA, Heesters V, Kamlin O, Springer L, Lista G, Cavigioli F, Vento M, Núñez-Ramiro A, Kuester H, Horn S, Weinberg DD, Foglia EE, Morley CJ, Davis PG, Te Pas AB. Resuscitators' opinions on using a respiratory function monitor during neonatal resuscitation. Acta Paediatr 2023; 112:63-68. [PMID: 36177808 PMCID: PMC10092741 DOI: 10.1111/apa.16559] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to assess the resuscitators' opinions of the usefulness and clinical value of using a respiratory function monitor (RFM) when resuscitating extremely preterm infants with positive pressure ventilation. METHODS The link to an online survey was sent to 106 resuscitators from six countries who were involved in a multicentre trial that compared the percentage of inflations within a predefined target range with and without the RFM. The resuscitators were asked to assess the usefulness and clinical value of the RFM. The survey was online for 4 months after the trial ended in May 2019. RESULTS The survey was completed by 74 (70%) resuscitators of which 99% considered the RFM to be helpful during neonatal resuscitation and 92% indicated that it influenced their decision-making. The majority (76%) indicated that using the RFM improved their practice and made resuscitation more effective, even when the RFM was not available. Inadequate training was the key issue that limited the effectiveness of the RFM: 45% felt insufficiently trained, and 78% felt more training in using and interpreting the RFM would have been beneficial. CONCLUSION Resuscitators considered the RFM to be helpful to guide neonatal resuscitation, but sufficient training was required to achieve the maximum benefit.
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Affiliation(s)
- Kristel L A M Kuypers
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Henriëtte A van Zanten
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Veerle Heesters
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Omar Kamlin
- Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Laila Springer
- Department of Neonatology, University Children's Hospital, Tübingen, Germany
| | - Gianluca Lista
- Department of Neonatology, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Francesco Cavigioli
- Department of Neonatology, V. Buzzi Children's Hospital, ASST-FBF-Sacco, Milan, Italy
| | - Maximo Vento
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Antonio Núñez-Ramiro
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Helmut Kuester
- Neonatology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Sebastian Horn
- Neonatology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Danielle D Weinberg
- Division of Neonatology, Department of Paediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Paediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colin J Morley
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK
| | - Peter G Davis
- Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Arjan B Te Pas
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
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8
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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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9
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Wenn die Maskenbeatmung beim Neugeborenen schwierig ist. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungDie entscheidende und zumeist einzig notwendige Maßnahme für die erfolgreiche Reanimation eines Neugeborenen nach der Geburt ist die effektive Ventilation der Lunge [1]. Bereits eine kurze Maskenbeatmung führt, bei einem zunächst nicht oder nicht suffizient spontan atmenden Neugeborenen, in den meisten Fällen zum Einsetzen einer effektiven Eigenatmung und damit zu einer raschen klinischen Stabilisierung. In den meisten Fällen gelingt eine Maskenbeatmung problemlos, allerdings bereitet sie immer wieder auch Schwierigkeiten.In Kursen, die sich mit der Versorgung des kritisch kranken Neugeborenen befassen (u. a. die Newborn-Life-Support-Kurse des Austrian Resuscitation Council (ARC), des German Resuscitation Council (GRC) und der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI)) [2], liegt daher ein Schwerpunkt auf Maßnahmen zur Optimierung einer nichtinvasiven Beatmung, die häufig nur unzureichend bekannt sind.Dieser Artikel widmet sich Strategien, wie eine nichtinvasive Beatmung beim Neugeborenen optimiert werden kann, und schlägt mit dem deutschsprachigen Akronym „RALPH“ eine Möglichkeit vor, wie Schwierigkeiten bei der Maskenbeatmung strukturiert und zielgerichtet überwunden werden können.
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10
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Neonatal resuscitation practices in Italy: a survey of the Italian Society of Neonatology (SIN) and the Union of European Neonatal and Perinatal Societies (UENPS). Ital J Pediatr 2022; 48:81. [PMID: 35655278 PMCID: PMC9164545 DOI: 10.1186/s13052-022-01260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providing appropriate care at birth remains a crucial strategy for reducing neonatal mortality and morbidity. We aimed to evaluate the consistency of practice and the adherence to the international guidelines on neonatal resuscitation in level-I and level-II Italian birth hospitals. METHODS This was a cross-sectional electronic survey. A 91-item questionnaire focusing on current delivery room practices in neonatal resuscitation was sent to the directors of 418 Italian neonatal facilities. RESULTS The response rate was 61.7% (258/418), comprising 95.6% (110/115) from level-II and 49.0% (148/303) from level-I centres. In 2018, approximately 300,000 births occurred at the participating hospitals, with a median of 1664 births/centre in level-II and 737 births/centre in level-I hospitals. Participating level-II hospitals provided nasal-CPAP and/or high-flow nasal cannulae (100%), mechanical ventilation (99.1%), HFOV (71.0%), inhaled nitric oxide (80.0%), therapeutic hypothermia (76.4%), and extracorporeal membrane oxygenation ECMO (8.2%). Nasal-CPAP and/or high-flow nasal cannulae and mechanical ventilation were available in 77.7 and 21.6% of the level-I centres, respectively. Multidisciplinary antenatal counselling was routinely offered to parents at 90.0% (90) of level-II hospitals, and 57.4% (85) of level-I hospitals (p < 0.001). Laryngeal masks were available in more than 90% of participating hospitals while an end-tidal CO2 detector was available in only 20%. Significant differences between level-II and level-I centres were found in the composition of resuscitation teams for high-risk deliveries, team briefings before resuscitation, providers qualified with full resuscitation skills, self-confidence, and use of sodium bicarbonate. CONCLUSIONS This survey provides insight into neonatal resuscitation practices in a large sample of Italian hospitals. Overall, adherence to international guidelines on neonatal resuscitation was high, but differences in practice between the participating centres and the guidelines exist. Clinicians and stakeholders should consider this information when allocating resources and planning perinatal programs in Italy.
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Batey N, Henry C, Garg S, Wagner M, Malhotra A, Valstar M, Smith T, Sharkey D. The newborn delivery room of tomorrow: emerging and future technologies. Pediatr Res 2022:10.1038/s41390-022-01988-y. [PMID: 35241791 DOI: 10.1038/s41390-022-01988-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/10/2022] [Accepted: 02/01/2022] [Indexed: 11/08/2022]
Abstract
Advances in neonatal care have resulted in improved outcomes for high-risk newborns with technologies playing a significant part although many were developed for the neonatal intensive care unit. The care provided in the delivery room (DR) during the first few minutes of life can impact short- and long-term neonatal outcomes. Increasingly, technologies have a critical role to play in the DR particularly with monitoring and information provision. However, the DR is a unique environment and has major challenges around the period of foetal to neonatal transition that need to be overcome when developing new technologies. This review focuses on current DR technologies as well as those just emerging and further over the horizon. We identify what key opinion leaders in DR care think of current technologies, what the important DR measures are to them, and which technologies might be useful in the future. We link these with key technologies including respiratory function monitors, electoral impedance tomography, videolaryngoscopy, augmented reality, video recording, eye tracking, artificial intelligence, and contactless monitoring. Encouraging funders and industry to address the unique technological challenges of newborn care in the DR will allow the continued improvement of outcomes of high-risk infants from the moment of birth. IMPACT: Technological advances for newborn delivery room care require consideration of the unique environment, the variable patient characteristics, and disease states, as well as human factor challenges. Neonatology as a speciality has embraced technology, allowing its rapid progression and improved outcomes for infants, although innovation in the delivery room often lags behind that in the intensive care unit. Investing in new and emerging technologies can support healthcare providers when optimising care and could improve training, safety, and neonatal outcomes.
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Affiliation(s)
- Natalie Batey
- Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Caroline Henry
- Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shalabh Garg
- Department of Neonatal Medicine, James Cook University Hospital, Middlesbrough, UK
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital and Department of Paediatrics, Monash University, Melbourne, Australia
| | - Michel Valstar
- School of Computer Science, University of Nottingham, Nottingham, UK
| | - Thomas Smith
- School of Computer Science, University of Nottingham, Nottingham, UK
| | - Don Sharkey
- Nottingham Neonatal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK.
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Ljungblad LW, Skovdahl K, McCormack B, Dahl B. "Keep It Simple"-Co-Creation of a Tailored Newborn Resuscitation Course for Midwifery Students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:81-93. [PMID: 35082549 PMCID: PMC8785135 DOI: 10.2147/amep.s346991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To develop a tailored newborn resuscitation course for midwifery students. PATIENTS AND METHODS A qualitative study using an explorative, abductive approach was applied. Co-creation through workshops was facilitated to develop a tailored newborn resuscitation course for midwifery students. Four workshops with midwifery students and midwives were conducted from May to October 2020. Twenty participants attended one workshop of their choice. Five out of Norway's six midwifery education programmes participated, and included midwives from across Norway. All workshops were held digitally via the Zoom platform. A seven-step framework analysis method was applied to analyse the workshop data. RESULTS We identified four themes: 1) practice guidance, 2) technical skills 3) non-technical skills 4) innovative methods. CONCLUSION Findings emphasize the importance of practice guidance, technical skills, non-technical skills and innovative methods to facilitate the learning process. However, these skills cannot be acquired without the context to facilitate them, and thus a supportive culture is essential to sustain newborn resuscitation expertise as a midwife/midwifery student. We found that midwives expressed the same need to learn, train and prepare themselves for newborn resuscitation as midwifery students. The importance of facilitating the learning of newborn resuscitation with low-dose, high-frequency training in a supportive culture thus matters to both midwifery students and expert midwives.
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Affiliation(s)
- Linda Wike Ljungblad
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Kirsti Skovdahl
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Brendan McCormack
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
- Centre for Person-Centred Practice Research, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
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Foglia EE, Kirpalani H, Ratcliffe SJ, Davis PG, Thio M, Hummler H, Lista G, Cavigioli F, Schmölzer GM, Keszler M, Te Pas AB. Sustained Inflation Versus Intermittent Positive Pressure Ventilation for Preterm Infants at Birth: Respiratory Function and Vital Sign Measurements. J Pediatr 2021; 239:150-154.e1. [PMID: 34453917 PMCID: PMC8604776 DOI: 10.1016/j.jpeds.2021.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/30/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To characterize respiratory function monitor (RFM) measurements of sustained inflations and intermittent positive pressure ventilation (IPPV) delivered noninvasively to infants in the Sustained Aeration of Infant Lungs (SAIL) trial and to compare vital sign measurements between treatment arms. STUDY DESIGN We analyzed RFM data from SAIL participants at 5 trial sites. We assessed tidal volumes, rates of airway obstruction, and mask leak among infants allocated to sustained inflations and IPPV, and we compared pulse rate and oxygen saturation measurements between treatment groups. RESULTS Among 70 SAIL participants (36 sustained inflations, 34 IPPV) with RFM measurements, 40 (57%) were spontaneously breathing prior to the randomized intervention. The median expiratory tidal volume of sustained inflations administered was 5.3 mL/kg (IQR 1.1-9.2). Significant mask leak occurred in 15% and airway obstruction occurred during 17% of sustained inflations. Among 34 control infants, the median expiratory tidal volume of IPPV inflations was 4.3 mL/kg (IQR 1.3-6.6). Mask leak was present in 3%, and airway obstruction was present in 17% of IPPV inflations. There were no significant differences in pulse rate or oxygen saturation measurements between groups at any point during resuscitation. CONCLUSION Expiratory tidal volumes of sustained inflations and IPPV inflations administered in the SAIL trial were highly variable in both treatment arms. Vital sign values were similar between groups throughout resuscitation. Sustained inflation as operationalized in the SAIL trial was not superior to IPPV to promote lung aeration after birth in this study subgroup. TRIAL REGISTRATION Clinicaltrials.gov: NCT02139800.
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Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Haresh Kirpalani
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sarah J Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Peter G Davis
- Newborn Research Center, The Royal Women's Hospital and The University of Melbourne, Victoria, Australia
| | - Marta Thio
- Newborn Research Center, The Royal Women's Hospital and The University of Melbourne, Victoria, Australia
| | | | - Gianluca Lista
- Department of Pediatrics, NICU, Ospedale dei Bambini V.Buzzi ASST-FBF-Sacco, Milan, Italy
| | - Francesco Cavigioli
- Department of Pediatrics, NICU, Ospedale dei Bambini V.Buzzi ASST-FBF-Sacco, Milan, Italy
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Martin Keszler
- Department of Pediatrics, Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Arjan B Te Pas
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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14
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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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Advances in Neonatal Critical Care: Pushing at the Boundaries and Connecting to Long-Term Outcomes. Crit Care Med 2021; 49:2003-2016. [PMID: 34380942 DOI: 10.1097/ccm.0000000000005251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patterson J, North K, Dempsey E, Ishoso D, Trevisanuto D, Lee AC, Kamath-Rayne BD. Optimizing initial neonatal resuscitation to reduce neonatal encephalopathy around the world. Semin Fetal Neonatal Med 2021; 26:101262. [PMID: 34193380 DOI: 10.1016/j.siny.2021.101262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One million two hundred thousand neonatal lives are lost each year due to intrapartum-related events; 99% of these deaths occur in low- and lower middle-income countries. Neonates exposed to intrapartum-related events present with failure to breathe at birth. Quick and effective delivery room management of these neonates is critical in the prevention of brain injury. Given the prominent role of lung aeration in the cardiopulmonary transition at birth, the mainstay of neonatal resuscitation is effective ventilation. Basic neonatal resuscitation focuses on simple stimulation, airway positioning and clearing, and bag-mask ventilation. Although principles for basic neonatal resuscitation remain the same for high- and low-resource settings, guidelines may differ based on available human and material resources. Formal training in basic resuscitation reduces intrapartum-related neonatal mortality in low-resource settings. However, there remain opportunities to improve provider performance for increased impact with other strategies such as regular practice and continuous quality improvement.
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Affiliation(s)
- Jackie Patterson
- Division of Neonatal-Perinatal Medicine, UNC Hospitals, 4th Floor, 101 Manning Drive, Room N45051, Campus Box 7596, Chapel Hill, NC, 27599-7596, USA.
| | - Krysten North
- Division of Neonatal-Perinatal Medicine, UNC Hospitals, 4th Floor, 101 Manning Drive, Room N45051, Campus Box 7596, Chapel Hill, NC, 27599-7596, USA.
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, INFANT Research Centre, University College Cork, Wilton, Cork, Ireland.
| | - Daniel Ishoso
- Department of Community Health, Kinshasa School of Public Health, University of Kinshasa, PO Box 11850, Kinshasa, Democratic Republic of the Congo.
| | - Daniele Trevisanuto
- Department of Women's and Child Health, University of Padova, Via Giustiniani, 3, Padova, Italy.
| | - Anne Cc Lee
- Harvard Medical School; Director of Global AIM Lab, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, 345 Park Blvd, Itasca, IL, 60143, USA.
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钱 苗, 余 章, 陈 小, 徐 艳, 马 月, 姜 善, 王 淮, 王 增, 韩 良, 李 双, 卢 红, 万 俊, 高 艳, 陈 筱, 赵 莉, 吴 明, 张 红, 薛 梅, 朱 玲, 田 兆, 屠 文, 吴 新, 韩 树, 顾 筱. [Clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation: a multicenter retrospective analysis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:593-598. [PMID: 34130781 PMCID: PMC8214002 DOI: 10.7499/j.issn.1008-8830.2101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation. METHODS A retrospective analysis was performed for the preterm infants with a birth weight less than 1 500 g and a gestational age less than 32 weeks who were treated in the neonatal intensive care unit of 20 hospitals in Jiangsu, China from January 2018 to December 2019. According to the intensity of resuscitation in the delivery room, the infants were divided into three groups:non-tracheal intubation (n=1 184), tracheal intubation (n=166), and extensive cardiopulmonary resuscitation (ECPR; n=116). The three groups were compared in terms of general information and clinical outcomes. RESULTS Compared with the non-tracheal intubation group, the tracheal intubation and ECPR groups had significantly lower rates of cesarean section and use of antenatal corticosteroid (P < 0.05). As the intensity of resuscitation increased, the Apgar scores at 1 minute and 5 minutes gradually decreased (P < 0.05), and the proportion of infants with Apgar scores of 0 to 3 at 1 minute and 5 minutes gradually increased (P < 0.05). Compared with the non-tracheal intubation group, the tracheal intubation and ECPR groups had significantly higher mortality rate and incidence rates of moderate-severe bronchopulmonary dysplasia and serious complications (P < 0.05). The incidence rates of grade Ⅲ-Ⅳ intracranial hemorrhage and retinopathy of prematurity (stage Ⅲ or above) in the tracheal intubation group were significantly higher than those in the non-tracheal intubation group (P < 0.05). CONCLUSIONS For preterm infants with a birth weight less than 1 500 g, the higher intensity of resuscitation in the delivery room is related to lower rate of antenatal corticosteroid therapy, lower gestational age, and lower birth weight. The infants undergoing tracheal intubation or ECRP in the delivery room have an increased incidence rate of adverse clinical outcomes. This suggests that it is important to improve the quality of perinatal management and delivery room resuscitation to improve the prognosis of the infants.
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Affiliation(s)
- 苗 钱
- 南京医科大学附属妇产医院/南京市妇幼保健院新生儿科, 江苏南京 210004Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - 章斌 余
- 南京医科大学附属妇产医院/南京市妇幼保健院新生儿科, 江苏南京 210004Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - 小慧 陈
- 南京医科大学附属妇产医院/南京市妇幼保健院新生儿科, 江苏南京 210004Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - 艳 徐
- 徐州医科大学附属医院新生儿科, 江苏徐州 221002
| | - 月兰 马
- 南京医科大学附属苏州医院/苏州市立医院新生儿科, 江苏苏州 215002
| | - 善雨 姜
- 无锡市妇幼保健院新生儿科, 江苏无锡 214002
| | - 淮燕 王
- 常州市妇幼保健院新生儿科, 江苏常州 213003
| | - 增芹 王
- 徐州市妇幼保健院新生儿科, 江苏徐州 221009
| | - 良荣 韩
- 淮安市妇幼保健院新生儿科, 江苏淮安 223002
| | - 双双 李
- 南通市妇幼保健院新生儿科, 江苏南通 226001
| | - 红艳 卢
- 江苏大学附属医院新生儿科, 江苏镇江 212001
| | | | - 艳 高
- 连云港市妇幼保健院新生儿科, 江苏连云港 222000
| | - 筱青 陈
- 南京医科大学第一附属医院新生儿科, 江苏南京 210036
| | - 莉 赵
- 南京医科大学附属儿童医院新生儿科, 江苏南京 210008
| | - 明赴 吴
- 扬州大学附属医院新生儿科, 江苏扬州 225001
| | | | | | | | - 兆方 田
- 淮安市第一人民医院新生儿科, 江苏淮安 223002
| | | | - 新萍 吴
- 扬州市妇幼保健院新生儿科, 江苏扬州 225002
| | - 树萍 韩
- 南京医科大学附属妇产医院/南京市妇幼保健院新生儿科, 江苏南京 210004Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
| | - 筱琪 顾
- 南京医科大学附属妇产医院/南京市妇幼保健院新生儿科, 江苏南京 210004Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
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Haase B, Badinska AM, Poets CF, Koos B, Springer L. An approach to define newborns´ sniffing position using an angle based on reproducible facial landmarks. Paediatr Anaesth 2021; 31:404-409. [PMID: 33555071 DOI: 10.1111/pan.14154] [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: 10/02/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND The neutral or sniffing position is advised for mask ventilation in neonates to avoid airway obstruction. As definitions are manifold and often unspecific, we wanted to investigate the reliability and reproducibility of angle measurements based on facial landmarks that may be used in future clinical trials to determine a hypothetical head position with minimal airway obstruction during mask ventilation. METHODS In a prospective single-center observational study, 2D sagittal photographs of 24 near-term and term infants were taken, with five raters marking facial landmarks to assess interobserver agreement of those landmarks and angle δ, defined as the angle between the line parallel to the lying surface and the line crossing Subnasale (Sn) and Porion' (P'). Angle δ was assessed in sniffing (δsniff ) and physiologic (δphys ) head position, the former based on a published, yet poorly defined head position where the tip of the nose aligns to the ceiling with the head in a supine, relaxed mid-position. RESULTS Infants had a mean (SD) gestational age of 37.3 (2.3) weeks. Angle δ could be determined in all 48 images taken in either the sniffing or the physiological head position. Interobserver correlation coefficient was 98.6 for all measurements independent of head position. Angle δsniff was 90.5° (5.7) in the sniffing position. CONCLUSIONS This study provides a new measuring technique using an angle that is reproducible and reliable and may be used in future studies to correlate head position with airway obstruction.
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Affiliation(s)
- Bianca Haase
- Department of Neonatology, University Children's Hospital of Tuebingen, Tuebingen, Germany
| | - Ana-Maria Badinska
- Department of Neonatology, University Children's Hospital of Tuebingen, Tuebingen, Germany
| | - Christian F Poets
- Department of Neonatology, University Children's Hospital of Tuebingen, Tuebingen, Germany
| | - Bernd Koos
- Department of Orthodontics, University Hospital of Tuebingen, Tuebingen, Germany
| | - Laila Springer
- Department of Neonatology, University Children's Hospital of Tuebingen, Tuebingen, Germany
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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: 234] [Impact Index Per Article: 78.0] [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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Effect of a positive pressure ventilation-refresher program on ventilation skill performance during simulated newborn resuscitation. Resusc Plus 2021; 5:100091. [PMID: 34223356 PMCID: PMC8244303 DOI: 10.1016/j.resplu.2021.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 11/22/2022] Open
Abstract
Aim Clinical staff highly proficient in neonatal resuscitation are essential to ensure prompt, effective positive pressure ventilation (PPV) for infants that do not breathe spontaneously after birth. However, it is well-documented that resuscitation competency is transient after standard training. We hypothesized that brief, repeated PPV psychomotor skill refresher training would improve PPV performance for newborn care nurses. Methods Subjects completed a blinded baseline and post PPV-skills assessment. Data on volume and rate for each ventilation was recorded. After baseline assessment, subjects completed PPV-Refreshers over 3 months consisting of psychomotor skill training using a newborn manikin with visual feedback. Subjects provided PPV until they could deliver ≥30 s of PPV meeting targets for volume (10-21 mL) and rate (40-60 ventilations per minute [vpm]). Baseline and post assessments were compared for total number PPV delivered, number target PPV delivered (volume 10-21 mL), mean volume and mean rate (Wilcoxon signed-rank test, median[IQR]). Results Twenty-six subjects were enrolled and completed a baseline assessment; 24 (92%) completed a post-assessment; 2 (8%) were lost to follow-up. Over 3 months, a mean 3.2 (range 1-6) PPV-Refreshers/subject were completed. Compared to baseline, subjects demonstrated significant improvement for total (57 [36-74] vs. 33 [26-46]; p = 0.0007) and target PPV (23 [13-23] vs. 11 [5-21]; p = 0.024), and a significant change in mean volume (mL) (11.5 [10.2-13] vs. 13.4 [11-16]; p = 0.02) and mean rate (vpm) (54 [45-61] vs. 40 [28-49]; p = 0.019). Conclusions A PPV-Refresher program with brief, repeated psychomotor skill practice significantly improved PPV performance with the greatest improvement in total PPV and target PPV. Additional investigation is warranted to determine optimal PPV-Refresher frequency.Registered at ClinicalTrials.gov #NCT02347241.
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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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Tidal volume measurements in the delivery room in preterm infants requiring positive pressure ventilation via endotracheal tube-feasibility study. J Perinatol 2021; 41:1930-1935. [PMID: 34112962 PMCID: PMC8191447 DOI: 10.1038/s41372-021-01113-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/05/2021] [Accepted: 05/18/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Current delivery room (DR) resuscitation utilizes pressure-limited devices without tidal volume (TV) measurements. Clinicians use chest expansion as a surrogate, which is a poor indicator of TV. TV in early life can be highly variable due to rapidly changing lung compliance. Our objectives were to assess feasibility of measuring TV in DR, and to report the generated TV in intubated patients. STUDY DESIGN Prospective, observational, feasibility study in infants <32 weeks GA and intubated in DR. TV was measured using a respiratory function monitor. RESULT Ten infants with mean GA 23.9(±1.5) weeks and mean BW 618.5(±155) gram were included. Total of 178 min (mean 17.8 min/patient) with 8175 individual breaths (mean 817.5 breaths/patient) were analyzed. Goal TV of 4-6 ml/kg was provided 23.5% of times with high TV (>6 ml/kg) provided 47.7% of times. CONCLUSION TV measurement in DR is feasible. It is associated with high intra and inter-patient variability.
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Baixauli-Alacreu S, Padilla-Sánchez C, Hervás-Marín D, Lara-Cantón I, Solaz-García A, Alemany-Anchel MJ, Vento M. Expired Tidal Volume and Respiratory Rate During Postnatal Stabilization of Newborn Infants Born at Term via Cesarean Delivery. THE JOURNAL OF PEDIATRICS: X 2021. [DOI: 10.1016/j.ympdx.2020.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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St. John Sutton EM, McKinsey S. Current Practices and Updates in Neonatal Resuscitation. CURRENT PEDIATRICS REPORTS 2020. [DOI: 10.1007/s40124-020-00232-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Foglia EE, te Pas AB, Kirpalani H, Davis PG, Owen LS, van Kaam AH, Onland W, Keszler M, Schmölzer GM, Hummler H, Lista G, Dani C, Bastrenta P, Localio R, Ratcliffe SJ. Sustained Inflation vs Standard Resuscitation for Preterm Infants: A Systematic Review and Meta-analysis. JAMA Pediatr 2020; 174:e195897. [PMID: 32011661 PMCID: PMC7042947 DOI: 10.1001/jamapediatrics.2019.5897] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Most preterm infants require respiratory support to establish lung aeration after birth. Intermittent positive pressure ventilation and continuous positive airway pressure are standard therapies. An initial sustained inflation (inflation time >5 seconds) is a widely practiced alternative strategy. OBJECTIVE To conduct a systematic review and meta-analysis of sustained inflation vs intermittent positive pressure ventilation and continuous positive airway pressure for the prevention of hospital mortality and morbidity for preterm infants. DATA SOURCES MEDLINE (through PubMed), Embase, the Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials were searched through June 24, 2019. STUDY SELECTION Randomized clinical trials of preterm infants born at less than 37 weeks' gestation that compared sustained inflation (inflation time >5 seconds) vs standard resuscitation with either intermittent positive pressure ventilation or continuous positive airway pressure were included. Studies including other cointerventions were excluded. DATA EXTRACTION AND SYNTHESIS Two reviewers assessed the risk of bias of included studies. Meta-analysis of pooled outcome data used a fixed-effects model specific to rarer events. Subgroups were based on gestational age and study design (rescue vs prophylactic sustained inflation). MAIN OUTCOMES AND MEASURES Death before hospital discharge. RESULTS Nine studies recruiting 1406 infants met inclusion criteria. Death before hospital discharge occurred in 85 of 736 infants (11.5%) treated with sustained inflation and 62 of 670 infants (9.3%) who received standard therapy for a risk difference of 3.6% (95% CI, -0.7% to 7.9%). Although analysis of the primary outcome identified important heterogeneity based on gestational age subgroups, the 95% CI for the risk difference included 0 for each individual gestational age subgroup. There was no difference in the primary outcome between subgroups based on study design. Sustained inflation was associated with increased risk of death in the first 2 days after birth (risk difference, 3.1%; 95% CI, 0.9%-5.3%). No differences in the risk of other secondary outcomes were identified. The quality-of-evidence assessment was low owing to risk of bias and imprecision. CONCLUSIONS AND RELEVANCE There was no difference in the risk of the primary outcome of death before hospital discharge, and there was no evidence of efficacy for sustained inflation to prevent secondary outcomes. These findings do not support the routine use of sustained inflation for preterm infants after birth.
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Affiliation(s)
- Elizabeth E. Foglia
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Arjan B. te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University, Leiden, the Netherlands
| | - Haresh Kirpalani
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Peter G. Davis
- Newborn Research Center, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Louise S. Owen
- Newborn Research Center, The Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Anton H. van Kaam
- Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Wes Onland
- Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin Keszler
- Department of Pediatrics, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence
| | - Georg M. Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Gianluca Lista
- Department of Pediatrics, Neonatal Intensive Care Unit, Ospedale dei Bambini V.Buzzi ASST-FBF-Sacco, Milan, Italy
| | - Carlo Dani
- Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
| | - Petrina Bastrenta
- Department of Pediatrics, Neonatal Intensive Care Unit, Ospedale dei Bambini V.Buzzi ASST-FBF-Sacco, Milan, Italy
| | - Russell Localio
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Sarah J. Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, Charlottesville
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Foglia EE, Jensen EA, Wyckoff MH, Sawyer T, Topjian A, Ratcliffe SJ. Survival after delivery room cardiopulmonary resuscitation: A national registry study. Resuscitation 2020; 152:177-183. [PMID: 31982507 DOI: 10.1016/j.resuscitation.2020.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/12/2019] [Accepted: 01/16/2020] [Indexed: 01/05/2023]
Abstract
AIMS Survival after delivery room cardiopulmonary resuscitation (DR-CPR) is not well characterized in full-term infants, and survival outcomes after DR-CPR have not been defined across the spectrum of gestation. The study objectives were to define gestational age (GA) specific survival following DR-CPR and to assess the association between GA and DR-CPR characteristics and survival outcomes. METHODS Retrospective cohort study of prospectively collected data in the American Heart Association Get With the Guidelines-Resuscitation registry. Newborn infants without congenital abnormalities who received greater than 1 min of chest compressions for DR-CPR were included. GA was stratified by categorical subgroups: ≥36 weeks; 33-356/7 weeks; 29-326/7 weeks; 25-286/7 weeks; 22-246/7 weeks. The primary outcome was survival to hospital discharge; the secondary outcome was return of circulation (ROC). RESULTS Among 1022 infants who received DR-CPR, 83% experienced ROC and 64% survived to hospital discharge. GA-stratified hospital survival rates were 83% (≥36 weeks), 66% (33-35 weeks), 60% (29-32 weeks), 52% (25-28 weeks), and 25% (22-24 weeks). Compared with GA ≥ 36 weeks, lower GA was independently associated with decreasing odds of survival (33-35 weeks: adjusted Odds Ratio [aOR] 0.46, 95% Confidence Interval [CI] 0.26-0.81; 29-32 weeks: aOR 0.40, 95% CI 0.23-0.69; 25-28 weeks: aOR 0.21, 95% CI 0.11-0.41; 22-24 weeks: aOR 0.06, 95% CI 0.03-0.10). CONCLUSIONS In this national registry of infants who received delivery room cardiopulmonary resuscitation (DR-CPR), 83% survived the event and two-thirds survived to hospital discharge. These results contribute to defining survival outcomes following DR-CPR across the continuum of gestation.
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Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Erik A Jensen
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Myra H Wyckoff
- Division of Neonatology, Department of Pediatrics, UT Southwestern, Dallas, TX, United States
| | - Taylor Sawyer
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, United States
| | - Alexis Topjian
- Divsion of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sarah J Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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Martinho S, Adão R, Leite-Moreira AF, Brás-Silva C. Persistent Pulmonary Hypertension of the Newborn: Pathophysiological Mechanisms and Novel Therapeutic Approaches. Front Pediatr 2020; 8:342. [PMID: 32850518 PMCID: PMC7396717 DOI: 10.3389/fped.2020.00342] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Persistent pulmonary hypertension of the newborn (PPHN) is one of the main causes of neonatal morbidity and mortality. It is characterized by sustained elevation of pulmonary vascular resistance (PVR), preventing an increase in pulmonary blood flow after birth. The affected neonates fail to establish blood oxygenation, precipitating severe respiratory distress, hypoxemia, and eventually death. Inhaled nitric oxide (iNO), the only approved pulmonary vasodilator for PPHN, constitutes, alongside supportive therapy, the basis of its treatment. However, nearly 40% of infants are iNO resistant. The cornerstones of increased PVR in PPHN are pulmonary vasoconstriction and vascular remodeling. A better understanding of PPHN pathophysiology may enlighten targeted and more effective therapies. Sildenafil, prostaglandins, milrinone, and bosentan, acting as vasodilators, besides glucocorticoids, playing a role on reducing inflammation, have all shown potential beneficial effects on newborns with PPHN. Furthermore, experimental evidence in PPHN animal models supports prospective use of emergent therapies, such as soluble guanylyl cyclase (sGC) activators/stimulators, l-citrulline, Rho-kinase inhibitors, peroxisome proliferator-activated receptor-γ (PPAR-γ) agonists, recombinant superoxide dismutase (rhSOD), tetrahydrobiopterin (BH4) analogs, ω-3 long-chain polyunsaturated fatty acids (LC-PUFAs), 5-HT2A receptor antagonists, and recombinant human vascular endothelial growth factor (rhVEGF). This review focuses on current knowledge on alternative and novel pathways involved in PPHN pathogenesis, as well as recent progress regarding experimental and clinical evidence on potential therapeutic approaches for PPHN.
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Affiliation(s)
- Sofia Martinho
- Department of Surgery and Physiology, Cardiovascular Research and Development Center-UnIC, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Adão
- Department of Surgery and Physiology, Cardiovascular Research and Development Center-UnIC, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Adelino F Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular Research and Development Center-UnIC, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carmen Brás-Silva
- Department of Surgery and Physiology, Cardiovascular Research and Development Center-UnIC, Faculty of Medicine, University of Porto, Porto, Portugal.,Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
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Holte K, Ersdal HL, Eilevstjønn J, Thallinger M, Linde J, Klingenberg C, Holst R, Jatosh S, Kidanto H, Stordal K. Predictors for expired CO 2 in neonatal bag-mask ventilation at birth: observational study. BMJ Paediatr Open 2019; 3:e000544. [PMID: 31646198 PMCID: PMC6783122 DOI: 10.1136/bmjpo-2019-000544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Expired carbon dioxide (ECO2) indicates degree of lung aeration immediately after birth. Favourable ventilation techniques may be associated with higher ECO2 and a faster increase. Clinical condition will however also affect measured values. The aim of this study was to explore the relative impact of ventilation factors and clinical factors on ECO2 during bag-mask ventilation of near-term newborns. METHODS Observational study performed in a Tanzanian rural hospital. Side-stream measures of ECO2, ventilation data, heart rate and clinical information were recorded in 434 bag-mask ventilated newborns with initial heart rate <120 beats per minute. We studied ECO2 by clinical factors (birth weight, Apgar scores and initial heart rate) and ventilation factors (expired tidal volume, ventilation frequency, mask leak and inflation pressure) in random intercept models and Cox regression for time to ECO2 >2%. RESULTS ECO2 rose non-linearly with increasing expired tidal volume up to >10 mL/kg, and sufficient tidal volume was critical for the time to reach ECO2 >2%. Ventilation frequency around 30/min was associated with the highest ECO2. Higher birth weight, Apgar scores and initial heart rate were weak, but significant predictors for higher ECO2. Ventilation factors explained 31% of the variation in ECO2 compared with 11% for clinical factors. CONCLUSIONS Our findings indicate that higher tidal volumes than currently recommended and a low ventilation frequency around 30/min are associated with improved lung aeration during newborn resuscitation. Low ECO2 may be used to identify unfavourable ventilation technique. Clinical factors are also associated with persistently low ECO2 and must be accounted for in the interpretation.
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Affiliation(s)
- Kari Holte
- Department of Paediatrics and Adolescence Medicine, Østfold Hospital Trust, Grålum, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Joar Eilevstjønn
- Strategic Research, Laerdal Medical AS, Stavanger, Rogaland, Norway
| | - Monica Thallinger
- Department of Anesthesiology and Intensive Care, Bærum Hospital, Vestre Viken HF, Bærum, Norway
| | - Jørgen Linde
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Paediatrics and Adolescence Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Claus Klingenberg
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
- Paediatric Research Group, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway
| | - Rene Holst
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
- Research Department, Østfold Hospital Trust, Grålum, Norway
| | - Samwel Jatosh
- Research Department, Haydom Lutheran Hospital, Mbulu, Tanzania
| | - Hussein Kidanto
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Medical college, Aga Khan University Hospital, Dar es Salaam, Tanzania
| | - Ketil Stordal
- Department of Paediatrics and Adolescence Medicine, Østfold Hospital Trust, Grålum, Norway
- Norwegian Institute of Public Health, Oslo, Norway
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