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Ali N, Donofrio MT. Delivery room and early postnatal management of neonates with congenital heart disease. Prenat Diagn 2024. [PMID: 38858803 DOI: 10.1002/pd.6617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Abstract
Advancements in prenatal detection have improved postnatal outcomes for patients with congenital heart disease (CHD). Detailed diagnosis during pregnancy allows for preparation for the delivery and immediate postnatal care for the newborns with CHD. Most CHDs do not result in hemodynamic instability at the time of birth and can be stabilized following the guidelines of the neonatal resuscitation program (NRP). Critical CHD that requires intervention immediately after birth is recommended to be delivered in facilities where immediate neonatal and cardiology care can be provided. Postnatal stabilization and resuscitation for these defects warrant deviation from the standardized NRP. For neonatal providers, knowing the diagnosis of fetal CHD allows for preparation for the anticipated instability in the delivery room. Prenatal detection fosters collaboration between fetal cardiology, cardiology specialists, obstetrics, and neonatology, improving outcomes for neonates with critical CHD.
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Affiliation(s)
- Noorjahan Ali
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Mary T Donofrio
- The George Washington University Division of Cardiology, Washington, Washington, USA
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Guerreiro MDM, Ogata JFM, Sanudo A, Prestes ACY, Conzi MF, Kawakami MD, Miyoshi MH, Almeida MFBD, Guinsburg R. Acquisition of Behavioral Skills after Manikin-Based Simulation of Neonatal Resuscitation by Fellows in Neonatology. Am J Perinatol 2024; 41:1094-1102. [PMID: 35272385 DOI: 10.1055/a-1793-8024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Behavioral performance of health professionals is essential for adequate patient care. This study aimed to assess the behavioral skills of fellows in neonatology before and after a simulation training program on neonatal resuscitation. STUDY DESIGN From March 2019 to February 2020, a prospective cohort with 12 second-year fellows in neonatology were evaluated during three training cycles (16 hours each) in manikin-based simulation of neonatal resuscitation with standardized scenarios. Each cycle lasted 1 month, followed by a 3-month interval. One video-recorded scenario of approximately 10 minutes was performed for each fellow at the beginning and at the end of each training cycle. Therefore, each fellow was recorded six times, before and after each one of three training cycles. Anxiety of the fellows was assessed by the Beck Anxiety Inventory applied before the first training cycle. The videos were independently analyzed in a random order by three trained facilitators using the Behavioral Assessment Tool. The behavioral performance was evaluated by repeated measures of analysis of variance adjusted for anxiety and for previous experience in neonatal resuscitation. RESULTS Fellows' overall behavioral performance improved comparing the moment before the first training and after the second training. The specific skills, such as communication with the team, delegation of tasks, allocation of attention, use of information, use of resources, and professional posture, showed a significant improvement after the second month of training. No further gains were noted with the third training cycle. Anxiety was observed in 42% of the fellows and its presence worsened their behavioral performance. CONCLUSION An improvement in behavioral performance was observed, comparing the moment before the first training and after the second training, without further gains after the third training. It is worth noting the important role of anxiety as a modulator of acquisition and retention of behavioral skills in health professionals in training. KEY POINTS · Simulation training should improve technical and behavioral skills of providers. · Behavioral skills improve after a first cycle of training, but not after a repeat cycle. · Anxiety modulates trainees' behavioral performance.
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Affiliation(s)
- Maiana D M Guerreiro
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Joice F M Ogata
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Adriana Sanudo
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Ana Claudia Y Prestes
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Maria F Conzi
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Mandira D Kawakami
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Milton H Miyoshi
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Maria Fernanda B de Almeida
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
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Alves N, Rocha G, Flor-de-Lima F, Rosário M, Pissarra S, Mateus M, Azevedo I, Soares H. Neonatal Resuscitation Practices in Portuguese Delivery Rooms: A Cross-Sectional Study. ACTA MEDICA PORT 2024; 37:342-354. [PMID: 38744237 DOI: 10.20344/amp.20009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/11/2023] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal. METHODS An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups. RESULTS In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate's temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate's transportation out of the delivery room. CONCLUSION Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.
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Affiliation(s)
- Natacha Alves
- Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Gustavo Rocha
- Serviço de Neonatologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Filipa Flor-de-Lima
- Serviço de Neonatologia. Centro Hospitalar e Universitário de São João. Porto; Departamento de Ginecologia-Obstetrícia e Pediatria. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Marta Rosário
- Serviço de Neonatologia. Centro Hospitalar e Universitário de São João. Porto; Departamento de Ginecologia-Obstetrícia e Pediatria. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Susana Pissarra
- Serviço de Neonatologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Mário Mateus
- Serviço de Neonatologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Inês Azevedo
- Departamento de Ginecologia-Obstetrícia e Pediatria. Faculdade de Medicina. Universidade do Porto. Porto; Serviço de Pediatria. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Henrique Soares
- Serviço de Neonatologia. Centro Hospitalar e Universitário de São João. Porto; Departamento de Ginecologia-Obstetrícia e Pediatria. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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Felton A, Cheshire K. Using Simulation-Based Training to Improve Neonatal Resuscitation Clinical Competency, Confidence, and Comfort Level of NICU Caregivers. J Contin Educ Nurs 2024; 55:175-180. [PMID: 38063802 DOI: 10.3928/00220124-20231130-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Approximately 10% of newborns require resuscitation at delivery or during a neonatal intensive care unit (NICU) stay. Neonatal intensive care unit caregivers competent in providing neonatal resuscitation decrease perinatal mortality and improve neonatal outcomes. Infrequency of resuscitation events, lack of repetition, and inexperience leave caregivers feeling un-prepared for emergency situations. There is a need for educational strategies to maintain competency and increase confidence and comfort level. METHOD This quality improvement project used a pre-post survey design. Competency was assessed during simulated mock codes using the Creighton Competency Evaluation Instrument. Self-perceived confidence and comfort level were assessed using a pre-post survey. RESULTS Descriptive statistics indicated that the average score on the Creighton Competency Evaluation Instrument fell below the targeted minimally competent goal of 80%. Practical significance was noted between the pre-intervention and post-intervention means of both perceived confidence and comfort level. CONCLUSION Simulation-based education may increase the competency, confidence, and comfort level of NICU caregivers and should be conducted routinely. Similar projects could be replicated at other institutions to address continuing competency with neonatal resuscitation. [J Contin Educ Nurs. 2024;55(4):175-180.].
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Chitkara R, Bennett M, Bohnert J, Yamada N, Fuerch J, Halamek LP, Quinn J, Padua K, Gould J, Profit J, Xu X, Lee HC. In Situ Simulation and Clinical Outcomes in Infants Born Preterm. J Pediatr 2023; 263:113715. [PMID: 37659586 PMCID: PMC10841094 DOI: 10.1016/j.jpeds.2023.113715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE To evaluate impact of a multihospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm. STUDY DESIGN Twelve neonatal intensive care units were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes. Infants with very low birth weight between 22 through 31 weeks gestation were included. Primary outcome was survival without chronic lung disease (CLD); secondary outcomes included intubation in the delivery room, delivery room continuous positive airway pressure, hypothermia (<36°C) upon neonatal intensive care unit admission, severe intraventricular hemorrhage, and mortality before hospital discharge. A mixed effects multivariable regression model was used to assess the intervention effect. RESULTS Between March 2017 and December 2020, a total of 2626 eligible very low birth weight births occurred at 12 collaborative participating sites. Rate of survival without CLD at participating sites was 74.1% in March to August 2017 and 76.0% in July to December 2020 (risk ratio 1.03; [0.94-1.12]); no significant improvement occurred during the study period for both participating and nonparticipating sites. The effect of in situ simulation on all secondary outcomes was stable. CONCLUSIONS Implementation of a multihospital collaborative providing in situ training for neonatal resuscitation did not result in significant improvement in survival without CLD. Ongoing in situ simulations may have an impact on unit practice and unmeasured outcomes.
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Affiliation(s)
- Ritu Chitkara
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA.
| | - Mihoko Bennett
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Janine Bohnert
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Nicole Yamada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Janene Fuerch
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Louis P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Center for Advanced Pediatric and Perinatal Education (CAPE), Stanford, CA
| | - Jenny Quinn
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Kimber Padua
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Jeffrey Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Henry C Lee
- California Perinatal Quality Care Collaborative (CPQCC), Stanford, CA; Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA
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Chiruvolu A, Fine S, Miklis KK, Desai S. Perinatal risk factors associated with the need for resuscitation in newborns born through meconium-stained amniotic fluid. Resuscitation 2023; 185:109728. [PMID: 36773837 DOI: 10.1016/j.resuscitation.2023.109728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE The Neonatal Life Support 2020 guidelines emphasize that meconium-stained amniotic fluid (MSAF) remains a significant risk factor for a newborn to receive advanced resuscitation, especially if additional risk factors are present at the time of birth. However, these additional perinatal risk factors are not clearly identified. The purpose of this study was to evaluate the importance of additional independent ante- and intrapartum risk factors in the era of no routine endotracheal suctioning that determine the need for resuscitation in newborns born through MSAF. METHODS This retrospective cohort study included deliveries ≥ 35 weeks' gestation associated with MSAF that occurred between January 1, 2017 and December 31, 2019. The newborns needing resuscitation (any intervention beyond the initial steps) were compared to those not needing resuscitation. Among newborns needing resuscitation, those needing advanced resuscitation (continuous positive airway pressure/ positive pressure ventilation or beyond) were compared to those not needing advanced resuscitation. RESULTS Logistic regression analysis revealed that among various perinatal factors, primigravida, thick meconium, fetal distress, chorioamnionitis, rupture of membranes ≥ 18 hours, post-term (gestational age ≥ 42 weeks), cesarean section or shoulder dystocia independently significantly increased the odds of a meconium-stained newborn needing resuscitation. Among these factors, fetal distress, chorioamnionitis or cesarean section independently further increased the odds of needing advanced resuscitation. CONCLUSION Risk stratification of perinatal factors associated with the need for newborn resuscitation and advanced resuscitation in the deliveries associated with MSAF may help neonatal teams and resources to be appropriately prioritized and optimally utilized.
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Affiliation(s)
- Arpitha Chiruvolu
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Baylor Scott & White Health, Pediatrix Medical Group, Dallas, TX, USA; Department of Medical Education, Texas A&M University College of Medicine, Bryan, TX, USA.
| | - Samantha Fine
- Department of Medical Education, Texas A&M University College of Medicine, Bryan, TX, USA; Department of Pediatrics, University of California San Diego/ Rady Childrens Hospital, San Diego, CA, USA
| | - Kimberly K Miklis
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Baylor Scott & White Health, Pediatrix Medical Group, Dallas, TX, USA
| | - Sujata Desai
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Baylor Scott & White Health, Pediatrix Medical Group, Dallas, TX, USA
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Neonatal Resuscitation: A Critical Incident Technique Study Exploring Pediatric Registered Nurses' Experiences and Actions. Adv Neonatal Care 2023; 23:220-228. [PMID: 36905225 DOI: 10.1097/anc.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Teamwork during neonatal resuscitation is essential. Situations arise quickly and unexpectedly and are highly stressful, requiring pediatric registered nurses (pRN) to respond effectively and in a structured manner. In Sweden, pRNs work in all pediatric settings including the neonatal intensive care unit. The experience and actions of pRNs are seldom explored, and studies within this area could develop and improve strategies for neonatal resuscitation situations. PURPOSE To describe pRNs' experiences and actions during neonatal resuscitation. METHODS A qualitative interview study based on the critical incident technique was performed. Sixteen pRNs from 4 neonatal intensive care units in Sweden were interviewed. RESULTS Critical situations were divided into 306 experiences and 271 actions. pRNs' experiences were divided into 2 categories: individual- and team-focused experiences. Critical situations were managed by individual- or team-focused actions.
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Zarkesh MR, Moradi R, Orooji A. Cardiopulmonary resuscitation of infants at birth: predictable or unpredictable? Acute Crit Care 2022; 37:438-453. [PMID: 36102005 PMCID: PMC9475154 DOI: 10.4266/acc.2021.01501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Anticipating the need for at-birth cardiopulmonary resuscitation (CPR) in neonates is very important and complex. Timely identification and rapid CPR for neonates in the delivery room significantly reduce mortality and other neurological disabilities. The aim of this study was to create a prediction system for identifying the need for at-birth CPR in neonates based on Machine Learning (ML) algorithms. Methods In this study, 3,882 neonatal medical records were retrospectively reviewed. A total of 60 risk factors was extracted, and five ML algorithms of J48, Naïve Bayesian, multilayer perceptron, support vector machine (SVM), and random forest were compared to predict the need for at-birth CPR in neonates. Two types of resuscitation were considered: basic and advanced CPR. Using five feature selection algorithms, features were ranked based on importance, and important risk factors were identified using the ML algorithms. Results To predict the need for at-birth CPR in neonates, SVM using all risk factors reached 88.43% accuracy and F-measure of 88.4%, while J48 using only the four first important features reached 90.89% accuracy and F-measure of 90.9%. The most important risk factors were gestational age, delivery type, presentation, and mother’s addiction. Conclusions The proposed system can be useful in predicting the need for CPR in neonates in the delivery room.
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Holm-Hansen CC, Poulsen A, Skytte TB, Stensgaard CN, Bech CM, Lopes MN, Kristiansen M, Kjærgaard J, Mzee S, Ali S, Ame S, Sorensen JL, Greisen G, Lund S. Video recording as an objective assessment tool of health worker performance in neonatal resuscitation at a district hospital in Pemba, Tanzania: a feasibility study. BMJ Open 2022; 12:e060642. [PMID: 35584880 PMCID: PMC9119158 DOI: 10.1136/bmjopen-2021-060642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the feasibility of using video recordings of neonatal resuscitation (NR) to evaluate the quality of care in a low-resource district hospital. DESIGN Prospective observational feasibility study. SETTING Chake-Chake Hospital, a district hospital in Pemba, Tanzania, in April and May 2019. PARTICIPANTS All delivering women and their newborns were eligible for participation. MAIN OUTCOME MEASURES Motion-triggered cameras were mounted on resuscitation tables and provided recordings that were analysed for quality of care indicators based on the national NR algorithm. Assessment of feasibility was conducted using Bowen's 8-point framework for feasibility studies. RESULTS 91% (126 of 139) of women and 96% (24 of 26) of health workers were comfortable or very comfortable with the video recordings. Of 139 newborns, 8 underwent resuscitation with bag and mask ventilation. In resuscitations, heat loss prevention measures were not performed in half of the cases (four of eight), clearing the airway was not performed correctly in five of eight cases, and all newborns were suctioned vigorously and repeatedly, even when not indicated. In a quarter (two of eight) of cases, the newborn's head was not positioned correctly. Additionally, two of the eight newborns needing ventilation were not ventilated within the first minute of life. In none of the eight cases did ventilation appear to be performed effectively. CONCLUSIONS It proved feasible to use video recordings to assess quality of care during NR in a low-resource setting, and the method was considered acceptable for the delivering women and health workers. Recordings of eight resuscitations all demonstrated deviations from NR guidelines.
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Affiliation(s)
- Charlotte Carina Holm-Hansen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tine Bruhn Skytte
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christina Nadia Stensgaard
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christine Manich Bech
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mads Nathaniel Lopes
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mads Kristiansen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Said Mzee
- Public Health Laboratory-Ivo de Carneri, Chake-Chake, Tanzania, United Republic of
| | - Said Ali
- Public Health Laboratory-Ivo de Carneri, Chake-Chake, Tanzania, United Republic of
| | - Shaali Ame
- Public Health Laboratory-Ivo de Carneri, Chake-Chake, Tanzania, United Republic of
| | - Jette Led Sorensen
- The Juliane Marie Centre for Children, Women and Reproduction, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medicine Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Clinical Medicine, Faculty of Health and Medicine Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Stine Lund
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Szyld E, Anderson MP, Shah BA, Roehr CC, Schmölzer GM, Fabres JG, Weiner GM. Risk calculator for advanced neonatal resuscitation. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001376. [PMID: 36053630 PMCID: PMC8966524 DOI: 10.1136/bmjpo-2021-001376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/05/2022] [Indexed: 11/16/2022] Open
Abstract
In order to predict which newborns will require advanced resuscitation (ANR), we developed an ANR risk calculator (calculator) using a bootstrap sample size of 52 973 from a case-control study of newborns ≥34 weeks gestation. Multivariable logistic regression coefficients were obtained for the 10 original risk factors and two interaction terms. The area under the receiving-operating characteristic curve predicting ANR was 0.9243. ANR prediction is improved by accounting for perinatal variables, beyond factors known prenatally. Prospective validation of this model is warranted in a clinical setting.
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Affiliation(s)
- Edgardo Szyld
- Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael P Anderson
- Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Birju A Shah
- Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Charles C Roehr
- Newborn Services, Southmead Hospital, Bristol, UK.,University of Bristol Faculty of Health Sciences, Bristol, UK
| | | | - Jorge G Fabres
- Neonatology, Pontificia Universidad Catolica De Chile School of Medicine, Santiago, Chile
| | - Gary M Weiner
- Neonatology, C S Mott Children's Hospital, Ann Arbor, Michigan, USA
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Assessment of temporal variations in adherence to NRP using video recording in the delivery room. Resusc Plus 2021; 8:100162. [PMID: 34522904 PMCID: PMC8427318 DOI: 10.1016/j.resplu.2021.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Video recording and video evaluation tools have been successfully used to evaluate neonatal resuscitation performance. The objective of our study was to evaluate differences in Neonatal Resuscitation Program (NRP) adherence at time of birth between three temporal resuscitative periods using scored video recordings. Methods This is a retrospective review of in-situ resuscitation video recordings from a level 3 perinatal center between 2017 and 2018. The modified Neonatal Resuscitation Assessment (mNRA) scoring tool was used as a surrogate marker to assess NRP adherence during daytime, evening, and nighttime hours. Results A total of 260 resuscitations, of which 258 were births via Cesarean section, were assessed. mNRA composite scores were 86.2% during daytime hours, 87% during evening hours, and 86.6% during nighttime hours. There were no significant differences in mNRA composite scores between any of the three time periods. Differences remained statistically similar after controlling for complexity of resuscitations with administration of positive pressure ventilation (PPV), intubation, or chest compressions. Conclusion Overall adherence to NRP, as measured by composite mNRA scores as a surrogate marker, was high across all three daily resuscitative periods without significant differences between daytime, evening, and nighttime hours.
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Litke-Wager C, Delaney H, Mu T, Sawyer T. Impact of Task-Oriented Role Assignment on Neonatal Resuscitation Performance: A Simulation-Based Randomized Controlled Trial. Am J Perinatol 2021; 38:914-921. [PMID: 31899928 DOI: 10.1055/s-0039-3402751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Task-oriented role assignment (TORA) is the assignment of a specific role, a list of tasks, and a location to stand to each resuscitation team member. We performed this study to examine the impact of TORA training during a Neonatal Resuscitation Program (NRP) course on neonatal resuscitation team technical performance and behavioral skills. STUDY DESIGN Participants were cluster randomized into either a standard NRP course (control) or an NRP course with TORA training. Both technical and behavioral skills were evaluated using standardized simulations. The simulations were video recorded and then scored by two blinded reviewers using previously validated instruments. RESULTS A total of 65 participants (62 resident physicians and 3 nurses) participated in 108 simulations (48 controls, 60 TORA). Technical skill scores were similar between the two groups (control = 77.6% [±8.4] vs. TORA = 78.1% [±8.1]; p = 0.74). The TORA group had higher behavior skill scores in 8 of the 10 NRP key behavioral skills and had higher overall behavioral skill scores (control = 30.1 [±7.2] vs. TORA = 34.9 [±4.8]; p < 0.001). CONCLUSION In resuscitation teams comprising mostly resident physicians, TORA training resulted in better behavioral skills during simulated neonatal resuscitation. Further study on the impact of TORA training on actual resuscitation performance in interdisciplinary teams is warranted.
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Affiliation(s)
- Carrie Litke-Wager
- Division of Neonatology, Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas.,Department of Simulation, Brooke Army Medical Center, San Antonio, Texas
| | - Heather Delaney
- Division of Neonatology, Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas.,Department of Simulation, Brooke Army Medical Center, San Antonio, Texas
| | - Thornton Mu
- Division of Neonatology, Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas.,Department of Simulation, Brooke Army Medical Center, San Antonio, Texas
| | - Taylor Sawyer
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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13
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Dinur G, Borenstein-Levin L, Vider S, Hochwald O, Jubran H, Littner Y, Fleischer-Sheffer V, Kugelman A. Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study. J Perinat Med 2021; 49:520-525. [PMID: 33470963 DOI: 10.1515/jpm-2020-0173] [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: 04/22/2020] [Accepted: 11/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine whether audio-voice guidance application improves adherence to resuscitation sequence and recommended time frames during neonatal resuscitation. METHODS A prospective, randomized, pilot study examining the use of an audio-voice application for guiding resuscitation on newborn mannequins, based on the Neonatal Resuscitation Program (NRP) algorithm. Two different scenarios, with and without voice guidance, were presented to 20 medical personnel (2 midwives, 8 nurses, and 10 physicians) in random order, and their performance videotaped. RESULTS Audio-voice guided resuscitation compared with non-guided resuscitation, resulted in significantly better compliance with NRP order sequence (p<0.01), correct use of oxygen supplementation (p<0.01) and performance of MR SOPA (Mask, reposition, suction, open mouth, pressure, airway) (p<0.01), and shortened the time to "positive pressure ventilation" (p<0.01). CONCLUSIONS In this pilot study, audio-voice guidance application for newborn resuscitation simulation on mannequins, based on the NRP algorithm, improved adherence and performance of NRP guidelines.
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Affiliation(s)
- Gil Dinur
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Liron Borenstein-Levin
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Shachar Vider
- Department of Orthopedic Surgery, Technion - Israel Institute of Technology, Rambam Health Care Campus, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Ori Hochwald
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Huda Jubran
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoav Littner
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Vered Fleischer-Sheffer
- Department of Neonatology, Galilee Medical Center, Naharia,Israel.,Bar-Ilan University, Azrieli Faculty of Medicine, Safed, Israel
| | - Amir Kugelman
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
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14
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Theoretical knowledge and skill retention 3 and 6 months after a European Newborn Life Support provider course. Am J Emerg Med 2021; 49:83-88. [PMID: 34089968 DOI: 10.1016/j.ajem.2021.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The European Resuscitation Council Newborn Life Support Course (ERC- NLS) aims at training healthcare professionals, involved in perinatal care, in order to intervene efficiently and promptly to assist transition or resuscitate neonates who require help at birth. However, limited data exists for the retention of the theoretical knowledge and practical skills provided by the course. This study aims to evaluate the degree of knowledge and skill retention 3 and 6 months after the ERC-NLS provider course. METHODS This is a prospective study. Theoretical knowledge was evaluated using the ERC-approved NLS written test (50 True/False questions). Evaluation of technical skills included performance, on an Advanced Life Support neonatal maniquin (LAERDAL), of airway management, ventilation and support of circulation (21 detailed skills). The effect of certain factors on theoretical skill retention was also evaluated. RESULTS One hundred and sixteen (n = 116) participants were initially recruited in the study (12 males and 104 females). Theoretical knowledge was evaluated in 113 participants (3 participants missed follow-up appointments) and technical skills in 80 participants. The mean score for theoretical knowledge was 86.24% ± 5.3, 80.88% ± 7.43 and 80.04% ± 7.04 at baseline, at 3 and 6 months, respectively. This difference was significant among the three time points (baseline vs 3 months: p < 0.001; baseline vs 6 months: p < 0.001; 3 month's vs 6 months: p = 0.034). Although gender did not have an effect, doctors and participants of higher education yielded higher score of success. Regarding technical skills, 9 skills showed a continuous decline of performance from baseline to 6 months, while no difference existed for 12 skills. CONCLUSIONS Healthcare professionals after the NLS provider course retain satisfactory levels of theoretical knowledge and technical skills even at 6 months post-training, although, there is a decline compared to baseline. Further research is needed in order to establish the proper time and type of refreshment course in order to improve outcomes.
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15
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Mitha A, Chen R, Johansson S, Razaz N, Cnattingius S. Maternal body mass index in early pregnancy and severe asphyxia-related complications in preterm infants. Int J Epidemiol 2021; 49:1647-1660. [PMID: 32588048 PMCID: PMC7746401 DOI: 10.1093/ije/dyaa088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little is known about the associations between maternal body mass index (BMI) and asphyxia-related morbidity in preterm infants (<37 weeks). We aimed to investigate associations between maternal BMI in early pregnancy and severe asphyxia-related neonatal complications in preterm infants (<37 weeks) and to examine whether possible associations were mediated by overweight- or obesity-related complications. METHODS In this Swedish population-based cohort of 62 499 singleton non-malformed preterm infants born from 1997 to 2011, risks of low Apgar scores (0-3) at 5 and 10 minutes, neonatal seizures and intraventricular haemorrhage (IVH) were estimated through two analytical approaches. In the conventional approach, the denominator for risk was all live births at a given gestational age. In the fetuses-at-risk (FAR) approach, the denominator for risk was ongoing pregnancies at a given gestational age. RESULTS Using the conventional approach, adjusted risk ratios per 10-unit BMI increase were 1.32 [95% confidence interval (CI) 1.13-1.54] and 1.37 (95% CI 1.12-1.67) for low Apgar scores at 5 and 10 minutes, respectively; 1.28 (95% CI 1.00-1.65) for neonatal seizures; and 1.18 (95% CI 1.01-1.37) for IVH. Using the FAR approach, corresponding risks were higher. These associations varied by gestational age (<32 and 32-36 weeks). Associations between maternal BMI and asphyxia-related outcomes were partly mediated through lower gestational age. CONCLUSIONS Increasing maternal BMI in early pregnancy is associated with increased risks of severe asphyxia-related complications in preterm infants. Our findings add to the evidence to support interventions to reduce obesity in woman of reproductive age.
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Affiliation(s)
- Ayoub Mitha
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM (U1153-Obstetrical, perinatal and Pediatric Epidemiology Research Team (EPOPé)), INRA, Hôpital Tenon, Bâtiment Recherche, Rue de la Chine, Paris, France
| | - Ruoqing Chen
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Corresponding author. Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden. E-mail:
| | - Stefan Johansson
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Neda Razaz
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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16
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European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation 2021; 161:291-326. [PMID: 33773829 DOI: 10.1016/j.resuscitation.2021.02.014] [Citation(s) in RCA: 214] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support.
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17
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Cavallin F, Calgaro S, Borellini M, Magnani M, Beltramini G, Seni AHA, Cebola BR, Tambo AN, Putoto G, Trevisanuto D. Midwives' Evaluation of a Neonatal Resuscitation in High- and Low-Resource Settings. Front Pediatr 2021; 9:644308. [PMID: 33768084 PMCID: PMC7985172 DOI: 10.3389/fped.2021.644308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/09/2021] [Indexed: 11/27/2022] Open
Abstract
Aim: To assess midwives' evaluation of a real-life neonatal resuscitation and their opinion on importance of resuscitation interventions. Methods: Multicenter, multi-country study. Setting: Beira Central Hospital (Mozambique) and Azienda Ospedale-Università di Padova (Italy). Subjects: Sixteen Mozambican midwives and 18 Italian midwives. Interventions: Midwives' assessment was evaluated by using a predefined score, which graded each resuscitation intervention (0-2 points) and summed to a total score for each step (initial steps, bag-mask ventilation, and chest compressions). All scores were compared with referral scores given by two expert neonatologists. Results: Both Mozambican and Italian midwives overestimated their performance regarding of initial steps taken during resuscitation, chest compressions, high-oxygen concentrations (p < 0.01), and underestimated the importance of stimulation (p < 0.05). Mozambicans overestimated suctioning (p < 0.001). Participants agreed with experts about the importance of equipment preparation, using a warmer, drying the newborn, removing wet linen and heart rate assessment. Conclusion: Mozambican and Italian midwives overestimated the performance of a real-life neonatal resuscitation, with heterogeneous evaluation of the importance of several aspects of neonatal resuscitation. These findings may be useful for identifying educational goals.
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Affiliation(s)
| | - Serena Calgaro
- Doctors With Africa Collegio Universitario Aspiranti Medici Missionari, Beira, Mozambique.,Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Martina Borellini
- Doctors With Africa Collegio Universitario Aspiranti Medici Missionari, Beira, Mozambique.,Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Margherita Magnani
- Doctors With Africa Collegio Universitario Aspiranti Medici Missionari, Beira, Mozambique.,Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Greta Beltramini
- Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | | | | | | | - Giovanni Putoto
- Doctors With Africa Collegio Universitario Aspiranti Medici Missionari, Padua, Italy
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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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19
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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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20
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Sawyer T. Educational Perspectives: Educational Strategies to Improve Outcomes from Neonatal Resuscitation. Neoreviews 2020; 21:e431-e441. [PMID: 32611561 DOI: 10.1542/neo.21-7-e431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since 1987, the Neonatal Resuscitation Program (NRP) course has taught the cognitive, technical, and behavioral skills required to effectively resuscitate newborns. To remain relevant and effective, the NRP course needs to continually evolve and embrace evidence-based educational strategies proven to improve outcomes from resuscitation. In this Educational Perspectives article, 6 educational strategies that can be applied to neonatal resuscitation education are reviewed. These educational strategies include mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, and innovative educational strategies Then knowledge translation and implementation of these educational strategies through passive and active knowledge translation, change theory, design thinking, performance measurement, deadoption strategies, continuous quality improvement, incentive and penalties, and psychological marketing are explored. Finally, ways to optimize faculty development of NRP instructors, including both initial instructor training and ongoing instructor development, are examined. The goal of this review is to help NRP program developers and instructors use evidence-based educational strategies to improve neonatal resuscitation outcomes.
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Affiliation(s)
- Taylor Sawyer
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
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21
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Marshall S, Lang AM, Perez M, Saugstad OD. Delivery room handling of the newborn. J Perinat Med 2019; 48:1-10. [PMID: 31834864 PMCID: PMC7771218 DOI: 10.1515/jpm-2019-0304] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/07/2019] [Indexed: 01/24/2023]
Abstract
For newly born babies, especially those in need of intervention at birth, actions taken during the first minute after birth, the so-called "Golden Minute", can have important implications for long-term outcomes. Both delivery room handling, including identification of maternal and infant risk factors and provision of effective resuscitation interventions, and antenatal care decisions regarding antenatal steroid administration and mode of delivery, are important and can affect outcomes. Anticipating risk factors for neonates at high risk of requiring resuscitation can decrease time to resuscitation and improve the prognosis. Following a review of maternal and fetal risk factors affecting newborn resuscitation, we summarize the current recommendations for delivery room handling of the newborn. This includes recommendations and rationale for the use of delayed cord clamping and cord milking, heart rate assessment [including the use of electrocardiogram (ECG) electrodes in the delivery room], role of suctioning in newborn resuscitation, and the impact of various ventilatory modes. Oxygenation should be monitored by pulse oximetry. Effects of oxygen and surfactant on subsequent pulmonary outcomes, and recommendations for provisions of appropriate thermoregulatory support are discussed. Regular teaching of delivery room handling should be mandatory.
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Affiliation(s)
- Stephanie Marshall
- Ann and Robert H. Lurie, Children’s Hospital of Chicago, Chicago, IL, USA
| | - Astri Maria Lang
- Department of Neonatology, Division of Child Health, and Adolescent Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Marta Perez
- Ann and Robert H. Lurie, Children’s Hospital of Chicago, Chicago, IL, USA
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22
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Halamek LP, Cady RAH, Sterling MR. Using briefing, simulation and debriefing to improve human and system performance. Semin Perinatol 2019; 43:151178. [PMID: 31500845 DOI: 10.1053/j.semperi.2019.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Safety, effectiveness and efficiency are keys to performance in all high-risk industries; healthcare is no exception, and neonatal-perinatal medicine is one of the highest risk subspecialties within healthcare. Briefing, simulation and debriefing are methods used by professionals in high-risk industries to reduce the overall risk to life and enhance the safety of the human beings involved in receiving and delivering the services provided by those industries. Although relatively new to neonatal-perinatal medicine, briefing, simulation and debriefing are being practiced with increasing frequency and have become embedded in training exercises such as the Neonatal Resuscitation Program (NRP) of the American Academy of Pediatrics (AAP). This chapter will define these terms and offer examples as to how they are used in high-risk activities including neonatal-perinatal medicine.
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Affiliation(s)
- Louis P Halamek
- Department of Pediatrics and Department of Obstetrics and Gynecology (by courtesy), School of Medicine, Stanford University, Stanford, CA, United States; Johnson Center for Pregnancy and Newborn Services, Stanford, United States.
| | - Robert A H Cady
- PEO Aircraft Carriers, U.S. Navy, Washington, D.C, United States
| | - Michael R Sterling
- Johnson Space Center, National Aeronautics and Space Administration, Houston, TX, United States
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Abstract
Effective communication is the keystone in the management of delivery room emergencies. A clearly defined framework and "shared mental model" optimize team collaboration and are essential when anticipating and preparing for high-stakes emergent cases. This review defines a framework to build shared mental models using dialogue, pre-briefing, checklists, simulation, debriefing and structured feedback to maintain a cohesive high functioning team. Strategies to approach different emergency lead-times will be discussed, and case examples will be used to illustrate concepts outlined.
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Affiliation(s)
- Catherine Chang
- Weill Cornell Medicine, 525 E. 68th Street, N-506 New York, NY, 10065, USA.
| | - Jeffrey Perlman
- Weill Cornell Medicine, 525 E. 68th Street, N-506 New York, NY, 10065, USA.
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Ergonomic Challenges Inherent in Neonatal Resuscitation. CHILDREN-BASEL 2019; 6:children6060074. [PMID: 31163596 PMCID: PMC6617094 DOI: 10.3390/children6060074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/17/2022]
Abstract
Neonatal resuscitation demands that healthcare professionals perform cognitive and technical tasks while working under time pressure as a team in order to provide efficient and effective care. Neonatal resuscitation teams simultaneously process and act upon multiple data streams, perform ergonomically challenging technical procedures, and coordinate their actions within a small physical space. An understanding and application of human factors and ergonomics science broadens the areas of need in resuscitation research, and will lead to enhanced technologies, systems, and work environments that support human limitations and maximize human performance during neonatal resuscitation.
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