Impact of neonatal resuscitation changes on outcomes of very-low-birth-weight infants

Updated Clinical Practice Guidelines in Resuscitation and the Management of Respiratory Distress Syndrome in Extremely Preterm Infants during Two Epochs in Romania: Impact on Outcomes

BACKGROUND

Adequate perinatal management is essential in caring for extremely preterm (EP) infants. We aimed to evaluate and compare the impact of different protocols on short-term outcomes.

METHODS

A retrospective study was conducted on EP infants in a Romanian perinatal tertiary center during 2008-2012 and 2018-2022.

RESULTS

Data on 270 EP infants (121 in period I, 149 in period II) were analyzed collectively and stratified into two subgroups by gestational age. Initial FiO2 administration (100% vs. 40%% p < 0.001), lung recruitment at birth (19.0% vs. 55.7% p < 0.001), early rescue surfactant administration (34.7% vs. 65.8%; p < 0.001), and the mechanical ventilation rate (98.3% vs. 58.4%; p < 0.001) were significantly improved during period II. Survival rates of EP infants significantly improved from 41.3% to 72.5%, particularly in the 26-28 weeks subgroup (63.8% to 83%). Compared to period I, the overall frequency of severe IVH decreased in period II from 30.6% to 14.1%; also, BPD rates were lower (36.6% vs. 23.4%; p = 0.045) in the 26-28 weeks subgroup. Despite improvements, there were no significant differences in the frequencies of NEC, sepsis, PVL, ROP, or PDA.

CONCLUSIONS

Implementing evidence-based clinical guidelines can improve short-term outcomes.

Variation in delivery room management of preterm infants across Europe: a survey of the Union of European Neonatal and Perinatal Societies

The aim of the present study, endorsed by the Union of European Neonatal and Perinatal Societies (UENPS) and the Italian Society of Neonatology (SIN), was to analyze the current delivery room (DR) stabilization practices in a large sample of European birth centers that care for preterm infants with gestational age (GA) < 33 weeks. Cross-sectional electronic survey was used in this study. A questionnaire focusing on the current DR practices for infants < 33 weeks' GA, divided in 6 neonatal resuscitation domains, was individually sent to the directors of European neonatal facilities, made available as a web-based link. A comparison was made between hospitals grouped into 5 geographical areas (Eastern Europe (EE), Italy (ITA), Mediterranean countries (MC), Turkey (TUR), and Western Europe (WE)) and between high- and low-volume units across Europe. Two hundred and sixty-two centers from 33 European countries responded to the survey. At the time of the survey, approximately 20,000 very low birth weight (VLBW, < 1500 g) infants were admitted to the participating hospitals, with a median (IQR) of 48 (27-89) infants per center per year. Significant differences between the 5 geographical areas concerned: the volume of neonatal care, ranging from 86 (53-206) admitted VLBW infants per center per year in TUR to 35 (IQR 25-53) in MC; the umbilical cord (UC) management, being the delayed cord clamping performed in < 50% of centers in EE, ITA, and MC, and the cord milking the preferred strategy in TUR; the spotty use of some body temperature control strategies, including thermal mattress mainly employed in WE, and heated humidified gases for ventilation seldom available in MC; and some of the ventilation practices, mainly in regard to the initial FiO2 for < 28 weeks' GA infants, pressures selected for ventilation, and the preferred interface to start ventilation. Specifically, 62.5% of TUR centers indicated the short binasal prongs as the preferred interface, as opposed to the face mask which is widely adopted as first choice in > 80% of the rest of the responding units; the DR surfactant administration, which ranges from 44.4% of the birth centers in MC to 87.5% in WE; and, finally, the ethical issues around the minimal GA limit to provide full resuscitation, ranging from 22 to 25 weeks across Europe. A comparison between high- and low-volume units showed significant differences in the domains of UC management and ventilation practices.    Conclusion: Current DR practice and ethical choices show similarities and divergences across Europe. Some areas of assistance, like UC management and DR ventilation strategies, would benefit of standardization. Clinicians and stakeholders should consider this information when allocating resources and planning European perinatal programs. What is Known: • Delivery room (DR) support of preterm infants has a direct influence on both immediate survival and long-term morbidity. • Resuscitation practices for preterm infants often deviate from the internationally defined algorithms. What is New: • Current DR practice and ethical choices show similarities and divergences across Europe. Some areas of assistance, like UC management and DR ventilation strategies, would benefit of standardization. • Clinicians and stakeholders should consider this information when allocating resources and planning European perinatal programs.

Application of Donabedian quality-of-care framework to assess quality of neonatal resuscitation, its outcome, and associated factors among resuscitated newborns at public hospitals of East Wollega zone, Oromia, Western Ethiopia, 2021

Background

Globally more than 650,000 newborns died on their first day of life from birth asphyxia. The outcome of an asphyxiated newborn depends on the quality of care they received at birth. However, the quality of care newborns received at birth may be below the WHO resuscitation standard. The reason for the poor quality of care is unclear. The Donabedian model, according to the World Health Organization (WHO), is an appropriate framework for health care assessment that focuses on improving the quality of care. So this study aims to assess the quality of neonatal resuscitation, outcome, and its associated factors among newborns with birth asphyxia at public hospitals in the East Wollega zone, 2021.

Methods

An institution-based cross-sectional study was conducted to observe 410 asphyxiated newborns using consecutive sampling methods. Data was gathered using a pretested structured questionnaire and checklist. Epi-data version 3.1 was used to enter data, which was subsequently exported to Statistical Package for Social Sciences version 25 for analysis. A logistic regression model was employed to determine the variables associated with the outcome variable. The adjusted odds ratio with a 95% confidence interval was calculated, and all variables associated with the outcome variable with a p-value less than 0.05 in multivariable analysis were determined to be significant factors for the outcome of resuscitated newborns.

Result

A total of 410 asphyxiated newborns were included in this study with a response rate of 97%. From this 87.6% of resuscitated newborns survived. Keeping baby warm [AOR = 6.9; CI (3.1, 15.6)] is associated significantly with increased chances of survival while meconium presence in the airway [AOR = 0.26; CI (0.1, 0.6)], prematurity [AOR = 0.24; CI (0.12, 0.48)], and presence of cord prolapse [AOR = 0.08; CI (0.03, 0.19)] were factors significantly associated with decreased survival of resuscitated newborns at 1 h of life.

Conclusion

Newborns who were kept warm were more likely to survive compared to their counterparts. While the presence of meconium in the airway, preterm, and cord prolapse was associated with the decreased survival status of newborns. Facilitating referral linkage in the event of cord prolapse, counseling on early antenatal care initiation to decrease adverse outcomes (prematurity), and neonatal resuscitation refresher training is strongly recommended.