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Kitamura T, Obara H, Honda M, Mori T, Ito T, Nagai M, Rattana S, Rathavy T, Sugiura Y. Early essential newborn care in national tertiary hospitals in Cambodia and Lao People's Democratic Republic: a cross-sectional study. BMC Pregnancy Childbirth 2022; 22:745. [PMID: 36195832 PMCID: PMC9531492 DOI: 10.1186/s12884-022-05056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ministries of health in collaboration with the World Health Organization Regional Office for the Western Pacific (WPRO) have been scaling up early essential newborn care (EENC). This study was carried out to understand current EENC practices at hospitals in two priority countries: the Kingdom of Cambodia (Cambodia) and Lao People's Democratic Republic (Lao PDR). METHODS EENC is subdivided into 79 checkpoints, referencing the self-monitoring checklist developed by the WPRO. Each checkpoint is rated using a 0 to 2-point scale, and a percentage was calculated for the rate of practice of each checkpoint by dividing the total scores by the maximum possible scores. RESULTS In total, 55 and 56 deliveries were observed in Cambodia and Lao PDR, respectively, and 35 and 34 normal deliveries were included in the analysis. The overall rates of the practices within the first 15 minutes after birth were high in both countries. The rates of the practices before birth and 15 minutes after birth were lower than the rates of the practices performed within the first 15 minutes after birth, especially "hand wash before preparation", "preparation for newborn resuscitation", and "monitoring of postpartum mothers and babies". A detailed analysis revealed that the quality of the practices differed between the two countries regarding skin-to-skin contact and breastfeeding support. CONCLUSIONS The high rates of the practices within the first 15 minutes after birth suggest that the EENC coaching sessions supported by ministries of health and the WPRO have been effective. Differences in the quality of practices performed at a high rate between the two countries appeared to be related to factors such as the timing of the study, the perception of the staff, and the situation at the health facilities. These differences and identified practices with lower rates should be improved according to the situation in each country or health facility. Therefore, determining the quality of the practices in a country or a health facility is important. To further improve the quality of EENC, interventions tailored to the specific situation are necessary.
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Affiliation(s)
- Tomomi Kitamura
- Bureau of International Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku Tokyo, 1628655, Japan.
| | - Hiromi Obara
- Bureau of International Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku Tokyo, 1628655, Japan
| | - Mari Honda
- Bureau of International Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku Tokyo, 1628655, Japan
| | - Tomoko Mori
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Tokyo, Shinjuku-ku, 160-0023, Japan
| | - Tomoo Ito
- Bureau of International Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku Tokyo, 1628655, Japan
| | - Mari Nagai
- Bureau of International Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku Tokyo, 1628655, Japan
| | - Sommana Rattana
- Ministry of Health, XJ48+FFP, Ban thatkhao, Sisattanack District, Rue Simeuang, Vientiane, Laos
| | - Tung Rathavy
- University of Health Sciences, Phnom Penh, Cambodia
| | - Yasuo Sugiura
- Bureau of International Cooperation, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku Tokyo, 1628655, Japan
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2
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Endo T, Sampei M, Fukuda S. Kangaroo mother care alters chromogranin A and perfusion index in preterm babies. Pediatr Int 2021; 63:53-59. [PMID: 32542824 DOI: 10.1111/ped.14350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/11/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND While providing various benefits, concerns about the potential risks of kangaroo mother care, or skin-to-skin contact (SSC), between mother and her preterm infant hinder its widespread implementation in some resource- rich countries. In neonates, salivary chromogranin A (s-CgA) is elevated upon exposure to stress, whereas the perfusion index (PI) is associated with hemodynamics and peripheral perfusion. Here, we investigated the effects of SSC on s-CgA and the PI in preterm infants. METHODS Twelve infants were enrolled in the study. Factors associated with baseline s-CgA were analyzed. Baseline s-CgA and the level after SSC were compared. Secreted IgA in the saliva was compared as the control. The PI before, throughout, and after SSC were compared. RESULTS Baseline s-CgA was significantly lower in infants who were supplemented with baby formula milk in addition to breast milk before SSC (n = 2) compared with those fed with their mother's breast milk alone (n = 10, P = 0.03). SSC significantly decreased s-CgA in babies who were fed breast milk only before SSC (n = 10, P = 0.01) but not in those supplemented with formula milk before SSC (n = 2). Secreted IgA in saliva was not affected by SSC. The PI was significantly elevated during SSC (P = .01). CONCLUSION Our data indicate that SSC can reduce s-CgA levels when combined with mother's breast milk and increase the PI in preterm infants, thereby providing additional evidence of the benefit of SSC.
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Affiliation(s)
- Tomohiro Endo
- Department of Clinical Nursing, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Mari Sampei
- Department of Clinical Nursing, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.,School of Nursing, Fukushima Medical University, Fukushima, Japan
| | - Seiji Fukuda
- Department of Clinical Nursing, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.,Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.,Division of Patient Safety, Shimane University Hospital, Izumo, Shimane, Japan
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3
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Rodríguez López J, García Lara NR, López Maestro M, De la Cruz Bértolo J, Martínez Ávila JC, Vento M, Parra Llorca A, Izquierdo Macián I, Pellicer A, Marín Huarte N, Asla Elorriaga I, Román Echevarría L, Copons Fernández C, Martín Ancel A, Cabañas F, García Algar Ó, Pallás Alonso CR. What is the impact of mother's bed incline on episodes of decreased oxygen saturation in healthy newborns in skin-to-skin contact after delivery: Study protocol for a randomized controlled trial. Trials 2019; 20:179. [PMID: 30894206 PMCID: PMC6427856 DOI: 10.1186/s13063-019-3256-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/27/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Early mother-child skin-to-skin contact (SSC) in the first 2 h postpartum is highly beneficial for both mother and child. However, cases have been reported of newborns who have experienced apparently life-threatening events (ALTEs) or sudden death during this procedure. The causes of these events are unknown. Newborn's prone position could influence the onset of these events but there is very little evidence to support any recommendation. We hypothesize that newborns' breathing obstruction episodes increase as mothers lie more horizontally. The main objective of this study is to compare the occurrence of desaturation and bradycardia episodes as a function of mother's bed incline. The study is designed as a randomized, controlled, assessor blind, multicenter, superiority trial with two parallel groups and 1:1 allocation ratio. METHODS The study participants will be full-term healthy mother-newborn dyads from ten hospitals in Spain. Participants will be randomly assigned to one of two study arms defined by mother's bed inclination (45° or 15°). The planned sample size is 5866. Centralized permuted blocks randomization and assessor blinding will be implemented. The newborns will be monitored remotely with pulse oximetry, from 10 min to 2 h after delivery. We established SO2 and heart rate (HR) limit alarms, as well as an action protocol in the event of alarm activation. The primary outcome is the number of healthy newborns who undergo episodes of SO2 ≤ 90%. Secondary outcomes are the mean SO2 level, the number of newborns who experience episodes of SO2 ≤ 85%, the time to SSC discontinuation due to abnormal SO2 or HR, and episodes of HR < 111 beats per minute (bpm) or > 180 bpm. Subgroups and pooled analysis will be performed to identify if breast-feeding and mother and child positions favor the occurrence of desaturation or bradycardia episodes. DISCUSSION A simple intervention such as modifying mother's bed angle of inclination while in SSC with her child during the first 2 h postpartum could favor newborn's hemodynamic and respiratory stabilization and thus contribute to reducing the onset of ALTEs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02585492 . Registered on 22nd October 2015. PROTOCOL VERSION 2 (30th June 2015).
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Affiliation(s)
- Jesús Rodríguez López
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Nadia Raquel García Lara
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - María López Maestro
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Javier De la Cruz Bértolo
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | | | - Máximo Vento
- Neonatology Department, La Fe University Hospital, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Ana Parra Llorca
- Neonatology Department, La Fe University Hospital, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Isabel Izquierdo Macián
- Neonatology Department, La Fe University Hospital, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Adelina Pellicer
- Neonatology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Natalia Marín Huarte
- Neonatology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Izaskun Asla Elorriaga
- Neonatology Department, Cruces University Hospital, Plaza de Cruces, S/N, 48903 Baracaldo, Vizcaya Spain
| | - Lourdes Román Echevarría
- Neonatology Department, Cruces University Hospital, Plaza de Cruces, S/N, 48903 Baracaldo, Vizcaya Spain
| | - Cristina Copons Fernández
- Neonatology Department, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119-129, 08035 Barcelona, Spain
| | - Ana Martín Ancel
- Neonatology Department, San Joan de Déu University Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Fernando Cabañas
- Neonatology Department, Quironsalud Madrid University Hospital, Calle Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Óscar García Algar
- Maternal, Fetal and Neonatal Department, Hospital Sant Joan de Déu- Clínic University Hospital, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Carmen Rosa Pallás Alonso
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
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Narayen IC, Mulder EEM, Boers KE, van Vonderen JJ, Wolters VERA, Freeman LM, Te Pas AB. Neonatal Safety of Elective Family-Centered Caesarean Sections: A Cohort Study. Front Pediatr 2018; 6:20. [PMID: 29484289 PMCID: PMC5816568 DOI: 10.3389/fped.2018.00020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although little data are available concerning safety for newborns, family-centered caesarean sections (FCS) are increasingly implemented. With FCS mothers can see the delivery of their baby, followed by direct skin-to-skin contact. We evaluated the safety for newborns born with FCS in the Leiden University Medical Center (LUMC), where FCS was implemented in June 2014 for singleton pregnancies with a gestational age (GA) ≥38 weeks and without increased risks for respiratory morbidity. METHODS The incidence of respiratory pathology, unplanned admission, and hypothermia in infants born after FCS in LUMC were retrospectively reviewed and compared with a historical cohort of standard elective cesarean sections (CS). RESULTS From June 2014 to November 2015, 92 FCS were performed and compared to 71 standard CS in 2013. Incidence of respiratory morbidity, hypothermia, temperatures at arrival at the department, GA, and birth weight were comparable (ns). Unplanned admission occurred more often after FCS when compared to standard CS (21 vs 7%; p = 0.03), probably due to peripheral oxygen saturation (SpO2) monitoring. There was no increase in respiratory pathology (8 vs 6%, ns). One-third of the babies were separated from their mother during or after FCS. CONCLUSION Unplanned neonatal admissions after elective CS increased after implementing FCS, without an increase in respiratory morbidity or hypothermia. SpO2 monitoring might have a contribution. Separation from the mother occurred often.
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Affiliation(s)
- Ilona C Narayen
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Kim E Boers
- Department of Obstetrics, Bronovo Hospital, The Hague, Netherlands
| | | | | | - Liv M Freeman
- Department of Obstetrics, Leiden University Medical Center, Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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5
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Lutz TL, Elliott EJ, Jeffery HE. Sudden unexplained early neonatal death or collapse: a national surveillance study. Pediatr Res 2016; 80:493-8. [PMID: 27384403 DOI: 10.1038/pr.2016.110] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/30/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND The incidence of sudden unexpected early neonatal death (SUEND) or acute life-threatening events (ALTEs) is reported as 0.05/1,000 to 0.38/1,000 live births. There is currently no national system in Australia for reporting and investigating such cases. METHODS A 3-y prospective, national surveillance study, run in collaboration with the Australian Pediatric Surveillance Unit (APSU). Data were provided by pediatricians reporting to APSU; and independently ascertained by the Coroner in two states (NSW and QLD) and the Newborn Early Transport Network in NSW. A detailed deidentified questionnaire was created. RESULTS In NSW and QLD, the incidence was 0.1 and 0.08/1,000 live births, respectively. Forty-eight definitive cases were identified. Common causes included accidental asphyxia, cardiac disease, persistent pulmonary hypertension of the newborn, and sudden infant death syndrome. Twenty-six babies collapsed on day 1 and 19 were found on the carer's chest. CONCLUSION The incidence in NSW and QLD is higher than previously published. The first postnatal day is a vulnerable period for newborns, who require close observation particularly during skin-to-skin contact. Development and implementation of guidelines for safe sleeping in hospital are needed. Collaboration between obstetricians, midwives, and pediatricians is essential to ensure safety of the newborn.
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Affiliation(s)
- Tracey L Lutz
- Department of Public Health, University of Sydney, Sydney, Australia.,The Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
| | - Elizabeth J Elliott
- The Sydney Children's Hospitals Network, Westmead, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, Sydney, Australia
| | - Heather E Jeffery
- Department of Public Health, University of Sydney, Sydney, Australia.,The Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
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6
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Stevens J, Schmied V, Burns E, Dahlen H. Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature. MATERNAL & CHILD NUTRITION 2014; 10:456-73. [PMID: 24720501 PMCID: PMC6860199 DOI: 10.1111/mcn.12128] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The World Health Organization and the United Nations International Children's Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress.
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Affiliation(s)
- Jeni Stevens
- School of Nursing and MidwiferyUniversity of Western SydneyPenrithNew South WalesAustralia
| | - Virginia Schmied
- School of Nursing and MidwiferyUniversity of Western SydneyPenrithNew South WalesAustralia
| | - Elaine Burns
- School of Nursing and MidwiferyUniversity of Western SydneyPenrithNew South WalesAustralia
| | - Hannah Dahlen
- School of Nursing and MidwiferyUniversity of Western SydneyPenrithNew South WalesAustralia
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7
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Feldman K, Whyte RK. Two cases of apparent suffocation of newborns during side-lying breastfeeding. Nurs Womens Health 2014; 17:337-41. [PMID: 23957800 DOI: 10.1111/1751-486x.12053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The side-lying position is one of several options offered to women in the postpartum period to assist with early establishment of breastfeeding. Many new mothers are exhausted and experiencing significant pain following birth. While the side-lying position for breastfeeding can allow women to get needed rest, it can increase their risk of falling asleep while in this position and potentially smothering their babies. We report two cases of apparent suffocation in newborns on the maternity ward when women unintentionally fell asleep while breastfeeding in the side-lying position. Interventions that may help to prevent such events are suggested.
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Affiliation(s)
- Kayla Feldman
- North York General Hospital in Toronto, Ontario, Canada.
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8
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Abstract
We examined the effect of early skin-to-skin contact (SSC) on breast-feeding at 1 month after delivery, in Japanese women. We reviewed the obstetric records of healthy nulliparous women with vaginal singleton delivery at 37-41 weeks' gestation, at the Japanese Red Cross Katsushika Maternity Hospital and between 1 February and 30 November 2011, there was a total of 403 women who planned to breast-feed their babies at birth. Of these, 272 women (67.5%) initiated early SSC in the delivery room and 131 women (32.5%) did not initiate early SSC. There were no significant differences in the obstetric characteristics and birth outcomes between the two groups of women with and without initiating early SSC. However, the rate of exclusive breast-feeding at 1 month after delivery in the group of women following early SSC (59.6%, 162/272) was significantly higher than that in the group of women without early SSC (45.8%, 60/131; crude OR 1.74, 95% CI 1.1-2.7, p = 0.009). The current results may support the benefit of early SSC in Japanese women after vaginal delivery.
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Affiliation(s)
- S Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital , Tokyo , Japan
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9
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Consideraciones en relación con la seguridad del contacto precoz piel con piel tras el parto. An Pediatr (Barc) 2014; 80:203-5. [DOI: 10.1016/j.anpedi.2014.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/29/2014] [Accepted: 02/06/2014] [Indexed: 11/23/2022] Open
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10
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Deaths and near deaths of healthy newborn infants while bed sharing on maternity wards. J Perinatol 2014; 34:275-9. [PMID: 24480904 DOI: 10.1038/jp.2013.184] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/04/2013] [Accepted: 11/20/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our aim was to evaluate programs promoting bed sharing on maternity wards and determining ways to reduce these risks. STUDY DESIGN Members of the National Association of Medical Examiners were contacted requesting information on deaths of healthy infants while bed sharing on maternity wards. RESULT Fifteen deaths and three near deaths are reported. One or more factors that increase the risk of bed sharing were present in all cases. Accidental suffocation was deemed the most likely cause of these incidents. CONCLUSION Cases of infant deaths and near deaths while bed sharing on maternity wards are under reported. The 'Baby Friendly' (BF) initiative in maternity hospitals to promote breastfeeding is endorsed by the American Academy of Pediatrics and the US Center for Disease Control and Prevention. The BF initiative encourages prolonged skin-to-skin contact and bed sharing. Education of mothers and more efficient monitoring should significantly reduce the risk of maternity ward bed sharing.
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11
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Marin N, Valverde E, Cabañas F. [Severe apparent life-threatening event during "skin-to-skin": treatment with hypothermia]. An Pediatr (Barc) 2013; 79:253-6. [PMID: 24051185 DOI: 10.1016/j.anpedi.2013.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 06/25/2013] [Indexed: 02/05/2023] Open
Abstract
'Skin-to-skin' in healthy newborn infants is currently routine practice in Spanish maternity wards. This practice has shown benefits in increasing the duration of breast-feeding and maternal bonding behaviour with no significant adverse events. Early sudden deaths and severe apparent life-threatening events (ALTE) during the first 24 hours of life are infrequent, but well recognised. Risk factors during 'skin to skin' have been established. These events can lead to high neonatal morbidity and mortality. Hypothermia is now the standard of care for moderate to severe hypoxic-ischaemic encephalopathy and has shown to reduce mortality and neurological morbidity in children with hypoxic-ischaemic brain injury. Although there are no clinical trials that evaluate hypothermia after a severe ALTE, neonates who suffer it should be considered for this treatment. We present a case of a healthy newborn who had an ALTE during skin-to-skin with his mother and was treated with hypothermia.
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Affiliation(s)
- N Marin
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España.
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12
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Herlenius E, Kuhn P. Sudden unexpected postnatal collapse of newborn infants: a review of cases, definitions, risks, and preventive measures. Transl Stroke Res 2013; 4:236-47. [PMID: 23518795 PMCID: PMC3599160 DOI: 10.1007/s12975-013-0255-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/31/2013] [Accepted: 02/04/2013] [Indexed: 11/15/2022]
Abstract
This study aimed to review available published reports concerning sudden unexpected postnatal collapse (SUPC) of apparently healthy infants within the first days of postnatal life, establish a structured presentation and delineate recommendations for preventive measures. All published reports of SUPC cases were retrospectively analyzed, and three not previously published SUPC cases at Karolinska University Hospital were detailed to exemplify the varying presentations and outcomes of SUPC. We found 398 published cases of SUPC occurring during first postnatal week. Estimated incidence of the SUPC of a presumably healthy infant after birth differs widely, ranging from 2.6 cases to 133 cases/100,000. However, definition, inclusion, and exclusion criteria vary substantially between reports. Our summary indicates that reported SUPC occurs more frequently than expected from recent surveys. About half of the infants die, and of the remaining survivors, half have neurological sequela. Of the 233 cases of sudden unexpected death described, no etiology was found in 153 cases. When a defined time for the SUPC event is described, approximately one third of reported events occur during the first 2 h, between 2 and 24 h and between 1 and 7 days after birth, respectively. Adequate education of caregivers and appropriate surveillance during the first days of newborns should enable us to save hundreds of lives.
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Affiliation(s)
- Eric Herlenius
- Neonatal Unit Q2:07, Department of Women’s and Children’s Health, Astrid Lindgren Children’s Hospital, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Pierre Kuhn
- Neonatal Unit Q2:07, Department of Women’s and Children’s Health, Astrid Lindgren Children’s Hospital, Karolinska Institutet, 17176 Stockholm, Sweden
- Service de Pediatrie 2, Médecine et Réanimation néonatales, Hopital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
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13
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Right-to-left shunting in the ductus arteriosus is induced readily by intense crying and rapid postural change in neonates with meconium-stained amniotic fluid. Pediatr Crit Care Med 2012; 13:60-5. [PMID: 21460760 DOI: 10.1097/pcc.0b013e3182191a35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate postnatal changes in the direction of blood flow through the ductus arteriosus in neonates with meconium-stained amniotic fluid, we measured preductal and postductal oxygen saturation in normal neonates, neonates with meconium-stained amniotic fluid, and a neonate with persistent pulmonary hypertension of the newborn. DESIGN Prospective, observational case series report. SETTING A single, tertiary neonatal intensive care unit. PATIENTS Twelve normal neonates, seven neonates with meconium-stained amniotic fluid, and a neonate with persistent pulmonary hypertension of the newborn. INTERVENTIONS SpO2 is simultaneously monitored in the right upper and lower limbs after birth. MEASUREMENTS AND MAIN RESULTS Compared with normal neonates, three neonates with meconium-stained amniotic fluid required longer than +2 SD of the mean time for the postductal SpO2 to reach 90% and/or 95%. In a neonate with meconium-stained amniotic fluid, intense crying triggered frequent decreases to <70% in the postductal SpO2 from 25 mins after birth, while the preductal SpO2 remained at 95% or above. When the other newborn with meconium-stained amniotic fluid was held in the father's arms after 98 mins, the postductal SpO2 decreased rapidly to <80%, while the preductal SpO2 remained at 95%. Thus, 5% or greater difference between the preductal and postductal SpO2 was observed from 25 mins after birth until 120 mins in all neonates with meconium-stained amniotic fluid, whereas the difference disappeared after 25 mins in 12 normal neonates. In a neonate with persistent pulmonary hypertension of the newborn who required vigorous resuscitation, 5% or greater difference between the preductal and postductal SpO2 levels was observed until 6 hrs after birth. CONCLUSIONS Right-to-left shunting in the ductus arteriosus may be induced readily by intense crying and rapid postural change in infants with meconium-stained amniotic fluid. It is important to monitor SpO2 at both pre- and postductal regions until 120 mins after birth in neonates with meconium-stained amniotic fluid and to subject these infants to minimal manipulations.
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14
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Andres V, Garcia P, Rimet Y, Nicaise C, Simeoni U. Apparent life-threatening events in presumably healthy newborns during early skin-to-skin contact. Pediatrics 2011; 127:e1073-6. [PMID: 21402632 DOI: 10.1542/peds.2009-3095] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The death or near death of a presumably healthy newborn in the delivery room is uncommon. We report here 6 cases of apparent life-threatening events (ALTEs) in the delivery room during the first 2 hours of life. In each case, the incident occurred in a healthy infant who was in a prone position on his or her mother's abdomen during early skin-to-skin contact. In most cases, the mother was primiparous, and in all cases the mother and infant were not observed during the initiation of skin-to-skin contact and breastfeeding. There are many benefits of early skin-to-skin contact and breastfeeding in the delivery room. However, in view of the risk of a rare but significant ALTE, we suggest that surveillance of newborns is needed. Although many ALTEs are apparently caused by obstruction, we suggest that a standardized investigational workup be performed after an ALTE.
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Affiliation(s)
- Virginie Andres
- Neonatal Intensive Care Unit, La Conception University Hospital, Marseille, France.
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Poets A, Steinfeldt R, Poets CF. Sudden deaths and severe apparent life-threatening events in term infants within 24 hours of birth. Pediatrics 2011; 127:e869-73. [PMID: 21444593 DOI: 10.1542/peds.2010-2189] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE AND DESIGN To determine the incidence of and possible risk factors for unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) that occurred within 24 hours of birth. This was a monthly epidemiologic survey. PATIENTS AND METHODS Throughout 2009, every pediatric department in Germany was asked to report such cases of unexplained SID or S-ALTE in term infants after a good postnatal adaptation (10-minute Apgar score ≥ 8) to the Surveillance Unit for Rare Pediatric Conditions in Germany. The latter has a capture rate of > 95%. S-ALTE was defined as acute cyanosis/pallor and unconsciousness, requiring bagging, intubation and/or cardiac compressions. Hospitals that reported a case were asked to return an anonymized questionnaire and discharge letter as well as the autopsy protocol in SID cases. RESULTS Of 43 cases reported, 17 fulfilled entry criteria, yielding an incidence of 2.6 in 100 000 live births. There were 7 deaths (ie, 1.1/100 000); 6 of the 10 S-ALTE infants were neurologically abnormal at discharge. Twelve infants were found lying on their mother's chest or abdomen, or very close to and facing her. Nine events occurred in the first 2 hours after birth; 7, were only noticed by a health professional despite the mother being present and awake. CONCLUSIONS SID or S-ALTE may occur in the first 24 hours after birth, particularly within the first 2 hours. Events seem often related to a potentially asphyxiating position. Parents may be too fatigued or otherwise not able to assess their infant's condition correctly. Closer observation during these earliest hours seems warranted.
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Affiliation(s)
- Anette Poets
- Department of Neonatology, Tuebingen University Hospital, Calwerstr. 7, 72076 Tuebingen, Germany.
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Rodriguez-Alarcón Gómez J, Elorriaga IA, Fernández-Llebrez L, Fernández AP, Avellanal CU, Sierra CO. Episodios aparentemente letales en las primeras dos horas de vida durante el contacto piel con piel. Incidencia y factores de riesgo. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.pog.2010.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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