Factors associated with fall in neonatal intubation rates in the United Kingdom - prospective study

Impact of virtual simulation vs. Video refresher training on NRP simulation performance: a randomized controlled trial

OBJECTIVE

To assess the impact of NRP virtual simulations (eSim™), video or no refresher training, on simulation performance, six months after a provider course; and to evaluate eSim™ acceptability.

STUDY DESIGN

In this multi-site randomized controlled trial, NRP providers from four U.S. institutions were randomized to receive refreshers every two months with NRP eSim™, NRP resuscitation video, or no refresher (control). Simulation performance was assessed immediately after an NRP course and six months later.

RESULT

248 participants completed the baseline simulation and 148 completed the six-month follow-up simulation. The majority (71%) of subjects had a decline in resuscitation skills at 6 months. There were no differences in performance between the study groups, but participants who reported using either the video or eSim™ had less decline in performance at the 6-month follow-up (p < 0.05).

CONCLUSION

NRP refreshers with either eSim™ or NRP video may mitigate the decline in resuscitation skills after training.

Anticipation and preparation for every delivery room resuscitation

A majority of babies initiate spontaneous respirations shortly after birth. Up to 10%, however, require resuscitative measures to make the transition from fetus to newborn. Ideally, the need for resuscitation at birth would be predicted before delivery, and a skilled neonatal resuscitation team would be available and ready. This is not always possible. Therefore, neonatal resuscitation teams must be prepared to provide lifesaving resuscitation at every delivery. In this report, we examine risk factors for resuscitation at birth, discuss the importance of communication between obstetric and newborn teams, review key questions to ask before delivery, and investigate antenatal counseling methods. We also investigate ways to prepare for newborn deliveries, including personnel and equipment preparation, and pre-delivery team briefing. Finally, we explore ways in which neonatal resuscitation teams can improve their preparedness through the use of simulation and post-resuscitation debriefing. This report will help neonatal resuscitation teams to anticipate and prepare for every delivery room resuscitation.

Do We Need an Intubation-Skilled Person at All High-Risk Deliveries?

OBJECTIVE

To evaluate the significance and predictive value of each of the Neonatal Resuscitation Program (NRP)-listed ante- and intrapartum risk factors for the need of neonatal intubation at birth.

STUDY DESIGN

In this population-based study, perinatal data of all infants born at ≥ 35 weeks gestation in the province of Nova Scotia between 1994 and 2014, were identified and reviewed from the Nova Scotia Atlee Database. The frequency of occurrence of risk factors, incidence of neonatal intubation at birth, and its relationship with the different NRP-listed risk factors, were examined. Variables that were significant (P < .05) in univariate analyses were entered into the regression model.

RESULTS

During the 20-year study period, 176,365 infants ≥ 35 weeks gestation were born. In presence of any of the listed risk factors, 0.3% of infants received intubation at birth compared with 0.08% in absence of any risk factor (P < .001). On logistic regression analysis, only 16 of the NRP-listed risk factors had a significant relationship with intubation at birth (P < .001). Delivery in a tertiary care center did not have an impact.

CONCLUSIONS

The presence of an intubation-skilled person at birth may not be indicated in all the NRP-listed ante- and intrapartum risk factors. Stratification of the relative significance of different risk factors may be of importance for the less-resourced health care units providing maternal and newborn care.

Just-in-Time Video Laryngoscopy Versus Direct Laryngoscopy for Neonatal Intubation

As neonatal endotracheal intubation (ETI) is a low-frequency, high-consequence event, it is essential that providers have access to resources to aid in ETI. We sought to determine the impact of video laryngoscopy (VL) with just-in-time training on intubation outcomes over direct laryngoscopy (DL) when performed by neonatal nurses. We conducted a prospective, randomized, crossover study with neonatal nurses employed at a level 2 neonatal intensive care unit (NICU). Nurses performed both DL and VL on a neonatal mannequin using a CMAC (Karl Storz Corp, Tuttlingen, Germany) either with the assistance of the screen (VL) or without (DL). Before performing the intubation, providers were given a just-in-time, brief education presentation and allowed to practice with the device. Each ETI attempt was reviewed to obtain the percentage of glottic opening (POGO) score, time to intubation (TTI, time from insertion of the blade into the mouth until the first breath was delivered), and time from blade insertion until the best POGO score. We enrolled 19 participants, with a median (interquartile range) of 20 (9-26) years of experience and having a median of 2 (1-3) intubations within the past year. None had used VL in the NICU previously. Median TTI did not differ between DL and VL: 19.9 (15.3-41.5) vs 20.3 (17.9-24.4) (P = 1). POGO scores and the number of attempts also did not differ between DL and VL. In our simulated setting, just-in-time VL training provided similar intubation outcomes compared with DL in ETI performed by neonatal nurses. Just-in-time VL education may be an alternative to traditional DL for neonatal intubations.

Has electronic fetal heart rate monitoring made a difference

Electronic fetal heart rate monitoring (EFHRM) has revolutionised our understanding of the function of the cardiovascular system of the fetus during labour, and how the fetus responds to hypoxia. However, although it is a sensitive technique for the detection of hypoxia during labour, it is relatively non-specific for detecting the development of acidosis. Moreover, it is highly dependent on accurate interpretation of fetal heart rate (FHR) patterns, which has been shown to be commonly of a low standard in everyday clinical practice. Use of EFHRM has probably reduced the incidence of birth asphyxia, but it has also contributed to the rise in the caesarean section rate. Ancillary techniques, such as pulse oximetry, have not proved useful, although ST-segment analysis of the ECG waveform shows some promise. Computerised expert systems for the analysis of FHR patterns may be more successful at avoiding poor outcomes.