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Berisha G, Kvenshagen LN, Boldingh AM, Nakstad B, Blakstad E, Rønnestad AE, Solevåg AL. Video-Recorded Airway Suctioning of Clear and Meconium-Stained Amniotic Fluid and Associated Short-Term Outcomes in Moderately and Severely Depressed Preterm and Term Infants. CHILDREN (BASEL, SWITZERLAND) 2023; 11:16. [PMID: 38255330 PMCID: PMC10814005 DOI: 10.3390/children11010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The aim of this study was to investigate delivery room airway suctioning and associated short-term outcomes in depressed infants. METHODS This is a single-centre prospective observational study of transcribed video recordings of preterm (gestational age, GA < 37 weeks) and term (GA ≥ 37 weeks) infants with a 5 min Apgar score ≤ 7. We analysed the association between airway suctioning, breathing, bradycardia and prolonged resuscitation (≥10 min). For comparison, non-suctioned infants with a 5 min Apgar score ≤ 7 were included. RESULTS Two hundred suction episodes were performed in 19 premature and 56 term infants. Breathing improved in 1.9% of premature and 72.1% of term infants, and remained unchanged in 84.9% of premature and 27.9% of term infants after suctioning. In our study, 61 (81.3%) preterm and term infants who were admitted to the neonatal intensive care unit experienced bradycardia after airway suctioning. However, the majority of the preterm and more than half of the term infants were bradycardic before the suction procedure was attempted. Among the non-airway suctioned infants (n = 26), 73.1% experienced bradycardia, with 17 non-airway suctioned infants being admitted to the neonatal intensive care unit. There was a need for resuscitation ≥ 10 min in 8 (42.1%) preterm and 32 (57.1%) term infants who underwent airway suctioning, compared to 2 (33.3%) preterm and 19 (95.0%) term infants who did not receive airway suctioning. CONCLUSIONS In the infants that underwent suctioning, breathing improved in most term, but not preterm infants. More non-suctioned term infants needed prolonged resuscitation. Airway suctioning was not directly associated with worsening of breathing, bradycardia, or extended resuscitation needs.
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Affiliation(s)
- Gazmend Berisha
- The Department of Paediatric and Adolescent Medicine, Akershus University Hospital, P.O. Box 1000, 1478 Lørenskog, Norway; (A.M.B.); (E.B.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway; (L.N.K.); (B.N.); (A.E.R.)
- The Department of Anaesthesia and Intensive Care Unit, Stavanger University Hospital, P.O. Box 8100, 4068 Stavanger, Norway
| | - Line Norman Kvenshagen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway; (L.N.K.); (B.N.); (A.E.R.)
- Department of Paediatrics and Adolescent Medicine, Østfold Hospital Trust Kalnes, P.O. Box 300, 1714 Grålum, Norway
| | - Anne Marthe Boldingh
- The Department of Paediatric and Adolescent Medicine, Akershus University Hospital, P.O. Box 1000, 1478 Lørenskog, Norway; (A.M.B.); (E.B.)
| | - Britt Nakstad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway; (L.N.K.); (B.N.); (A.E.R.)
- Department of Paediatrics and Adolescent Health, University of Botswana, Private Bag, Gaborone 0022, Botswana
| | - Elin Blakstad
- The Department of Paediatric and Adolescent Medicine, Akershus University Hospital, P.O. Box 1000, 1478 Lørenskog, Norway; (A.M.B.); (E.B.)
| | - Arild Erland Rønnestad
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1171, 0318 Oslo, Norway; (L.N.K.); (B.N.); (A.E.R.)
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, P.O. Box 4950, 0424 Oslo, Norway;
| | - Anne Lee Solevåg
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, P.O. Box 4950, 0424 Oslo, Norway;
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Modi N. Facilitating quality improvement through routinely recorded clinical information. Semin Fetal Neonatal Med 2021; 26:101195. [PMID: 33549518 DOI: 10.1016/j.siny.2021.101195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In this chapter, I discuss how quality improvement activities can be facilitated using routinely available clinical data. I begin by providing a definition of quality improvement and quality healthcare, and identifying what I consider key components and their information requirements. I suggest that quality improvement can be made simpler, more efficient and less labour and resource intensive by focussing on outcomes. Finally, I provide pointers for developing resources of routinely available clinical information.
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Affiliation(s)
- Neena Modi
- Professor of Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, 369 Fulham Road, London, SW10 9NH, UK.
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Evaluating preterm care across Europe using the eNewborn European Network database. Pediatr Res 2020; 88:484-495. [PMID: 31972855 DOI: 10.1038/s41390-020-0769-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/12/2019] [Accepted: 01/08/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND The inefficiency of recording data repeatedly limits the number of studies conducted. Here we illustrate the wider use of data captured as part of the European eNewborn benchmarking programme. METHODS We extracted data on 39,529 live-births from 22 weeks 0 days to 31 weeks 6 days gestational age (GA) or ≤1500 g birth weight. We explored relationships between delivery room care and Apgar scores on mortality and bronchopulmonary dysplasia (BPD) and calculated the time needed for each country to detect a clinically relevant change in these outcomes following a hypothetical intervention. RESULTS Early neonatal, neonatal, and in-hospital mortality were 3.90% (95% CI 3.71, 4.09), 6.00% (5.77, 6.24) and 7.57% (7.31, 7.83), respectively. The odds of death were greater with decreasing GA, lower Apgar scores, growth restriction, male sex, multiple birth and no antenatal steroids. Relationships for BPD were similar. The time required for participating countries to achieve 80% power to detect a relevant change in outcomes following a hypothetical intervention in 23-25 weeks' GA infants ranged from 12 years for neonatal mortality and 22 years for BPD compared to 1 year for the whole network. CONCLUSIONS The eNewborn platform offers opportunity to drive efficiencies in benchmarking, quality control and research.
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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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Modi N. Information technology infrastructure, quality improvement and research: the UK National Neonatal Research Database. Transl Pediatr 2019; 8:193-198. [PMID: 31413953 PMCID: PMC6675679 DOI: 10.21037/tp.2019.07.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Technological developments, coupled with strengthened governance and data security have led to increasing recognition of the potential of real-world health data to benefit patient care and health services. Real-world health data are those captured in the course of routine care. Here I describe a mature source of real-world health data, the UK National Neonatal Research Database and provide examples of the many types of uses it supports.
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Affiliation(s)
- Neena Modi
- Section of Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
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Can a collaborative healthcare network improve the care of people with epilepsy? Epilepsy Behav 2018; 82:189-193. [PMID: 29573986 DOI: 10.1016/j.yebeh.2018.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/31/2023]
Abstract
New opportunities are now available to improve care in ways not possible previously. Information contained in electronic medical records can now be shared without identifying patients. With network collaboration, large numbers of medical records can be searched to identify patients most like the one whose complex medical situation challenges the physician. The clinical effectiveness of different treatment strategies can be assessed rapidly to help the clinician decide on the best treatment for this patient. Other capabilities from different components of the network can prompt the recognition of what is the best available option and encourage the sharing of information about programs and electronic tools. Difficulties related to privacy, harmonization, integration, and costs are expected, but these are currently being addressed successfully by groups of organizations led by those who recognize the benefits.
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