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Rodríguez-López J, De la Cruz Bértolo J, García-Lara NR, Asla Elorriaga I, Román Echevarría L, Vento M, Parra-Llorca A, Cabañas F, Lozano P, García-Algar Ó, Martín-Ancel A, Copons Fernández C, González Carrasco E, Olabarrieta Arnal I, Pellicer A, Marín Huarte N, Pallás-Alonso CR. Maternal and Neonatal Prognostic Factors for Cardiorespiratory Events in Healthy Term Neonates During Early Skin-to-Skin Contact. Front Pediatr 2022; 10:907570. [PMID: 35712622 PMCID: PMC9194510 DOI: 10.3389/fped.2022.907570] [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: 03/29/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During early skin-to-skin contact (ESSC), alterations in peripheral oxygen saturation (SpO2) and heart rate (HR) have been frequently observed. OBJECTIVES This study aimed to determine the incidence of cardiorespiratory events (CREs) during ESSC in healthy term newborns (HTNs) and estimate the association of maternal and neonatal prognostic factors with the risk of CREs. METHODS A pooled analysis of the cohort from a clinical trial involving healthy mother-child dyads during ESSC was performed. Pulse oximetry was employed to continuously monitor SpO2 and HR within 2 h after birth. The individual and combined prognostic relevance of the demographic and clinical characteristics of dyads for the occurrence of a CRE (SpO2 <91% or HR <111 or >180 bpm) was analyzed through logistic regression models. RESULTS Of the 254 children assessed, 169 [66.5%; 95% confidence interval (95% CI), 60.5-72.5%] had at least one CRE. The characteristics that increased the risk of CRE were maternal age ≥35 years (odds ratio, 2.21; 95% CI, 1.19-4.09), primiparity (1.96; 1.03-3.72), gestational body mass index (BMI) >25 kg/m2 (1.92; 1.05-3.53), and birth time between 09:00 p.m. and 08:59 a.m. (2.47; 1.02-5.97). CONCLUSION CREs were more frequent in HTNs born during nighttime and in HTNs born to first-time mothers, mothers ≥35 years, and mothers with a gestational BMI >25 kg/m2. These predictor variables can be determined during childbirth. Identification of neonates at higher risk of developing CREs would allow for closer surveillance during ESSC.
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Affiliation(s)
- Jesús Rodríguez-López
- Department of Neonatology, Health Research Institute Imas12, 12 de Octubre University Hospital, Complutense University, Madrid, Spain
| | | | - Nadia Raquela García-Lara
- Department of Neonatology, Health Research Institute Imas12, 12 de Octubre University Hospital, Complutense University, Madrid, Spain
| | | | | | - Máximo Vento
- Division of Neonatology, Neonatal Research Group, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Anna Parra-Llorca
- Division of Neonatology, Neonatal Research Group, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Fernando Cabañas
- Department of Pediatrics and Neonatology, Quirónsalud Madrid University Hospital, Madrid, Spain
| | - Pedro Lozano
- Department of Pediatrics and Neonatology, Quirónsalud Madrid University Hospital, Madrid, Spain
| | - Óscar García-Algar
- Neonatology Unit, Institut Clínic de Ginecologia, Obstetrícia i Nonatologia (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic-Maternitat, Barcelona, Spain
| | - Ana Martín-Ancel
- Neonatology Unit, Sant Joan de Déu University Hospital and Clínic University Hospital, BCNatal, Barcelona, Spain
| | | | | | | | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | | | - Carmen Rosa Pallás-Alonso
- Department of Neonatology, Health Research Institute Imas12, 12 de Octubre University Hospital, Complutense University, Madrid, Spain
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Badurdeen S, Santomartino GA, Thio M, Heng A, Woodward A, Polglase GR, Hooper SB, Blank DA, Davis PG. Respiratory support after delayed cord clamping: a prospective cohort study of at-risk births at ≥35 +0 weeks gestation. Arch Dis Child Fetal Neonatal Ed 2021; 106:627-634. [PMID: 34112723 PMCID: PMC8543210 DOI: 10.1136/archdischild-2020-321503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To identify risk factors associated with delivery room respiratory support in at-risk infants who are initially vigorous and received delayed cord clamping (DCC). DESIGN Prospective cohort study. SETTING Two perinatal centres in Melbourne, Australia. PATIENTS At-risk infants born at ≥35+0 weeks gestation with a paediatric doctor in attendance who were initially vigorous and received DCC for >60 s. MAIN OUTCOME MEASURES Delivery room respiratory support defined as facemask positive pressure ventilation, continuous positive airway pressure and/or supplemental oxygen within 10 min of birth. RESULTS Two hundred and ninety-eight infants born at a median (IQR) gestational age of 39+3 (38+2-40+2) weeks were included. Cord clamping occurred at a median (IQR) of 128 (123-145) s. Forty-four (15%) infants received respiratory support at a median of 214 (IQR 156-326) s after birth. Neonatal unit admission for respiratory distress occurred in 32% of infants receiving delivery room respiratory support vs 1% of infants who did not receive delivery room respiratory support (p<0.001). Risk factors independently associated with delivery room respiratory support were average heart rate (HR) at 90-120 s after birth (determined using three-lead ECG), mode of birth and time to establish regular cries. Decision tree analysis identified that infants at highest risk had an average HR of <165 beats per minute at 90-120 s after birth following caesarean section (risk of 39%). Infants with an average HR of ≥165 beats per minute at 90-120 s after birth were at low risk (5%). CONCLUSIONS We present a clinical decision pathway for at-risk infants who may benefit from close observation following DCC. Our findings provide a novel perspective of HR beyond the traditional threshold of 100 beats per minute.
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Affiliation(s)
- Shiraz Badurdeen
- Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia .,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | | | - Marta Thio
- Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Alissa Heng
- Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Anthony Woodward
- Department of Obstetrics, Royal Women's Hospital Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia,Obstetrics and Gynaecology, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia,Obstetrics and Gynaecology, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Douglas A Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia,Monash Newborn, Monash Health, Clayton, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
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Havranek T, Shatzkin E, Chuang M, Xie X, Kim M, Rosen O. Respiratory outcomes after neonatal prone versus supine positioning following scheduled cesarean delivery: a randomized trial. J Matern Fetal Neonatal Med 2019; 34:2938-2944. [PMID: 31564177 DOI: 10.1080/14767058.2019.1674805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Prone positioning is a common practice after vaginal birth promoting skin to skin contact and has been associated with improved oxygenation in mechanically ventilated neonates in the recent analysis. Neonates of women not in labor delivered via C-section are at increased risk of respiratory distress; it is unclear whether vigorous neonates without a need of resuscitation would benefit from prone positioning immediately after birth. OBJECTIVE To determine whether prone positioning of vigorous term neonates for the first 5 min after scheduled cesarean delivery will decrease the incidence of respiratory distress and therapeutic interventions, characterized by the frequency and duration of respiratory support (RS). DESIGN/METHODS In a single center, randomized parallel clinical trial, vigorous term neonates delivered via scheduled cesarean delivery were positioned prone or supine and their heart rate, oxygen saturation and signs of respiratory distress were recorded at 1-min intervals for the first 5 min. Infants not reaching target oxygen saturations suggested by the neonatal resuscitation guidelines received RS via Neopuff in supine position; respiratory support was discontinued once oxygen saturation targets were met and infant was free of respiratory symptoms. Primary outcomes measured were frequency and duration of RS, secondary outcomes were admission to the NICU for respiratory distress, length of stay, heart rate and oxygen saturation during the initial 5 min of life. RESULTS Two hundred twenty-five neonates in prone and 231 in supine position completed the study out of 500 randomized subjects. Frequency of RS (31 versus 30%, p = .93), mean RS duration (4.08 versus 4.39 min; p = .71), frequency of admission to the NICU (5% in both groups; p = .95) and mean length of stay (0.14 versus 0.28 days; p = .42) were similar between the prone and supine groups. The supine cohort had higher initial oxygen saturation (p = .02) as well as heart rate (p = .004). CONCLUSIONS Prone or supine positioning of term neonates after scheduled cesarean delivery resulted in comparable respiratory outcomes including the need for resuscitation in the first minutes of life.
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Affiliation(s)
- Tomas Havranek
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Ellen Shatzkin
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
| | - Meleen Chuang
- Department of OB/GYN Women's Health/Montefiore, Bronx, NY, USA
| | - Xianhong Xie
- Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mimi Kim
- Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Orna Rosen
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore, Bronx, NY, USA
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