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Shah S, Myers P, Enciso JM, Davis AS, Crouch EE, Scheurer AM, Song C, Lakshminrusimha S. Should neonatal-perinatal medicine move to two-year fellowships? J Perinatol 2024; 44:1222-1227. [PMID: 38851854 DOI: 10.1038/s41372-024-02020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/25/2024] [Accepted: 05/24/2024] [Indexed: 06/10/2024]
Abstract
The duration of the majority of fellowships in pediatrics has been three-years. With increasing shortages of some outpatient-based pediatric subspecialists, shorter two-year fellowships are being considered for clinically oriented trainees not interested in a career based on research. Shortening the duration of fellowship may have some financial merits such as achieving a higher salary earlier after shorter training. However, we feel that continuing with a three-year duration for neonatology is more pragmatic at this time due to reductions in intensive care rotations during residency, time required to achieve procedural excellence, the need for exposure to quality assurance methodology, proficiency in novel techniques such as bedside ultrasound, and to maintain the physician-scientist pipeline. The demand for neonatal fellowship continues to be high. Ongoing evaluation of the job market, training needs and fellowship curriculum is needed to determine if the duration of fellowship should be altered in the future.
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Affiliation(s)
- Shetal Shah
- Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA.
| | - Patrick Myers
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Josephine M Enciso
- Department of Pediatrics, Division of Neonatology and Developmental Biology, University of California Los Angeles, Los Angeles, CA, USA
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Elizabeth E Crouch
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California San Francisco, San Francisco, CA, USA
| | - Andrea M Scheurer
- Department of Pediatric and Adolescent Medicine, Homer Stryker School of Medicine, Western Michigan University, Kalamazoo, MI, USA
- Neonatal Intensive Care, Bronson Children's Hospital, Kalamazoo, MI, USA
| | - Clara Song
- Department of Neonatal-Perinatal Medicine, Southern California Permanente Medical Group, Anaheim, CA, USA
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Kumar G, Goel S, Nangia S, Ramaswamy VV. Outcomes of Nonvigorous Neonates Born through Meconium-Stained Amniotic Fluid after a Practice Change to No Routine Endotracheal Suctioning from a Developing Country. Am J Perinatol 2024; 41:1163-1170. [PMID: 35288884 DOI: 10.1055/a-1797-7005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The International Liaison Committee on Resuscitation (ILCOR) 2015 gave a weak recommendation based on low certainty of evidence against routine endotracheal (ET) suctioning in non-vigorous (NV) neonates born through meconium-stained amniotic fluid (MSAF) and suggested for immediate resuscitation without direct laryngoscopy. A need for ongoing surveillance post policy change has been stressed upon. This study compared the outcomes of NV MSAF neonates before and after implementation of the ILCOR 2015 recommendation. STUDY DESIGN This was a prospective cohort study of term NV MSAF neonates who underwent immediate resuscitation without ET suctioning (no ET group, July 2018 to June 2019, n = 276) compared with historical control who underwent routine ET suction (ET group, July 2015 to June 2016, n = 271). RESULTS Baseline characteristics revealed statistically significant higher proportion of male gender and small for gestational age neonates in the prospective cohort. There was no significant difference in the incidence of primary outcome of meconium aspiration syndrome (MAS) between the groups (no ET group: 27.2% vs ET group: 25.1%; p = 0.57). NV MSAF neonates with hypoxic ischemic encephalopathy (HIE) was significantly lesser in the prospective cohort (no ET group: 19.2% vs ET group: 27.3%; p = 0.03). Incidence of air leaks and need for any respiratory support significantly increased after policy change. In NV MSAF neonates with MAS, need for mechanical ventilation (MV) (no ET group: 24% vs ET group: 39.7%; p = 0.04) and mortality (no ET group: 18.7% vs ET group: 33.8%; p = 0.04) were significantly lesser. CONCLUSION Current study from a developing country indicates that immediate resuscitation and no routine ET suctioning of NV MSAF may not be associated with increased risk of MAS and may be associated with decreased risk of HIE. Increased requirement of any respiratory support and air leak post policy change needs further deliberation. Decreased risk of MV and mortality among those with MAS was observed. KEY POINTS · Not performing ET suction in NV MSAF infants is not associated with increase in the incidence of MAS.. · Initiating immediate resuscitation without ET suctioning was associated with decreased risk of HIE but increased receipt of any respiratory support and air leak.. · Large multicentric trial is required to generate robust evidence..
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Affiliation(s)
- Gunjana Kumar
- Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Srishti Goel
- Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
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Sheikh M, Nanda V, Kumar R, Khilfeh M. Neonatal Outcomes since the Implementation of No Routine Endotracheal Suctioning of Meconium-Stained Nonvigorous Neonates. Am J Perinatol 2024; 41:1366-1372. [PMID: 36170887 DOI: 10.1055/a-1950-2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effect of the 2015 Neonatal Resuscitation Program recommendations of no routine endotracheal suctioning for nonvigorous neonates on the incidence of meconium aspiration syndrome (MAS) and death. We hypothesized that the revised guidelines have not changed the outcome of MAS/death. STUDY DESIGN This was a single-center retrospective cohort study. We recorded data on nonvigorous neonates born at gestational age > 37 weeks, who were divided into period 1, n = 95 (before the new guidelines, January 1, 2013-December 31, 2015) and prospective period 2, n = 91 (after the implementation of new guidelines, January 1, 2017-December 31, 2020). Primary outcomes included MAS and death. Secondary outcomes included respiratory neonatal intensive care unit (NICU) admission, length of NICU stay, and feeding difficulties. RESULTS No significant differences in the occurrence of MAS (11 vs. 17%) (odds ratio [OR] of 1.46 [95% confidence interval [CI]: 0.59-3.55]) or death (1 vs. 3%) (OR of 2.00 [95% CI: 0.18-21.57]) among the two periods were observed. In period 2, there was an increased NICU respiratory admission (37 vs. 61%), with an OR of 2.31 (95% CI: 1.10-4.84). More neonates in period 2 required subsequent intubation for respiratory failure in the delivery room (12 vs. 28%) with an OR of 2.03 (95% CI: 1.02-4.51); p-value of 0.05. CONCLUSION Our study did not observe a significant difference in the incidence of MAS or death between the two periods since the 2015 guidelines. However, the incidence of NICU respiratory admission increased. KEY POINTS · Nonvigorous neonates born through MSAF who did not undergo ET suctioning soon after birth did not have increased incidence of MAS or death, but had increased NICU respiratory admissions.. · A large Multi-center RCT may give more clear verdict on the outcomes of these newborns..
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Affiliation(s)
- Mehwish Sheikh
- Division of Neonatology, Department of Pediatrics, University of Illinois Chicago College of Medicine at Peoria, Peoria, Illinois
| | - Vishakha Nanda
- John H. Stroger, Jr. Cook County Hospital, Chicago, Illinois
| | - Rajeev Kumar
- John H. Stroger, Jr. Cook County Hospital, Chicago, Illinois
| | - Manhal Khilfeh
- John H. Stroger, Jr. Cook County Hospital, Chicago, Illinois
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Byrne BJ, Kapadia V. Improving Accuracy for Initial Endotracheal Tube Size Selection for Newborns. Pediatrics 2024; 153:e2023064843. [PMID: 38469641 DOI: 10.1542/peds.2023-064843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Bobbi J Byrne
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Pinheiro JMB, Fisher M, Munshi UK, Khalak R, Tauber KA, Cummings JJ, Cerone JB, Monaco-Brown M, Geis G, Chowdhry R, Fay M, Paul AA, Levine C, Pan P, Horgan MJ. A Multifunctional, Low Cost and Sustainable Neonatal Database System. CHILDREN (BASEL, SWITZERLAND) 2024; 11:217. [PMID: 38397329 PMCID: PMC10887617 DOI: 10.3390/children11020217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Continuous improvement in the clinical performance of neonatal intensive care units (NICU) depends on the use of locally relevant, reliable data. However, neonatal databases with these characteristics are typically unavailable in NICUs using paper-based records, while in those using electronic records, the inaccuracy of data and the inability to customize commercial data systems limit their usability for quality improvement or research purposes. We describe the characteristics and uses of a simple, neonatologist-centered data system that has been successfully maintained for 30 years, with minimal resources and serving multiple purposes, including quality improvement, administrative, research support and educational functions. Structurally, our system comprises customized paper and electronic components, while key functional aspects include the attending-based recording of diagnoses, integration into clinical workflows, multilevel data accuracy and validation checks, and periodic reporting on both data quality and NICU performance results. We provide examples of data validation methods and trends observed over three decades, and discuss essential elements for the successful implementation of this system. This database is reliable and easily maintained; it can be developed from simple paper-based forms or used to supplement the functionality and end-user customizability of existing electronic medical records. This system should be readily adaptable to NICUs in either high- or limited-resource environments.
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Affiliation(s)
- Joaquim M. B. Pinheiro
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Marilyn Fisher
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Upender K. Munshi
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Rubia Khalak
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Kate A. Tauber
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - James J. Cummings
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Jennifer B. Cerone
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Meredith Monaco-Brown
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Gina Geis
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Rehman Chowdhry
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Mary Fay
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Anshu A. Paul
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
| | - Carolyn Levine
- Neonatology, Ellis Hospital, Schenectady, NY 12308, USA; (C.L.); (P.P.)
| | - Phillip Pan
- Neonatology, Ellis Hospital, Schenectady, NY 12308, USA; (C.L.); (P.P.)
| | - Michael J. Horgan
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA; (M.F.); (U.K.M.); (R.K.); (K.A.T.); (J.J.C.); (J.B.C.); (M.M.-B.); (G.G.); (R.C.); (M.F.); (A.A.P.); (M.J.H.)
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Saint-Fleur AL, Alcalá HE, Sridhar S. Outcomes of neonates born through meconium-stained amniotic fluid pre and post 2015 NRP guideline implementation. PLoS One 2023; 18:e0289945. [PMID: 37561740 PMCID: PMC10414582 DOI: 10.1371/journal.pone.0289945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023] Open
Abstract
A shift in the Neonatal Resuscitation Program (NRP) guidelines occurred in 2015 from routine intubation and endotracheal suctioning of all meconium-stained non-vigorous infants towards less aggressive interventions based on response to initial resuscitation. This study aims to examine the impact of this change on outcomes of non-vigorous infants born through meconium-stained amniotic fluid at a level III academic NICU encompassing years before and after the change in guideline. This single-center retrospective study compared NICU therapies and clinical outcomes of 117 non-vigorous newborns pre-guideline implementation to 106 non-vigorous newborns post-guideline implementation. Nearly two thirds of infants in the pre-guideline cohort received endotracheal suctioning with recovery of meconium compared to less than a third of infants in the post-guideline cohort (p<0.01). Though a higher proportion of the pre-guideline cohort were admitted to the NICU for respiratory issues compared to the post-guideline cohort, the two groups did not differ significantly with regard to morbidity and therapies. Despite a marked reduction in rates of intubation and endotracheal suctioning, there is no difference in outcomes between pre-guideline implementation vs post-guideline implementation in non-vigorous meconium-stained infants, supporting the recent NRP guideline change and highlighting the benefit of expectant management.
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Affiliation(s)
- Ashley L. Saint-Fleur
- Department of Pediatrics, Stony Brook Children’s Hospital, Stony Brook, New York, United States of America
| | - Héctor E. Alcalá
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
- Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, United States of America
| | - Shanthy Sridhar
- Department of Pediatrics, Division of Neonatology, Stony Brook Children’s Hospital, Stony Brook, New York, United States of America
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Srinivasan M, Sylvia G, Justin H, Mausma B, Jayasree N, Praveen C, Munmun R. Laryngeal mask ventilation with chest compression during neonatal resuscitation: randomized, non-inferiority trial in lambs. Pediatr Res 2022; 92:671-677. [PMID: 34732813 PMCID: PMC9061897 DOI: 10.1038/s41390-021-01820-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Effective positive-pressure ventilation is a critical factor in newborn resuscitation. Neonatal endotracheal intubation (ETT) needs considerable training and experience, which poses a human factor challenge. Laryngeal mask airway (LMA) ventilation can be a secure and viable alternative during the initial stages of newborn resuscitation. However, there is limited evidence for its use during chest compression (CC). METHODS Seventeen lambs were randomized into LMA or ETT ventilation post cord occlusion induced cardiac arrest. After 5 min of cardiac arrest, resuscitation was initiated as per NRP recommendations. Ventilation, oxygenation, systemic and pulmonary hemodynamic parameters were recorded till the return of spontaneous circulation (ROSC) or 20 min. RESULTS Baseline characteristics were similar between the groups. The incidence of ROSC was 75% (6/8) in the LMA group and 56% (5/9) in the ETT group (p = 0.74). The median (IQR) time to achieve ROSC was 6.85 min (6 min-9.1 min) in the LMA group and 7.50 min (5.33 min-18 min) in the ETT group (p = 0.65). CONCLUSION LMA ventilation during CC is feasible and non-inferior to ETT in this model. IMPACT Laryngeal mask airway (LMA) ventilation with chest compression is feasible and non-inferior to endotracheal tube ventilation in this experimental near-term lamb model of asphyxial cardiac arrest. First translational study to evaluate the use of LMA as an airway device with chest compression. Evidence primer for clinical studies to evaluate and confirm the feasibility and efficacy of LMA ventilation with chest compression are necessary before randomized clinical trials in neonates. LMA use in neonatal cardiopulmonary resusciation (CPR) could have the potential to optimize advanced resuscitation, especially in resource-limited healthcare settings.
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Affiliation(s)
- Mani Srinivasan
- Department of Pediatrics, University at Buffalo, Buffalo, NY, 14203
| | - Gugino Sylvia
- Department of Pediatrics, University at Buffalo, Buffalo, NY, 14203
| | - Helman Justin
- Department of Pediatrics, University at Buffalo, Buffalo, NY, 14203
| | - Bawa Mausma
- Department of Pediatrics, University at Buffalo, Buffalo, NY, 14203
| | - Nair Jayasree
- Department of Pediatrics, University at Buffalo, Buffalo, NY, 14203
| | | | - Rawat Munmun
- Department of Pediatrics, University at Buffalo, Buffalo, NY, 14203
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Kalra V, Leegwater AJ, Vadlaputi P, Garlapati P, Chawla S, Lakshminrusimha S. Neonatal outcomes of non-vigorous neonates with meconium-stained amniotic fluid before and after change in tracheal suctioning recommendation. J Perinatol 2022; 42:769-774. [PMID: 34997221 PMCID: PMC9188988 DOI: 10.1038/s41372-021-01287-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/08/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the short-term outcomes of non-vigorous infants born through meconium-stained amniotic fluid (MSAF) before and after implementation of no-tracheal suctioning guidelines. STUDY DESIGN Single-center retrospective study of ≥36-week gestation neonates with MSAF. RESULTS During routine-suction era (9/2013-12/2014), 280/2306 neonates (12%) were born through MSAF and 39 (14%) were non-vigorous. Thirty (77%) of non-vigorous infants underwent tracheal suctioning. In the no-suction era (1/2017-12/2018), 282/2918 neonates (9.7%) were born through MSAF and 30 (10.6%) were non-vigorous and one needed intubation. Admissions for meconium aspiration syndrome (15% vs 53%) and respiratory distress (18% vs 57%) were significantly higher among non-vigorous infants in the no-suction era. CONCLUSIONS In this single-center study, non-vigorous infants born through MSAF without routine-tracheal suctioning had a higher incidence of NICU admission for MAS and respiratory distress compared to the routine-suction era. Multicenter randomized trials evaluating tracheal suction in non-vigorous infants with MSAF are warranted.
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Affiliation(s)
- Vaneet Kalra
- Department of Pediatrics, University of California at Davis, Sacramento CA
| | | | - Pranjali Vadlaputi
- Department of Pediatrics, University of California at Davis, Sacramento CA
| | - Pranav Garlapati
- Department of Pediatrics, University of California at Davis, Sacramento CA
| | - Sanjay Chawla
- Department of Pediatrics, Central Michigan University, Children’s Hospital of Michigan, Detroit MI
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Adnan M, Mydam J, Hageman JR, Cohen L. Fetal Heart Tracing Patterns and the Outcomes of Newborns With Meconium-Stained Amniotic Fluid. Cureus 2022; 14:e24545. [PMID: 35651407 PMCID: PMC9138189 DOI: 10.7759/cureus.24545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To determine if the presence of meconium-stained amniotic fluid (MSAF) by itself or in combination with abnormal fetal heart tracing (FHT) (category II and III) is associated with poor neonatal outcomes in full-term newborns. Design/methods This is a retrospective cohort study. Cases included singleton and full-term neonates with MSAF. Cases were compared to matched controls (clear amniotic fluids) for the outcomes. SPSS (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY, USA) and SAS 9.4 (SAS Institute Inc., Cary, NC, USA) were used for data analysis. Results From 5512 deliveries, 210 cases (MSAF group) and 210 matched controls were identified. Cases and controls were similar in most maternal characteristics. Abnormal FHT was present in 43.2% of cases compared to 17.6% of controls (p<0.001). Low Apgar scores (<7) at one and five minutes were more common in the MSAF group (p=0.03 and 0.007, respectively). The neonatal intensive care unit (NICU) admission rate was also higher in the MSAF group (p=0.002). However, the mean hospital stay was similar in both groups (p=0.44). Twenty-two (10.5%) cases required resuscitation at birth compared to six (2.9%) controls (p=0.003). After applying the logistic regression model to adjust for the FHT pattern and Apgar scores at one minute, the association of MSAF with resuscitation lost significance. The factors associated with resuscitation requirement at birth were Apgar score at one minute (adjusted odds ratios (aOR) 4.1; 95% CI 2.8-5.1, p<0.001) and abnormal FHTs (aOR, 0.03; 95% CI 0.004-0.257, p=0.001). Conclusions Neonates born with MSAF were more likely to have abnormal FHT and require resuscitation at birth. However, after adjusting for confounding factors, abnormal FHT and one-minute Apgar scores were the only variables predictive of resuscitation needs at birth.
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Cicalese E, Wraight CL, Falck AJ, Izatt SD, Nair J, Lawrence KG. Essentials of Neonatal-Perinatal Medicine fellowship: part 2 - clinical education and experience. J Perinatol 2022; 42:410-415. [PMID: 33850281 DOI: 10.1038/s41372-021-01042-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 11/09/2022]
Abstract
This is the second article in a seven-part series in the Journal of Perinatology that aims to critically examine the current state of Neonatal-Perinatal Medicine (NPM) fellowship training from the structure and administration of a program, to the clinical and scholarly requirements, and finally to the innovations and future careers awaiting successful graduates. This article focuses on the current clinical requirements; recent changes to the clinical environment and their effect on learning; and additional challenges and opportunities in clinical education.
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Affiliation(s)
- Erin Cicalese
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - C Lydia Wraight
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alison J Falck
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Susan D Izatt
- Division of Neonatology, Duke University Medical Center, Durham, NC, USA
| | - Jayasree Nair
- Department of Pediatrics, Division of Neonatology, University at Buffalo, Buffalo, NY, USA
| | | | - Karena G Lawrence
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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李 开, 唐 成. A retrospective cohort study of tracheal intubation for meconium suction in nonvigorous neonates. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:65-70. [PMID: 35177178 PMCID: PMC8802384 DOI: 10.7499/j.issn.1008-8830.2109178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To study the feasibility of tracheal intubation for meconium suction immediately after birth of nonvigorous neonates born through meconium-stained amniotic fluid (MSAF). METHODS A retrospective cohort study was performed on nonvigorous neonates born through MSAF who were admitted to the Department of Neonatology, Zhecheng People's Hospital. The neonates without meconium suction who were admitted from July 1, 2017 to June 30, 2018 were enrolled as the control group. The neonates who underwent meconium suction from July 1, 2018 to June 30, 2019 were enrolled as the suction group. The two groups were compared in terms of the mortality rate and the incidence rates of neonatal meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn, pneumothorax, and pulmonary hemorrhage. RESULTS There were 80 neonates in the control group and 71 in the suction group. There were no significant differences between the two groups in the incidence rates of MAS (11% vs 7%), persistent pulmonary hypertension of the newborn (5% vs 4%), pneumothorax (3% vs 1%), and death (0% vs 1%). Compared with the control group, the suction group had a significantly lower proportion of neonates requiring oxygen inhalation (16% vs 33%, P<0.05), noninvasive respiratory support (25% vs 41%, P<0.05) or mechanical ventilation (10% vs 23%, P<0.05) and significantly shorter duration of noninvasive ventilation [(58±24) hours vs (83±41) hours, P<0.05] and length of hospital stay [6(4, 8) days vs 7(5, 10) days, P<0.05]. CONCLUSIONS Although tracheal intubation for meconium suction immediately after birth may shorten the duration of respiratory support for mild respiratory problems, it cannot reduce the incidence rate of MAS, mortality rate, or the incidence rate of serious complications in nonvigorous infants born through MSAF.
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Affiliation(s)
| | - 成和 唐
- 新乡医学院第一附属医院新生儿科,河南新乡453100
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Heo JS, Kim SY, Park HW, Choi YS, Park CW, Cho GJ, Oh AY, Jang EK, Kim HS, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 8. Neonatal resuscitation. Clin Exp Emerg Med 2021; 8:S96-S115. [PMID: 34034452 PMCID: PMC8171175 DOI: 10.15441/ceem.21.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/05/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Su Yeong Kim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Ah Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyung Jang
- Office of Patient Safety, Yonsei University Severance Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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St. John Sutton EM, McKinsey S. Current Practices and Updates in Neonatal Resuscitation. CURRENT PEDIATRICS REPORTS 2020. [DOI: 10.1007/s40124-020-00232-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gupta A, Lee HC. Revisiting the Latest NRP Guidelines for Meconium: Searching for Clarity in a Murky Situation. Hosp Pediatr 2020; 10:300-302. [PMID: 32094238 DOI: 10.1542/hpeds.2020-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Arun Gupta
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - Henry Chong Lee
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
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