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Bergman KA, Bouma BA, Semmekrot BA, Matthijsse RP, Reiss IKM, Ikkink HK, Hulzebos CV. The use of in-hospital guidelines for prevention of sudden unexpected postnatal collapse: A national survey. Acta Paediatr 2024; 113:2031-2036. [PMID: 38808465 DOI: 10.1111/apa.17292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
AIM Sudden unexpected postnatal collapse is a life-threatening event and may occur in any newborn infant. Safe skin-to-skin contact, and awareness of sudden unexpected postnatal collapse are key to its prevention. The aim of this study was to survey the presence of skin-to-skin contact and/or sudden unexpected postnatal collapse protocols in the 70 perinatal centres in the Netherlands. METHODS We performed a survey among Dutch paediatricians to examine the safe skin-to-skin contact and sudden unexpected postnatal collapse protocols. RESULTS We received data from 59/70 (85%) perinatal centres. At least one case of sudden unexpected postnatal collapse was reported in 35/59 (59%) of these centres. Nearly half the centres had safe skin-to-skin contact and/or sudden unexpected postnatal collapse protocols. Ultimately, 16 protocols were available for analysis. They showed considerable differences in the type of perinatal care provided. Most protocols lacked recently published insights on safe skin-to-skin contact. Besides, protocols failed to incorporate awareness of and knowledge on how to prevent sudden unexpected postnatal collapse. CONCLUSION This study underlines the importance of drawing up uniform, multidisciplinary guidelines containing recommendations for the prevention of sudden unexpected postnatal collapse in the Netherlands.
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Affiliation(s)
- Klasien A Bergman
- Division of Neonatology, Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, The Netherlands
| | - Bea A Bouma
- Division of Neonatology, Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ben A Semmekrot
- Department of Paediatrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - René P Matthijsse
- Division of Neonatology, Department of Paediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia, Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Henrike Klein Ikkink
- The Netherlands Paediatric Surveillance Unit, Dutch Society of Pediatrics, Utrecht, The Netherlands
| | - Christian V Hulzebos
- Division of Neonatology, Department of Paediatrics, Beatrix Children's Hospital, University Medical Centre Groningen, Groningen, The Netherlands
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Stichtenoth G, Gonser M, Hentschel R, Janke E, Maul H, Schmitt A, Steppat S, Werner J, Herting E. Betreuung von Neugeborenen in der Geburtsklinik (Entwicklungsstufe
S2k, AWMF-Leitlinien-Register-Nr. 024–005, März 2021). Z Geburtshilfe Neonatol 2024; 228:137-150. [PMID: 38608666 DOI: 10.1055/a-2195-3995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Guido Stichtenoth
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Markus Gonser
- Universitätsspital Zürich, Klinik für Geburtshilfe, Zürich, Schweiz
| | - Roland Hentschel
- Neonatologie/Intensivmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg
| | - Evelin Janke
- Katholische Bildungsstätte für Berufe im Sozial- und Gesundheitswesen GmbH, Akademie St. Franziskus, Lingen (Ems)
| | - Holger Maul
- Geburtshilfe und Pränatalmedizin, Asklepios Klinik Barmbek, Hamburg
| | - Anne Schmitt
- Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken
| | | | - Janne Werner
- Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Düsseldorf
| | - Egbert Herting
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
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Ludington-Hoe SM, Addison C. Sudden Unexpected Postnatal Collapse: Review and Management. Neonatal Netw 2024; 43:76-91. [PMID: 38599773 DOI: 10.1891/nn-2023-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript.
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Poets CF, Paditz E, Erler T, Hübler A, Jückstock J, Quante M, Pauluschke-Fröhlich J, Schlüter B, Hoch B, Kerzel S, Abou-Dakn M, Schneider B, Wiater A. Prävention des plötzlichen Säuglingstods (SIDS, „sudden infant death syndrome“, ICD 10: R95). Monatsschr Kinderheilkd 2023. [DOI: 10.1007/s00112-023-01724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
ZusammenfassungDieser Beitrag fasst die Datenlage zu den wichtigsten Handlungsanweisungen für Eltern bezüglich der Gewährleistung einer sicheren Schlafumgebung für Säuglinge zusammen. Hierzu gehören folgende: 1. Legen Sie Ihr Kind zum Schlafen auf den Rücken; benutzen Sie dabei eine feste und waagerechte Unterlage. 2. Legen Sie Ihr Kind tagsüber, solange es wach ist und Sie es gut beobachten können, regelmäßig für kurze Zeit auch auf den Bauch. 3. Vermeiden Sie Überwärmung: Während der Nacht ist eine Raumtemperatur von 18 °C optimal, anstelle einer Bettdecke empfiehlt sich die Verwendung eines Baby-Schlafsacks in altersentsprechender Größe. 4. Falls Sie keinen Schlafsack verwenden möchten, achten Sie darauf, dass Ihr Kind nicht mit dem Kopf unter die Bettdecke rutschen kann, indem Sie es so ins Bett legen, dass es mit den Füßen am Fußende anstößt. 6. Verzichten Sie auf Kopfkissen, Fellunterlagen, „Nestchen“, gepolsterte Bettumrandungen und größere Kuscheltiere, mit denen sich Ihr Kind überdecken könnte. 7. Wickeln Sie Ihr Kind zum Schlafen nicht fest ein. 8. lassen Sie Ihr Kind bei sich im Zimmer, aber im eigenen Kinderbett schlafen. 9. Achten Sie auf eine rauchfreie Umgebung für Ihr Kind auch schon während der gesamten Schwangerschaft. 10. Stillen Sie im 1. Lebensjahr, möglichst mindestens 4 bis 6 Monate. 11. Bieten Sie Ihrem Kind zum Schlafengehen einen Schnuller an. 12. Diese Empfehlungen gelten auch für die Zeit unmittelbar nach Geburt: Sollte Ihr Kind auf Ihrem Körper liegen, achten Sie darauf, dass es stets freie Atemwege hat.
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Bedetti L, Lugli L, Garetti E, Guidotti I, Roversi MF, Della Casa E, Miselli F, Bariola MC, Di Caprio A, Pugliese M, Ferrari F, Berardi A. Sudden Unexpected Postnatal Collapse and Therapeutic Hypothermia: What's Going On? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121925. [PMID: 36553368 PMCID: PMC9776888 DOI: 10.3390/children9121925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Sudden unexpected postnatal collapse (SUPC) is a rare event, potentially associated with catastrophic consequences. Since the beginning of the 2000s, therapeutic hypothermia (TH) has been proposed as a treatment for asphyxiated neonates after SUPC. However, only a few studies have reported the outcome of SUPC after TH. The current study presents the long-term neurodevelopmental outcome of four cases of SUPC treated with TH in a single Italian center. Furthermore, we reviewed the previous literature concerning 49 cases of SUPC treated with TH. Among 53 total cases (of whom four occurred in our center), 15 (28.3%) died before discharge from the NICU. A neurodevelopmental follow-up was available only for 21 (55.3%) out of the 38 surviving cases, and seven infants developed neurodevelopmental sequelae. TH should be considered in neonates with asphyxia after SUPC. However, SUPC is a rare event, and there is a lack of comparative clinical data to establish the risk/benefit of TH after SUPC with different degrees of asphyxia. Analysis of large cohorts of newborns with SUPC, whether treated with TH or untreated, are needed in order to better identify infants who should undergo TH.
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Affiliation(s)
- Luca Bedetti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy
| | - Elisabetta Garetti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy
| | - Isotta Guidotti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy
| | | | - Elisa Della Casa
- Neonatal Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy
| | - Francesca Miselli
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Neonatal Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy
- Correspondence:
| | - Maria Carolina Bariola
- Pediatric Post-Graduate School, University Hospital of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Antonella Di Caprio
- Pediatric Post-Graduate School, University Hospital of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Marisa Pugliese
- Psychology Unit, University Hospital of Modena, 41125 Modena, Italy
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena, 41125 Modena, Italy
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Hegyi T, Ostfeld BM. Sudden unexpected infant death risk profiles in the first month of life. J Matern Fetal Neonatal Med 2022; 35:10444-10450. [PMID: 36195459 DOI: 10.1080/14767058.2022.2128662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Limited improvement in current SUID rates requires further identification of its characteristics, including age-specific risk patterns. OBJECTIVE Compare SUID risk factors in the first week versus the remainder in the first month of life. DESIGN/METHODS We compared maternal and infant data from New Jersey databases for SUID from 2000 to 2015 in infants ≥ 34 weeks GA in the two groups. RESULTS In the period studied, 123 died in the first 27 days, 24 before seven. Deaths in the first week had a higher percentage of mothers with post-High School education (OR 3.50, CI: 1.38-8.87) and a primary Cesarean section delivery (OR 4.0, CI: 1.39-11.49), and a smaller percentage with inadequate prenatal care (OR 0.36, CI: 0.14, 0.94). A smaller percentage of first-week deaths had mothers who smoked during pregnancy or identified as Black, non-Hispanic, but these findings did not reach significance (p < .08 and p < .09, respectively). CONCLUSIONS SUID in the first week and the first month of life is rare. However, despite a limited sample size, data suggest that even within the first month of life, there are differences in risk patterns for SUID based on age at death. Age-specific profiles may lead to new hypotheses regarding causality and more refined risk-reduction guidelines and warrant further study.
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Affiliation(s)
- Thomas Hegyi
- Division of Neonatology, Department of Pediatrics and SIDS Center of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Barbara M Ostfeld
- Division of Neonatology, Department of Pediatrics and SIDS Center of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Standards for Professional Registered Nurse Staffing for Perinatal Units. Nurs Womens Health 2022; 26:e1-e94. [PMID: 35750618 DOI: 10.1016/j.nwh.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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8
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Standards for Professional Registered Nurse Staffing for Perinatal Units. J Obstet Gynecol Neonatal Nurs 2022; 51:e5-e98. [PMID: 35738987 DOI: 10.1016/j.jogn.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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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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Batra EK, Lewis M, Saravana D, Corr TE, Daymont C, Miller JR, Hackman NM, Mikula M, Ostrov BE, Fogel BN. Improving Hospital Infant Safe Sleep Compliance by Using Safety Prevention Bundle Methodology. Pediatrics 2021; 148:183392. [PMID: 34851414 DOI: 10.1542/peds.2020-033704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sudden unexpected infant death often results from unsafe sleep environments and is the leading cause of postneonatal mortality in the United States. Standardization of infant sleep environment education has been revealed to impact such deaths. This standardized approach is similar to safety prevention bundles typically used to monitor and improve health outcomes, such as those related to hospital-acquired conditions (HACs). We sought to use the HAC model to measure and improve adherence to safe sleep guidelines in an entire children's hospital. METHODS A hospital-wide safe sleep bundle was implemented on September 15, 2017. A safe sleep performance improvement team met monthly to review data and discuss ideas for improvement through the use of iterative plan-do-study-act cycles. Audits were performed monthly from March 2017 to October 2019 and monitored safe sleep parameters. Adherence was measured and reviewed through the use of statistical process control charts (p-charts). RESULTS Overall compliance improved from 9% to 72%. Head of bed flat increased from 62% to 93%, sleep space free of extra items increased from 52% to 81%, and caregiver education completed increased from 10% to 84%. The centerline for infant in supine position remained stable at 81%. CONCLUSIONS Using an HAC bundle safety prevention model to improve adherence to infant safe sleep guidelines is a feasible and effective method to improve the sleep environment for infants in all areas of a children's hospital.
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Affiliation(s)
- Erich K Batra
- Departments of Family and Community Medicine.,Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Mary Lewis
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Deepa Saravana
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Tammy E Corr
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Carrie Daymont
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Jennifer R Miller
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Nicole M Hackman
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Margaret Mikula
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania.,Samaritan Health Services, Corvallis, Oregon
| | - Barbara E Ostrov
- Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
| | - Benjamin N Fogel
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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Anderson TM, Ferres JML, Ramirez JM, Mitchell EA. Sudden Unexpected Postnatal Collapse Resulting in Newborn Death in the United States. MCN Am J Matern Child Nurs 2021; 46:130-136. [PMID: 33587345 PMCID: PMC8349372 DOI: 10.1097/nmc.0000000000000711] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The sudden collapse of an apparently healthy newborn, or sudden unexpected postnatal collapse (SUPC) is fatal in about half of cases. Epidemiological characteristics of sudden unexpected infant death (SUID) in the first week of life differ from those in the postperinatal age group (7-365 days). AIM To describe the characteristics of SUPC resulting in neonatal death. METHODS We analyzed the Centers for Disease Control and Prevention Birth Cohort Linked Birth/Infant Death Data Set (2003-2013: 41,125,233 births and 37,624 SUIDs). SUPC was defined as infants born ≥35 weeks gestational age, with a 5-minute Apgar score of ≥7, who died suddenly and unexpectedly in the first week of life. RESULTS Of the 37,624 deaths categorized as SUID during the study period, 616 met the SUPC criteria (1.5/100,000 live births). Eleven percent occurred on the first day of life and nearly three quarters occurred during postnatal days 3-6. SUPC deaths differed statistically from SUID deaths occurring 7-364 days of age, in particular for sex, marital status, and live birth order. IMPLICATIONS These data support the need for adequate nurse staffing during the immediate recovery period and for the entire postpartum stay as well as nurse rounding for new mothers in the hospital setting.
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Du Plessis J, Kirk M, Quilatan M, Mehta S. Continuous pulse oximetry during skin-to-skin care: An Australian initiative to prevent sudden unexpected postnatal collapse. Acta Paediatr 2021; 110:1166-1170. [PMID: 32866301 DOI: 10.1111/apa.15552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 11/27/2022]
Abstract
AIM To examine the use of continuous pulse oximetry monitoring (CPOM) of newborns as a non-invasive and non-intrusive standard of care for promoting early and safe skin-to-skin contact between mothers and newborns immediately after birth and to gather acceptability feedback from midwifery staff and mothers. METHODS All babies receiving skin-to-skin contact (SSC) had continuous pulse oximetry monitoring (CPOM) for the first-hour postbirth. Staff were trained with education sessions before implementation. Midwives and mothers were surveyed post-implementation and again after distribution of an education brochure regarding CPOM. RESULTS Seventy per cent of midwives and 66% of mothers responded to the survey. The majority of midwives received the practice positively and felt reassured by the use of CPOM in the immediate postpartum period. The survey identified gaps in maternal knowledge of the risk and benefits of SSC which improved significantly after the distribution of the educational brochure (P = .01). CONCLUSION Continuous pulse oximetry monitoring with a compact monitor in the first-hour postbirth is a simple, non-invasive and innovative approach to enhance safe skin-to-skin care by improving vigilance of newborns. Our study confirmed the acceptance of such approach by midwives and mothers in our population.
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Affiliation(s)
- Jean Du Plessis
- Department of Neonatology Fiona Stanley Hospital Murdoch Western Australia Australia
- School of Medicine University of Notre Dame Fremantle Western Australia Australia
| | - Michael Kirk
- Department of Neonatology Fiona Stanley Hospital Murdoch Western Australia Australia
| | - Myra Quilatan
- Department of Neonatology Fiona Stanley Hospital Murdoch Western Australia Australia
| | - Shailender Mehta
- Department of Neonatology Fiona Stanley Hospital Murdoch Western Australia Australia
- School of Medicine University of Notre Dame Fremantle Western Australia Australia
- School of Medicine Curtin University Perth Western Australia Australia
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Tyrala E, Goodstein MH, Batra E, Kelly B, Bannon J, Bell T. Post-Partum Skin-to-Skin Care and Infant Safety: Results of a State-Wide Hospital Survey. Glob Pediatr Health 2021; 8:2333794X21989549. [PMID: 33614840 PMCID: PMC7841652 DOI: 10.1177/2333794x21989549] [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] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/25/2020] [Accepted: 12/31/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives. Survey current experience with Skin to Skin care (SSC) in Pennsylvania Maternity Centers. Study Design. The nursing director of each Maternity Center in PA (n = 95) was sent an on-line confidential survey querying SSC practices. Responses were compared by delivery size, location, and nature of affiliation. Statistics analyzed by chi-square and student t-test. Results. Of these 64/95 MCs (67%) responded. All allowed SSC after vaginal deliveries, 55% after C-section, 73% mother's room. Monitoring included delivery room nurse (94%) with support from other providers (61%), family members (37%), and electronic monitoring (5%). If SSC occurred in mother's room all reported family education on safe practices. 40% were aware of adverse SSC events, including falls and suffocation. About 80% educated staff about infant safety during SSC. Conclusions. Gaps in education and supervision during SSC were identified. Additional education and standardization of best practices are needed to reduce risks from falls and suffocation during SSC.
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Affiliation(s)
- Eileen Tyrala
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Erich Batra
- PennState College of Medicine, Hershey, PA, USA
| | | | | | - Ted Bell
- WellSpan York Hospital, York, PA, USA
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14
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Rodríguez-López J, De la Cruz Bértolo J, García-Lara NR, Núñez Vecino JL, Soriano-Ramos M, Asla Elorriaga I, Román Echevarría L, Pellicer A, Marín Huarte N, Vento M, Parra-Llorca A, Cabañas F, González Sánchez R, García-Algar Ó, Martín-Ancel A, Copons Fernández C, González Carrasco E, Beato M, Pallás-Alonso CR. Mother's Bed Incline and Desaturation Episodes in Healthy Term Newborns during Early Skin-to-Skin Contact: A Multicenter Randomized Controlled Trial. Neonatology 2021; 118:702-709. [PMID: 34695832 DOI: 10.1159/000519387] [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: 04/29/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Early skin-to-skin contact (ESSC) is associated with rare, sudden, unexpected postnatal collapse episodes. Placing the newborn in ESSC closer to an upright position may reduce the risk of airway obstruction and improve respiratory mechanics. This study assessed whether a greater inclination of the mother's bed during ESSC would reduce the proportion of healthy term newborns (HTNs) who experienced episodes of pulse oximeter saturation (SpO2) <91%. METHODS We conducted a multicenter randomized controlled trial comparing the effect of the mother's bed incline, 45° versus 15°, on desaturation in HTNs during ESSC. Before delivery on 1,271 dyads, randomization was conducted, and stringent criteria to select healthy mothers and term newborns were monitored until after birth. Preductal SpO2 was continuously monitored between 10 min and 2 h after birth. The primary outcome was the occurrence of at least one episode of SpO2 <91%. RESULTS 254 (20%) mother-infant dyads were eligible for analysis (45°, n = 126; 15°, n = 128). Overall, 57% (95% confidence interval [CI]: 51%-63%) of newborns showed episodes of SpO2 <91%. The proportion of infants with SpO2 <91% episodes was 52% in 45° and 62% in 15° (relative risk: 0.80; 95% CI: 0.6-1.07). CONCLUSIONS We did not show that a high mother bed inclination during ESSC led to significantly fewer HTNs who experienced episodes of SpO2 <91%. Desaturation episodes from 10 min to 2 h after birth occurred in more than half of HTNs.
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Affiliation(s)
- Jesús Rodríguez-López
- Department of Neonatology, Health Research Institute Imas12, Complutense University, Madrid, Spain
| | | | - Nadia Raquel García-Lara
- Department of Neonatology, Health Research Institute Imas12, Complutense University, Madrid, Spain
| | - José Luis Núñez Vecino
- Department of Neonatology, Health Research Institute Imas12, Complutense University, Madrid, Spain
| | - María Soriano-Ramos
- Department of Neonatology, Health Research Institute Imas12, Complutense University, Madrid, Spain
| | | | | | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, 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
| | - Raquel González Sánchez
- Department of Pediatrics and Neonatology, Quirónsalud Madrid University Hospital, Madrid, Spain
| | - Óscar García-Algar
- Neonatology Unit, ICGON, IDIBAPS, Hospital Clinic-Maternitat, Barcelona, Spain
| | - Ana Martín-Ancel
- Neonatology Unit, Sant Joan de Déu University Hospital and Clínic University Hospital, Barcelona, Spain
| | | | | | - Maite Beato
- Neonatology Unit, Severo Ochoa University Hospital, Madrid, Spain
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Reiss J, Upadhyayula PS, You H, Xu R, Stellwagen LM. Short-Term Outcomes following Standardized Admission of Late Preterm Infants to Family-Centered Care. Am J Perinatol 2021; 38:131-139. [PMID: 31430819 DOI: 10.1055/s-0039-1694981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The study compares the short-term outcomes of late preterm infants (LPI) at an academic center in San Diego, California after a change in protocol that eliminated a previously mandatory 12-hour neonatal intensive care unit (NICU) observation period after birth. STUDY DESIGN This is a retrospective observational study examining all LPI born with gestational age 35 to 366/7 weeks between October 1, 2016 and October 31, 2017. A total of 189 infants were included in the review. Short-term outcomes were analyzed before and after the protocol change. RESULTS Transfers to the NICU from family-centered care (FCC) were considerably higher (23.2%) following the protocol change, compared to before (8.2%). More infants were transferred to the NICU for failed car seat tests postprotocol compared to preprotocol. Length of stay before the protocol change was 5.13 days compared to 4.80 days after. CONCLUSION LPI are vulnerable to morbidities after delivery and through discharge. We found an increase in failed car seat tests in LPI cared for in FCC after elimination of a mandatory NICU observation after birth. The transitions of care from delivery to discharge are key checkpoints in minimizing complications.
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Affiliation(s)
- Jonathan Reiss
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | | | - Hyeri You
- University of California San Diego Altman Clinical and Translational Research Institute, Biostatistics Unit, La Jolla, California
| | - Ronghui Xu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.,Department of Mathematics, University of California San Diego, La Jolla, California
| | - Lisa M Stellwagen
- Division of Academic General Pediatrics, Department of Pediatrics, University of California San Diego, La Jolla, California
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16
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Nadjafizadeh M, Caron FM. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Newborn care in the delivery room]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:944-952. [PMID: 33011378 DOI: 10.1016/j.gofs.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The purpose of this literature review is to make recommendations regarding the first steps and care provided to the healthy newborn. METHODS Consultation of the Medline database, and of national and international guidelines. RESULTS The initial assessment of the newborn should quickly determine whether resuscitation is necessary or not. Any anomaly requires the help of the pediatrician (Consensus agreement). For a newborn with no cardiorespiratory adaptation, delayed cord clamping may be considered more as a physiological modality of delivery, which may help prevent iron deficiency in the first months of life, without deleterious effects for the child or his/her mother, apart from a slightly increased risk of neonatal jaundice (gradeC). In order to avoid separating a woman and her child, it is recommended to postpone routine postnatal procedures, to allow for skin-to-skin contact between the mother and the newborn, if she wishes, according to a defined/specified surveillance protocol (grade B). Breastfeeding should be encouraged, and supported, especially the first time (Consensus agreement). In the absence of suggestive clinical signs, aspiration of the upper airways and systematic verification of the permeability of posterior nasal apertures and of the esophagus are not recommended (Consensus agreement). The prevention of hemorrhagic disease of the newborn by the oral administration of vitamin K1 to all healthy term babies begins in the delivery room, preferably in the presence of the parents and after having obtained their consent (Consensus agreement). CONCLUSION Regarding the birth of a healthy newborn, it is strongly advised to avoid unnecessary technical actions and to favor the mother-child relationship in a safe environment.
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Affiliation(s)
- M Nadjafizadeh
- Département Universitaire de Maieutique, UFR de Médecine, Université de Lorraine, 54505 Vandoeuvre-les-Nancy, France; CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France.
| | - F-M Caron
- Pôle femme enfant Victor-Pauchet, 80000 Amiens, France
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Sudden Unexpected Postnatal Collapse in Healthy Term Newborns: AWHONN Practice Brief Number 8. J Obstet Gynecol Neonatal Nurs 2020; 49:388-390. [DOI: 10.1016/j.jogn.2020.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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18
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Sudden Unexpected Postnatal Collapse in Healthy Term Newborns: AWHONN Practice Brief Number 8. Nurs Womens Health 2020; 24:300-302. [PMID: 32600920 DOI: 10.1016/j.nwh.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Alhaboob AA. Clinical Characteristics and Outcomes of Patients Admitted with Brief Resolved Unexplained Events to a Tertiary Care Pediatric Intensive Care Unit. Cureus 2020; 12:e8664. [PMID: 32699664 PMCID: PMC7370642 DOI: 10.7759/cureus.8664] [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] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to determine outcomes of patients admitted to a tertiary care pediatric intensive care unit (PICU) with brief, resolved, unexplained event (BRUE), and to review the diagnostic and treatment options utilized for such patients. A retrospective data analysis was conducted for infants and children who were admitted to the PICU at a tertiary hospital with a diagnosis of BRUE over a period of three years (2015-2017). The study included 30 infants, 15 males, and 15 females. All patients survived to hospital discharge. The most frequent presenting symptoms and signs were apnea (73.3%), cyanosis (60.0%), and cough (20.0%). The most frequent reported affected systems were respiratory (33.3%), gastrointestinal (20%), and infection-related illness (20.0%). We conclude that the careful history taking, complete physical examination, and the appropriate workup for patients with BRUE play an integral role in optimum health service and utilization of critical care beds. Survival to hospital discharge with no serious in-hospital events warrants the adaptation of evidence-based medicine guidelines to stratify such patients based on the risk of recurrence or a serious underlying condition. Prospective multicenter studies are recommended to explore the effectiveness of such guidelines implementation on outcomes and diagnostic testing in such patients to optimize the utilization of the limited critical care beds.
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Miyazawa T, Itabashi K, Tamura M, Suzuki H, Ikenoue T. Unsupervised breastfeeding was related to sudden unexpected postnatal collapse during early skin-to-skin contact in cerebral palsy cases. Acta Paediatr 2020; 109:1154-1161. [PMID: 31385353 PMCID: PMC7318205 DOI: 10.1111/apa.14961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/12/2019] [Accepted: 08/02/2019] [Indexed: 12/02/2022]
Abstract
AIM This study aimed to identify the clinical features of infants who were healthy at birth, but developed sudden unexpected collapse and were then diagnosed with cerebral palsy before 5 years of age. METHODS We retrospectively analysed 1182 records from the no-fault Japan Obstetric Compensation System for Cerebral Palsy database up to 2016. This identified 45 subjects (3.8%) who were subsequently diagnosed with severe cerebral palsy due to sudden unexpected postnatal collapse (SUPC). They were all healthy at birth, based on the criteria of five-minute Apgar scores of seven or more, with normal umbilical cord blood gases and no need for neonatal resuscitation within five minutes of birth. RESULTS The median birth weight of the 45 subjects (26 males) was 2770 g (range 2006-3695 g). Of these, 10 developed SUPC during early skin-to-skin contact (SSC). Medical personnel were not present in all 10 cases: nine were being breastfed at the time and eight of the mothers did not notice their infant's abnormal condition until medical staff alerted them. CONCLUSION This national study of children with cerebral palsy who appeared healthy at birth found that unsupervised breastfeeding was a common factor in cases of SUPC during early SSC.
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Affiliation(s)
- Tokuo Miyazawa
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated FoundationJapan Council for Quality Health CareTokyoJapan
- Department of PediatricsShowa University School of MedicineTokyoJapan
| | | | - Masanori Tamura
- Department of PediatricsSaitama Medical CenterSaitama Medical UniversityKawagoeJapan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated FoundationJapan Council for Quality Health CareTokyoJapan
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21
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Burgmann DM, Foerster K, Klemme M, Delius M, Hübener C, Wisskott R, Boulesteix AL, Flemmer AW. Delivery room desaturations and bradycardia in the early postnatal period of healthy term neonates - a prospective observational study. J Matern Fetal Neonatal Med 2020; 35:1457-1461. [PMID: 32375581 DOI: 10.1080/14767058.2020.1757064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE It has been suggested that desaturations and bradycardia precede acute life-threatening events (ALTE) and that ALTE is more common in the delivery room than later in life. However, frequency, duration and severity of desaturations in the first hours of life and additional risk factors have not readily been studied. METHODS Term neonates (n = 100) were monitored for the first two hours after birth by pulse oximetry. The impact of maternal and perinatal factors on the frequency and severity of desaturations (<85%) and bradycardia (<80/min) was evaluated. RESULTS Desaturations were detected in 30%, prolonged desaturations in 25% of infants. Desaturations were observed significantly more often in infants born by planned Cesarean section (pCs) compared to other modes of delivery (pCs 20/49; others 10/51; p = .029). Desaturations were also more frequent in infants diagnosed with neonatal infection (NI) or infants born to a mother with gestational diabetes (GDM), although not significantly. No bradycardia <80/min was detected. CONCLUSIONS In our collective 4% of healthy term neonates had prolonged, clinically relevant desaturations in the first hours after birth. The mode of delivery and maternal risk factors may increase the risk for these events. However, our cohort was too small to detect any ALTE or SIDS and determine potential risk factors for these events. Our data lay ground for a large-scale prospective trial to investigate whether the mode of delivery could be an indication for general pulse oximetry monitoring of newborn in the delivery room.
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Affiliation(s)
- D-M Burgmann
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - K Foerster
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - M Klemme
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - M Delius
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - C Hübener
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - R Wisskott
- Department of Medical Information Processing, Biometry and Epidemiology, University Hospital, LMU Munich, Munich, Germany
| | - A L Boulesteix
- Department of Medical Information Processing, Biometry and Epidemiology, University Hospital, LMU Munich, Munich, Germany
| | - A W Flemmer
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
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Bartick M, Boisvert ME, Philipp BL, Feldman-Winter L. Trends in Breastfeeding Interventions, Skin-to-Skin Care, and Sudden Infant Death in the First 6 Days after Birth. J Pediatr 2020; 218:11-15. [PMID: 31753326 DOI: 10.1016/j.jpeds.2019.09.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/28/2019] [Accepted: 09/25/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine if implementation of skin-to-skin care and the Baby-Friendly Hospital Initiative (BFHI) contributes to sudden unexpected infant death (SUID) and asphyxia in the first 6 days after birth. STUDY DESIGN Survey data were used to determine a correlation between BFHI and deaths from SUID and asphyxia among infants <7 days in the US and Massachusetts. Using data from the Centers for Disease Control and Prevention, implementation of BFHI was tracked from 2004-2016 and skin-to-skin care was tracked from 2007-2015. Using data from Centers for Disease Control and Prevention WONDER and the Massachusetts Department of Public Health, SUID and asphyxia were tracked from 2004-2016. RESULTS Nationally, births in Baby-Friendly facilities rose from 1.8% to 18.3% and the percentage of facilities in which most dyads experienced skin-to-skin care rose from 40% to 83%. SUID prevalence among infants <7 days was rare (0.72% of neonatal deaths) and decreased significantly from 2004-2009 compared with 2010-2016, from 0.033 per 1000 live births to 0.028, OR 0.85 (95% CI 0.77, 0.94). In Massachusetts, births in Baby-Friendly facilities rose from 2.8% to 13.9% and skin-to-skin care rose from 50% to 97.8%. SUID prevalence decreased from 2010-2016 compared with 2004-2009: OR 0.32 (95% CI 0.13, 0.82), with 0 asphyxia deaths during the 13-year period. CONCLUSION Increasing rates of breastfeeding initiatives and skin-to-skin care are temporally associated with decreasing SUID prevalence in the first 6 days after birth in the US and Massachusetts.
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Affiliation(s)
- Melissa Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA.
| | | | - Barbara L Philipp
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Lori Feldman-Winter
- Department of Pediatrics, Cooper Medical School of Rowan University, Camden, NJ
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Abstract
Objective: The goal of this study was to verify the details of neonatal respiratory inhibition (NRI) in healthy infants.Methods: We screened for NRI in 521 infants who weighed at least 2000 g and who were born at a gestational age of at least 36 weeks. Respiratory inhibition was defined as severe hypoxemia, accompanied by clinical manifestations of central cyanosis and a decrease in SpO2 to less than 70%. NRI consists of feeding hypoxemia, respiratory inhibition after crying (RIAC), and respiratory inhibition after gastroesophageal reflux (RIGER). The subjects were monitored continuously via pulse oximetry from birth until discharge. To identify the details of NRI, we analyzed detailed notes taken by both parents and medical staff during monitoring using specific software designed to interpret pulse oximetry measurements. The mothers of infants with feeding hypoxemia received nursing guidance.Results: NRI was observed in 268 (51.4%) infants (feeding hypoxemia in 227 (43.6%); RIAC in 121 (23.2%); and RIGER in 12 (2.3%)). Among perinatal factors, NRI was related to diabetes mellitus (p = .008; odds ratio = 3.290; 95% CI: 1.371-7.895), twin pregnancy (p = .032; odds ratio = 2.061; 95% CI: 1.062-3.998), and cesarean section (p = .036; odds ratio = 1.537; 95% CI: 1.027-2.299) using multiple logistic regression analysis. Almost all infants with RIAC and RIGER, even those with severe cases, recovered until discharge. However, 93 (41.0%) infants with feeding hypoxemia needed additional feeding control after being discharged. Despite the provision of nursing guidance in feeding control, 143 (63.0%) infants experienced feeding hypoxemia continuously. The more frequently the infants experienced feeding hypoxemia, the more severe the degree of feeding hypoxemia became. Breastfeeding reduced the frequency and degree of feeding hypoxemia compared to bottle-feeding.Conclusions: NRI was often observed in healthy infants. Breastfeeding and careful feeding control should be recommended to mothers of infants with repeated feeding hypoxemia.
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Affiliation(s)
- Hideki Minowa
- Department of Neonatal Intensive Care Unit, Nara Prefecture General Medical Center, Nara, Japan
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Echeverría-Palacio CM, Agut T, Arnaez J, Valls A, Reyne M, Garcia-Alix A. Neuron-Specific Enolase in Cerebrospinal Fluid Predicts Brain Injury After Sudden Unexpected Postnatal Collapse. Pediatr Neurol 2019; 101:71-77. [PMID: 31023601 DOI: 10.1016/j.pediatrneurol.2019.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Biomarkers of brain injury with high predictive value in newborns in critical neurological status are increasingly required. Neuron-specific enolase in cerebrospinal fluid has been shown to be highly predictive in newborns with perinatal hypoxic-ischemic encephalopathy, but its utility has not been examined in sudden unexpected postnatal collapse. PURPOSE We analyzed whether the levels of neuron-specific enolase in cerebrospinal fluid can be a useful biomarker to estimate the severity of brain injury in neonates after a sudden unexpected postnatal collapse. METHODS This is a prospective observational study of near-term infants who were consecutively admitted with sudden unexpected postnatal collapse in two neonatal intensive care units during a nine-year period. Variables were collected and analyzed regarding the perinatal period, clinical course, severity of encephalopathy, amplitude-integrated encephalography, magnetic resonance imaging findings, and outcome. Neuron-specific enolase in cerebrospinal fluid samples were obtained in 18 infants with sudden unexpected postnatal collapse between 12 and 72 hours after the collapse and compared with those of 29 controls. RESULTS The levels of neuron-specific enolase in cerebrospinal fluid were higher in patients than in controls (P < 0.001). Levels of neuron-specific enolase in cerebrospinal fluid in infants with sudden unexpected postnatal collapse were significantly higher in patients who presented severe encephalopathy, seizures, abnormal amplitude-integrated encephalography background, or brain injury on magnetic resonance imaging. Receiver operator characteristic curve analysis revealed a neuron-specific enolase in cerebrospinal fluid cutoff value of maximum predictive accuracy of 61 ng/mL (area under the curve, 1.0; sensitivity, specificity, positive predictive value, and negative predictive value, 100%) for identifying infants who died or had adverse outcomes. CONCLUSIONS Levels of neuron-specific enolase in cerebrospinal fluid obtained between 12 and 72 hours after a sudden unexpected postnatal collapse event seem to be a useful biomarker for identifying newborns with severe brain injury and for predicting outcome.
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Affiliation(s)
- Carlos Mario Echeverría-Palacio
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain; Research Group "Neuroped-UNAL", School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Thais Agut
- Department of Neonatology, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Juan Arnaez
- Department of Neonatology, Hospital Universitario de Burgos, Burgos, Spain; Fundación NeNe, Spain
| | - Ana Valls
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mar Reyne
- Department of Neonatology, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Alfredo Garcia-Alix
- Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; CIBERER. U724, Madrid, Spain; Fundación NeNe, Spain.
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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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Barbaglia M, Finale E, Noce S, Vigo A, Arioni C, Visentin R, Scurati-Manzoni E, Guala A. Skin-to-skin contact and delivery room practices: a longitudinal survey conducted in Piedmont and the Aosta Valley. Ital J Pediatr 2019; 45:95. [PMID: 31375123 PMCID: PMC6679473 DOI: 10.1186/s13052-019-0688-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/24/2019] [Indexed: 01/25/2023] Open
Abstract
Background Sudden unexpected postnatal collapse of presumably healthy neonates during early skin-to-skin contact is a rare, yet recognized occurrence, associated with a high risk of mortality and morbidity. A survey was conducted in 2012 in 30 delivery wards throughout Piedmont and the Aosta Valley to evaluate the environmental and logistical aspects that could be linked to SUPC. The survey was again conducted in 2016 in 28 delivery wards in Piedmont and the Aosta Valley in order to evaluate organizational improvements introduced after ministerial indications and recommendations by the Italian Society of Neonatology were published in 2014, in light of new findings regarding the phenomenon. Methods A questionnaire specifically asking about the organization of delivery wards, and surveillance or supervision during early skin-to-skin contact, was sent to all of the hospitals taking part in the survey in both 2012 and 2016. The collected data were elaborated anonymously and the statistical analysis was performed by using the two by two table. Results In 2012, 28 out of 30 delivery wards in Piedmont and Aosta, with a total of 31,074 newborns out of 35,435, were evaluated in all of the environmental and logistical aspects that might be cause for SUPC to occur. An identical survey was taken again in 2016; 26 out of 28 wards participated with a total of 27,484 newborns out of 30,339. In 2012, early skin-to-skin contact took place immediately in all the delivery rooms in 27 wards, and soon after in the post-partum room in one; in 11 out of 28 wards there was early skin-to-skin contact in the operating theater itself, following caesarean sections (11/26 in 2016). Routine newborn care was given after 3 h in 8 delivery wards (7/26 in 2016); after 2 h in 12 (7/26 in 2016); after 1 h in 2 (4/26 in 2016); after 30 min in 3 (2/26 in 2016); after 10 min in 1 (0/26 in 2016); after 1 or 2 min in 1 (0/26 in 2016) and at any time in one ward (6/26 in 2016). Conclusion Periodic surveys of delivery wards are useful for the assessment of all the aspects and risk factors that need to be changed in order to implement safe early skin-to-skin contact. Electronic supplementary material The online version of this article (10.1186/s13052-019-0688-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelangelo Barbaglia
- Struttura Complessa Pediatria, Ospedale Castelli, Azienda Sanitaria Locale VCO, Verbania, Italy
| | - Enrico Finale
- Struttura Complessa Pediatria, Ospedale Castelli, Azienda Sanitaria Locale VCO, Verbania, Italy. .,Dipartimento Materno Infantile VCO, Ospedale Castelli, Verbania, Italy.
| | - Silvia Noce
- Centro di Riferimento Regionale per la SIDS, ASO/ OIRM/Sant'Anna, Torino, Italy
| | - Alessandro Vigo
- Centro di Riferimento Regionale per la SIDS, ASO/ OIRM/Sant'Anna, Torino, Italy
| | - Cesare Arioni
- Struttura Complessa Pediatria, Ospedale Umberto Parini, Azienda Sanitaria Locale della Valle d'Aosta, Aosta, Italy
| | - Raffaella Visentin
- Struttura Complessa Pediatria, Ospedale Castelli, Azienda Sanitaria Locale VCO, Verbania, Italy
| | | | - Andrea Guala
- Struttura Complessa Pediatria, Ospedale Castelli, Azienda Sanitaria Locale VCO, Verbania, Italy
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Development of a single-center quality bundle to prevent sudden unexpected postnatal collapse. J Perinatol 2019; 39:1008-1013. [PMID: 31089255 DOI: 10.1038/s41372-019-0393-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/03/2019] [Accepted: 04/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recent reports suggest a rising awareness of sudden unexpected postnatal collapse (SUPC). LOCAL PROBLEM Five SUPC events during a 17-month period. METHODS A multidisciplinary team used a quality-improvement approach to develop the intervention. The smart aim was to develop a bundled intervention to eliminate SUPC from occurring in the delivery room during skin-to-skin care. INTERVENTION A bundled intervention included a standardized assessment tool and measurement of oxygen saturation levels, with prescribed responses to abnormal values, during skin-to-skin care in the delivery room. RESULTS Pre-intervention, there were five SUPC events/9143 live births (incidence 0.54/1000 live births) compared with 0 SUPC events/13,964 live births post intervention, p = 0.011. Special cause variation was achieved after implementation when the number of deliveries between SUPC events exceeded 3-sigma. CONCLUSION A bundled approach to monitoring during skin-to-skin care, including measurement of oxygen saturation, was associated with no additional cases of SUPC.
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Joshi NS, Gupta A, Allan JM, Cohen RS, Aby JL, Kim JL, Benitz WE, Frymoyer A. Management of Chorioamnionitis-Exposed Infants in the Newborn Nursery Using a Clinical Examination-Based Approach. Hosp Pediatr 2019; 9:227-233. [PMID: 30833294 DOI: 10.1542/hpeds.2018-0201] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Antibiotic use in well-appearing late preterm and term chorioamnionitis-exposed (CE) infants was reduced by 88% after the adoption of a care approach that was focused on clinical monitoring in the intensive care nursery to determine the need for antibiotics. However, this approach continued to separate mothers and infants. We aimed to reduce maternal-infant separation while continuing to use a clinical examination-based approach to identify early-onset sepsis (EOS) in CE infants. METHODS Within a quality improvement framework, well-appearing CE infants ≥35 weeks' gestation were monitored clinically while in couplet care in the postpartum unit without laboratory testing or empirical antibiotics. Clinical monitoring included physician examination at birth and nurse examinations every 30 minutes for 2 hours and then every 4 hours until 24 hours of life. Infants who developed clinical signs of illness were further evaluated and/or treated with antibiotics. Antibiotic use, laboratory testing, and clinical outcomes were collected. RESULTS Among 319 initially well-appearing CE infants, 15 (4.7%) received antibiotics, 23 (7.2%) underwent laboratory testing, and 295 (92.5%) remained with their mothers in couplet care throughout the birth hospitalization. One infant had group B Streptococcus EOS identified and treated at 24 hours of age based on new-onset tachypnea and had an uncomplicated course. CONCLUSIONS Management of well-appearing CE infants by using a clinical examination-based approach during couplet care in the postpartum unit maintained low rates of laboratory testing and antibiotic use and markedly reduced mother-infant separation without adverse events. A framework for repeated clinical assessments is an essential component of identifying infants with EOS.
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Affiliation(s)
- Neha S Joshi
- Department of Pediatrics, Stanford University, Stanford, California; and
| | - Arun Gupta
- Department of Pediatrics, Stanford University, Stanford, California; and
| | | | - Ronald S Cohen
- Department of Pediatrics, Stanford University, Stanford, California; and
| | - Janelle L Aby
- Department of Pediatrics, Stanford University, Stanford, California; and
| | | | - William E Benitz
- Department of Pediatrics, Stanford University, Stanford, California; and
| | - Adam Frymoyer
- Department of Pediatrics, Stanford University, Stanford, California; and
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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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Abstract
This review of Sudden Unexpected Postnatal Collapse (SUPC) highlights the challenges in definition and nomenclature that currently exist. In comparing SUPC with Sudden Unexpected Death in Infancy (SUDI), the potentially avoidable nature of many SUPC is emphasised and the role of positioning and public awareness explored. The article focusses on the implementation of preventative strategies in the immediate postnatal period and the role of therapeutic hypothermia in ameliorating long term neurological injury.
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Affiliation(s)
- Vix Monnelly
- Department of Neonatology, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, EH16 4SA, United Kingdom.
| | - Julie-Clare Becher
- Department of Neonatology, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, EH16 4SA, United Kingdom.
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Abstract
INTRODUCTION An apparent life-threatening event (ALTE) is defined as "an episode that is frightening to the observer and is characterized by some combination of apnea, color change, marked change of muscle tone, choking, or gagging." OBJECTIVE The aims of this study were to determine etiology and outcome of severe ALTE (requiring resuscitation measures) and to review diagnostic approaches in infants hospitalized after such an episode of ALTE. METHODS Retrospective analysis included patients hospitalized at the Intensive Care Unit, Institute of Child and Youth Healthcare of Vojvodina, after an episode of severe ALTE over a 4-year period. RESULTS The study included 23 infants, 18 male (78.3%), and 5 female (21.7%). The average age at presentation was 78 days (1 day to 11 months). In 8 infants (34.7%), ALTE resulted in death. The most frequent conditions after diagnostic evaluation were lower respiratory tract infections (39.1%), intracranial and extracranial hemorrhages (13.0%), and central nervous system infections (8.6%). The cause remained unknown in 8.7% of cases. Initial investigations included complete blood cell count, C-reactive protein or procalcitonin, blood gasses, lactate, electrolytes, glucose, blood culture, urinalysis, and chest x-ray. CONCLUSIONS Apparent life-threatening event represents a diverse disorder. Lower respiratory tract infections and neurological disorders were the most common established etiology. Prematurity and congenital heart diseases stood out as important risk factors. Diagnostic evaluation varied according to suspected cause and trigger factors.
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The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature. J Perinatol 2018; 38:623-632. [PMID: 29416115 DOI: 10.1038/s41372-018-0068-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/01/2018] [Accepted: 01/18/2018] [Indexed: 11/08/2022]
Abstract
There is no doubt regarding the multiple benefits of breastfeeding for infants and society in general. Therefore, the World Health Organization (WHO) in a conjoint effort with United Nations International Children's Emergency Fund (UNICEF) developed the "Ten Steps to Successful Breastfeeding" in 1992, which became the backbone of the Baby Friendly Hospital Initiative (BFHI). Following this development, many hospitals and countries intensified their position towards creating a "breastfeeding oriented" practice. Over the past two decades, the interest increased in the BFHI and the Ten Steps. However, alongside the implementation of the initiative, extensive research continues to evaluate the benefits and dangers of the suggested practices. Hence, it is our intention to make a critical evaluation of the current BFHI and the Ten Steps recommendations in consideration of the importance of providing an evidence-based breastfeeding supported environment for our mothers and infants.
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Bass JL, Gartley T, Lyczkowski DA, Kleinman R. Trends in the Incidence of Sudden Unexpected Infant Death in the Newborn: 1995-2014. J Pediatr 2018; 196:104-108. [PMID: 29452740 DOI: 10.1016/j.jpeds.2017.12.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the epidemiology of sudden unexpected infant death (SUID) over a 20-year period in the US, to assess the potential frequency of sudden unexpected postnatal collapse in the early days of life, and to determine if SUID rates in the neonatal period (0-27 days) have changed in parallel with rates in the postneonatal periods, including the percentages attributed to codes that include accidental suffocation. STUDY DESIGN Data from the US Centers for Disease Control and Prevention Linked Birth/Infant Death Records for 1995-2014 were analyzed for the first hour, day, week, and month of life. A comparison of neonatal and postneonatal data related to SUID, including accidental suffocation, was carried out. RESULTS Death records for 1995-2014 indicate that, although SUID rates in the postneonatal period have declined subsequent to the 1992 American Academy of Pediatrics sleep position policy change, newborn SUIDs have failed to decrease, and the percentage of SUIDs attributed to unsafe sleep conditions has increased significantly in both periods; 29.2% of the neonatal cases occurred within the first 6 days of life. CONCLUSIONS The frequency of SUIDs during the neonatal period warrants ongoing attention to all circumstances contributing to this category of deaths. The development of a standardized definition of sudden unexpected postnatal collapse and a national registry of these events is recommended. Ongoing research on the effects of early neonatal practices on postneonatal SUID should also be encouraged.
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Affiliation(s)
- Joel L Bass
- Department of Pediatrics, Newton-Wellesley Hospital, Newton, MA.
| | - Tina Gartley
- Department of Pediatrics, Newton-Wellesley Hospital, Newton, MA
| | | | - Ronald Kleinman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
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Piumelli R, Davanzo R, Nassi N, Salvatore S, Arzilli C, Peruzzi M, Agosti M, Palmieri A, Paglietti MG, Nosetti L, Pomo R, De Luca F, Rimini A, De Masi S, Costabel S, Cavarretta V, Cremante A, Cardinale F, Cutrera R. Apparent Life-Threatening Events (ALTE): Italian guidelines. Ital J Pediatr 2017; 43:111. [PMID: 29233182 PMCID: PMC5728046 DOI: 10.1186/s13052-017-0429-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/22/2017] [Indexed: 02/07/2023] Open
Abstract
Five years after the first edition, we have revised and updated the guidelines, re-examining the queries and relative recommendations, expanding the issues addressed with the introduction of a new entity, recently proposed by the American Academy of Pediatrics: BRUE, an acronym for Brief Resolved Unexplained Events. In this manuscript we will use the term BRUE only to refer to mild, idiopathic cases rather than simply replace the acronym ALTE per se.In our guidelines the acronym ALTE is used for severe cases that are unexplainable after the first and second level examinations.Although the term ALTE can be used to describe the common symptoms at the onset, whenever the aetiology is ascertained, the final diagnosis may be better specified as seizures, gastroesophageal reflux, infection, arrhythmia, etc. Lastly, we have addressed the emerging problem of the so-called Sudden Unexpected Postnatal Collapse (SUPC), that might be considered as a severe ALTE occurring in the first week of life.
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Affiliation(s)
- Raffaele Piumelli
- Sleep Breathing Disorders and SIDS Center, Meyer Children's Hospital, Firenze, Italy.
| | - Riccardo Davanzo
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Niccolò Nassi
- Sleep Breathing Disorders and SIDS Center, Meyer Children's Hospital, Firenze, Italy
| | | | - Cinzia Arzilli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Firenze, Italy
| | - Marta Peruzzi
- Sleep Breathing Disorders and SIDS Center, Meyer Children's Hospital, Firenze, Italy
| | - Massimo Agosti
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy
| | - Antonella Palmieri
- SIDS Center, Pediatric Emergency Department, "G. Gaslini" Children's Hospital, Genova, Italy
| | - Maria Giovanna Paglietti
- Pneumology Unit - University Hospital Pediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Luana Nosetti
- Paediatric Department, University of Insubria, Varese, Italy
| | - Raffaele Pomo
- SIDS/ALTE Center, Buccheri la Ferla Hospital, Palermo, Italy
| | | | | | | | - Simona Costabel
- Emergency Department of Paediatrics, G. Gaslini Children's Hospital, Genova, Italy
| | | | - Anna Cremante
- National Neurological Institute IRCCS C, Mondino, Pavia, Italy
| | | | - Renato Cutrera
- Pneumology Unit - University Hospital Pediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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Abstract
Whereas apnea of prematurity has been well defined and its pathophysiology extensively studied, apnea in the term infant remains a greater challenge. Unfortunately, clear diagnostic criteria are lacking and pathogenesis and management vary widely. In this review we have arbitrarily organized the discussion chronologically into earlier and later postnatal periods. In the first days of life, presumed apnea may reflect physiologic events such as positional or feeding etiologies, or may be a manifestation of serious pathophysiology, such as a seizure disorder. Beyond the neonatal period, presumed apnea may be characterized as a BRUE event (brief resolved unexplained event; formerly referred to as ALTE: apparent life-threatening event) and most frequently a precipitating event cannot be identified. Medical providers are left with somewhat of a dilemma regarding the need to hospitalize and/or work up such patients.
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Lehtonen L, Gimeno A, Parra-Llorca A, Vento M. Early neonatal death: A challenge worldwide. Semin Fetal Neonatal Med 2017; 22:153-160. [PMID: 28238633 DOI: 10.1016/j.siny.2017.02.006] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Early neonatal death (ENND), defined as the death of a newborn between zero and seven days after birth, represents 73% of all postnatal deaths worldwide. Despite a 50% reduction in childhood mortality, reduction of ENND has significantly lagged behind other Millennium Developmental Goal achievements and is a growing contributor to overall mortality in children aged <5 years. The etiology of ENND is closely related to the level of a country's industrialization. Hence, prematurity and congenital anomalies are the leading causes in high-income countries. Furthermore, sudden unexpected early neonatal deaths (SUEND) and collapse have only recently been identified as relevant and often preventable causes of death. Concomitantly, perinatal-related events such as asphyxia and infections are extremely relevant in Africa, South East Asia, and Latin America and, together with prematurity, are the principal contributors to ENND. In high-income countries, according to current research evidence, survival may be improved by applying antenatal and perinatal therapies and immediate newborn resuscitation, as well as by centralizing at-risk deliveries to centers with appropriate expertise available around the clock. In addition, resources should be allocated to the close surveillance of newborn infants, especially during the first hours of life. Many of the conditions leading to ENND in low-income countries are preventable with relatively easy and cost-effective interventions such as contraception, vaccination of pregnant women, hygienic delivery at a hospital, training health care workers in resuscitation practices, simplified algorithms that allow for early detection of perinatal infections, and early initiation of breastfeeding and skin-to-skin care. The future is promising. As initiatives undertaken in previous decades have led to substantial reduction in childhood mortality, it is expected that new initiatives targeting the perinatal/neonatal periods are bound to reduce ENND and provide these babies with a better future.
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Affiliation(s)
- Liisa Lehtonen
- Division of Neonatology, Turku University Hospital, Turku, Finland; University of Turku, Turku, Finland
| | - Ana Gimeno
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Máximo Vento
- Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain; Health Research Institute La Fe, Valencia, Spain.
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Implementing Skin-to-Skin Contact for Cesarean Birth. AORN J 2017; 105:579-592. [DOI: 10.1016/j.aorn.2017.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/19/2016] [Accepted: 04/10/2017] [Indexed: 11/24/2022]
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Plötzlicher Kindstod und anscheinend lebensbedrohliche Ereignisse. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hubbard JM, Gattman KR. Parent-Infant Skin-to-Skin Contact Following Birth: History, Benefits, and Challenges. Neonatal Netw 2017; 36:89-97. [PMID: 28320495 DOI: 10.1891/0730-0832.36.2.89] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
It is a practice with strong roots in nature and has a significant influence on health outcomes, particularly for at-risk newborns in low-resource settings. In this comprehensive review, benefits of SSC for newborns, mothers, and fathers after vaginal and cesarean births are discussed as well as the benefits of SSC observed for infants in the NICU. Barriers to SSC practice implementation are discussed, and proposed solutions and recommendations are offered. By understanding the many benefits of SSC and strategies for implementation, health care providers can best support and promote this high-quality, evidence-based practice with mothers, newborns, and their families.
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Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2016; 11:CD003519. [PMID: 27885658 PMCID: PMC6464366 DOI: 10.1002/14651858.cd003519.pub4] [Citation(s) in RCA: 324] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior. OBJECTIVES To assess the effects of immediate or early SSC for healthy newborn infants compared to standard contact on establishment and maintenance of breastfeeding and infant physiology. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 December 2015), made personal contact with trialists, consulted the bibliography on kangaroo mother care (KMC) maintained by Dr Susan Ludington, and reviewed reference lists of retrieved studies. SELECTION CRITERIA Randomized controlled trials that compared immediate or early SSC with usual hospital care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups. Results for womenSSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07 to 1.43; participants = 887; studies = 14; I² = 41%; GRADE: moderate quality). SSC women also breast fed their infants longer, though data were limited (mean difference (MD) 64 days, 95% CI 37.96 to 89.50; participants = 264; studies = six; GRADE:low quality); this result was from a sensitivity analysis excluding one trial contributing all of the heterogeneity in the primary analysis. SSC women were probably more likely to exclusively breast feed from hospital discharge to one month post birth and from six weeks to six months post birth, though both analyses had substantial heterogeneity (from discharge average RR 1.30, 95% CI 1.12 to 1.49; participants = 711; studies = six; I² = 44%; GRADE: moderate quality; from six weeks average RR 1.50, 95% CI 1.18 to 1.90; participants = 640; studies = seven; I² = 62%; GRADE: moderate quality).Women in the SCC group had higher mean scores for breastfeeding effectiveness, with moderate heterogeneity (IBFAT (Infant Breastfeeding Assessment Tool) score MD 2.28, 95% CI 1.41 to 3.15; participants = 384; studies = four; I² = 41%). SSC infants were more likely to breast feed successfully during their first feed, with high heterogeneity (average RR 1.32, 95% CI 1.04 to 1.67; participants = 575; studies = five; I² = 85%). Results for infantsSSC infants had higher SCRIP (stability of the cardio-respiratory system) scores overall, suggesting better stabilization on three physiological parameters. However, there were few infants, and the clinical significance of the test was unclear because trialists reported averages of multiple time points (standardized mean difference (SMD) 1.24, 95% CI 0.76 to 1.72; participants = 81; studies = two; GRADE low quality). SSC infants had higher blood glucose levels (MD 10.49, 95% CI 8.39 to 12.59; participants = 144; studies = three; GRADE: low quality), but similar temperature to infants in standard care (MD 0.30 degree Celcius (°C) 95% CI 0.13 °C to 0.47 °C; participants = 558; studies = six; I² = 88%; GRADE: low quality). Women and infants after cesarean birthWomen practicing SSC after cesarean birth were probably more likely to breast feed one to four months post birth and to breast feed successfully (IBFAT score), but analyses were based on just two trials and few women. Evidence was insufficient to determine whether SSC could improve breastfeeding at other times after cesarean. Single trials contributed to infant respiratory rate, maternal pain and maternal state anxiety with no power to detect group differences. SubgroupsWe found no differences for any outcome when we compared times of initiation (immediate less than 10 minutes post birth versus early 10 minutes or more post birth) or lengths of contact time (60 minutes or less contact versus more than 60 minutes contact). AUTHORS' CONCLUSIONS Evidence supports the use of SSC to promote breastfeeding. Studies with larger sample sizes are necessary to confirm physiological benefit for infants during transition to extra-uterine life and to establish possible dose-response effects and optimal initiation time. Methodological quality of trials remains problematic, and small trials reporting different outcomes with different scales and limited data limit our confidence in the benefits of SSC for infants. Our review included only healthy infants, which limits the range of physiological parameters observed and makes their interpretation difficult.
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Affiliation(s)
- Elizabeth R Moore
- Vanderbilt UniversitySchool of Nursing314 Godchaux Hall21st Avenue SouthNashvilleTennesseeUSA37240‐0008
| | - Nils Bergman
- University of Cape TownSchool of Child and Adolescent Health, and Department of Human BiologyCape TownSouth Africa
| | - Gene C Anderson
- Professor Emerita, University of FloridaCase Western Reserve UniversityOak Hammock at the University of Florida5000 SW 25th Boulevard #2108GainesvilleFLUSA32608‐8901
| | - Nancy Medley
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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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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Feldman-Winter L, Goldsmith JP. Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns. Pediatrics 2016; 138:peds.2016-1889. [PMID: 27550975 DOI: 10.1542/peds.2016-1889] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Skin-to-skin care (SSC) and rooming-in have become common practice in the newborn period for healthy newborns with the implementation of maternity care practices that support breastfeeding as delineated in the World Health Organization's "Ten Steps to Successful Breastfeeding." SSC and rooming-in are supported by evidence that indicates that the implementation of these practices increases overall and exclusive breastfeeding, safer and healthier transitions, and improved maternal-infant bonding. In some cases, however, the practice of SSC and rooming-in may pose safety concerns, particularly with regard to sleep. There have been several recent case reports and case series of severe and sudden unexpected postnatal collapse in the neonatal period among otherwise healthy newborns and near fatal or fatal events related to sleep, suffocation, and falls from adult hospital beds. Although these are largely case reports, there are potential dangers of unobserved SSC immediately after birth and throughout the postpartum hospital period as well as with unobserved rooming-in for at-risk situations. Moreover, behaviors that are modeled in the hospital after birth, such as sleep position, are likely to influence sleeping practices after discharge. Hospitals and birthing centers have found it difficult to develop policies that will allow SSC and rooming-in to continue in a safe manner. This clinical report is intended for birthing centers and delivery hospitals caring for healthy newborns to assist in the establishment of appropriate SSC and safe sleep policies.
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Ferrarello D, Carmichael T. Sudden Unexpected Postnatal Collapse of the Newborn. Nurs Womens Health 2016; 20:268-275. [PMID: 27287353 DOI: 10.1016/j.nwh.2016.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/03/2015] [Indexed: 06/06/2023]
Abstract
Sudden unexpected postnatal collapse is a rare but devastating neonatal event. A well-appearing, full-term newborn with Agpar scores of eight or more suddenly crashes, often with full respiratory and cardiac arrest. Up to half of newborns with sudden unexpected postnatal collapse die, with many survivors suffering serious neurological damage. The first 2 hours of life are the hours of greatest risk, coinciding with the time frame when nurses encourage breastfeeding and uninterrupted skin-to-skin contact between women and newborns. Nursing assessments and measures to promote neonates' optimal transition to extrauterine life through skin-to-skin contact and early breastfeeding while decreasing the risk of this catastrophic event are described. Nursing surveillance to promote optimal transition in a safe environment is essential, and birth facilities should allocate staffing resources accordingly.
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Pronurturance Plus at birth: A risk reduction strategy for preventing postpartum haemorrhage. Women Birth 2016; 29:279-84. [PMID: 26724899 DOI: 10.1016/j.wombi.2015.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postpartum haemorrhage (PPH) rates continue to rise in the developed world. A recent study found that any skin-to-skin contact and breastfeeding within 30min of birth was associated with an almost 50% reduction in PPH rates. Improved oxytocin release is the biological reason proposed to explain this. The combination of skin-to-skin contact and breastfeeding within 30min of birth is termed 'Pronurturance'. Midwifery theory and research claims that optimal third stage care is more holistic than simple Pronurturnace which suggests that further reductions in PPH rates may be possible. QUESTION What can midwives and women do to minimise blood loss in the third and fourth stages of labour? METHOD We present a new theory that describes and explains how to optimise the woman's reproductive psychophysiology in the third and fourth stages of labour to ensure a well contracted uterus which inhibits excessive bleeding regardless of risk status or whether active management was used. In developing the Pronurturance Plus theory we expand upon what is already known about oxytocin in relation to simple pronurturance to integrate concepts from birth territory theory, cognitive neuroscience, mindfulness psychology and the autonomic nervous system to develop an holistic understanding of how to optimise care and minimise PPH. CONCLUSION Pronurturance Plus is a psycho-biologically grounded theory which is consistent with existing evidence. It is free, natural and socially desirable.
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Affiliation(s)
| | - Dhruv Gupta
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Deepak Kamat
- Children's Hospital of Michigan, Detroit, MI, USA
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Dangers of death on the first day of life by the minute. J Perinatol 2015; 35:958-64. [PMID: 26334397 DOI: 10.1038/jp.2015.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/23/2015] [Accepted: 07/28/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate mortality on the first day of life by minute and hour, and examine changes in major causes of death in the past three decades. STUDY DESIGN We evaluated mortality on the first day of life by the hour (0, 1, …, 23 h), and in the first hour by 5-min block (0-4, 5-9, …, 55-59 min) using data on cause of death for 15,690 infants in Canada from 1981 to 2012. RESULTS Infant mortality on the first day declined from 2.60 per 1000 in the 1980s to 1.26 in the 2000s. The decline was greater at 6-23 h than at 0-5 h of life, and among infants with congenital anomalies compared with prematurity and birth asphyxia. CONCLUSION Infant mortality is highest on the first day of life. More focus on prematurity and birth asphyxia in the first 5 h of life is needed to improve infant mortality.
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Casanueva CP, Cifuentes RJ. [Hospital Admissions due to cyanosis episodes in newborns with gestational age of 34 weeks or more]. ACTA ACUST UNITED AC 2015; 86:244-50. [PMID: 26298297 DOI: 10.1016/j.rchipe.2015.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/18/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A retrospective study was performed between January 2007 and December 2012 to assess the admission rates of newborns due to episodes of cyanosis PATIENTS AND METHOD Retrospective study that included all the newborns hospitalized with episodes of cyanosis between January 2007 and December 2012. In them were employed two study protocols that considered first and second line tests, the latter in view of recurrence of events. The first line protocol considered general biochemical tests, chest x-ray and echocardiography in selected cases, while the second line protocol included electroencephalogram, electrocardiogram, nuclear magnetic resonance of the brain, expanded metabolic screening, pyruvic acid, lactic acid, and in case of seizures, cytochemical, and culture of cerebrospinal fluid (CSF) and PCR (polymerase chain reaction) for herpes. RESULTS A total of 98 (2.8%) out of 3,454 newborns were admitted due to episodes of cyanosis. Gestational age: 37.8+1.4 weeks, birth weight: 3,145+477 g. Maternal age: 32+4.8 years. Disease was present in 19.4% of mothers; gestational diabetes (8.1%), pregnancy induced hypertension (5.1%), intrahepatic cholestasis (3.1%), and intrauterine growth retardation (3.1%). Gender: 48.8% male, 51.2% female (NS). Birth: caesarean section, 68.4%, and vaginal delivery, 31.6%. Age on admission 1.9+1.4 days. Hospital stay: 4.2+4.2 days. First line tests were performed in 100% of patients with 39.8% fulfilling the criteria for second line study. A condition was detected in 21.4%, with convulsive syndrome was the most frequent (33%). Newborns with an identified condition had 3.8+2.7 episodes versus 1.5+2,4 in those without diagnosis (NS). A home oxygen monitor was given to 15.4%. There were no re-admissions. CONCLUSIONS Most newborns admitted due to cyanosis are discharged with a condition of unknown origin. In this study, convulsive syndrome was the most frequent cause.
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Friedman F, Adrouche-Amrani L, Holzman IR. Breastfeeding and delivery room neonatal collapse. J Hum Lact 2015; 31:230-2. [PMID: 25389125 DOI: 10.1177/0890334414558597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/14/2014] [Indexed: 11/17/2022]
Abstract
Sudden unexpected neonatal collapse in the delivery room is a rare occurrence in healthy term infants. Upper airway obstruction may occur from improper positioning of the newborn even while breastfeeding. Such occlusion may have dire consequences if not recognized immediately. We report 2 healthy term neonates who suffered respiratory arrest while in the mother's arms and attempting breastfeeding. In each case, rapid response by the delivery room nurse averted tragedy. Metabolic and infectious evaluations were unremarkable. Both babies have been well on subsequent examinations. We conclude that proper education of mothers and safe positioning of neonates is critical during the initiation of breastfeeding.
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Affiliation(s)
- Frederick Friedman
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | | | - Ian R Holzman
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY, USA Department of Pediatrics, Icahn School of Medicine, Mount Sinai, New York, NY, USA
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