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Sheikh M, Nanda V, Kumar R, Khilfeh M. Neonatal Outcomes since the Implementation of No Routine Endotracheal Suctioning of Meconium-Stained Nonvigorous Neonates. Am J Perinatol 2024; 41:1366-1372. [PMID: 36170887 DOI: 10.1055/a-1950-2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate the effect of the 2015 Neonatal Resuscitation Program recommendations of no routine endotracheal suctioning for nonvigorous neonates on the incidence of meconium aspiration syndrome (MAS) and death. We hypothesized that the revised guidelines have not changed the outcome of MAS/death. STUDY DESIGN This was a single-center retrospective cohort study. We recorded data on nonvigorous neonates born at gestational age > 37 weeks, who were divided into period 1, n = 95 (before the new guidelines, January 1, 2013-December 31, 2015) and prospective period 2, n = 91 (after the implementation of new guidelines, January 1, 2017-December 31, 2020). Primary outcomes included MAS and death. Secondary outcomes included respiratory neonatal intensive care unit (NICU) admission, length of NICU stay, and feeding difficulties. RESULTS No significant differences in the occurrence of MAS (11 vs. 17%) (odds ratio [OR] of 1.46 [95% confidence interval [CI]: 0.59-3.55]) or death (1 vs. 3%) (OR of 2.00 [95% CI: 0.18-21.57]) among the two periods were observed. In period 2, there was an increased NICU respiratory admission (37 vs. 61%), with an OR of 2.31 (95% CI: 1.10-4.84). More neonates in period 2 required subsequent intubation for respiratory failure in the delivery room (12 vs. 28%) with an OR of 2.03 (95% CI: 1.02-4.51); p-value of 0.05. CONCLUSION Our study did not observe a significant difference in the incidence of MAS or death between the two periods since the 2015 guidelines. However, the incidence of NICU respiratory admission increased. KEY POINTS · Nonvigorous neonates born through MSAF who did not undergo ET suctioning soon after birth did not have increased incidence of MAS or death, but had increased NICU respiratory admissions.. · A large Multi-center RCT may give more clear verdict on the outcomes of these newborns..
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Affiliation(s)
- Mehwish Sheikh
- Division of Neonatology, Department of Pediatrics, University of Illinois Chicago College of Medicine at Peoria, Peoria, Illinois
| | - Vishakha Nanda
- John H. Stroger, Jr. Cook County Hospital, Chicago, Illinois
| | - Rajeev Kumar
- John H. Stroger, Jr. Cook County Hospital, Chicago, Illinois
| | - Manhal Khilfeh
- John H. Stroger, Jr. Cook County Hospital, Chicago, Illinois
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Mende S, Ahmed S, DeShea L, Szyld E, Shah BA. Electronic Heart (ECG) Monitoring at Birth and Newborn Resuscitation. CHILDREN (BASEL, SWITZERLAND) 2024; 11:685. [PMID: 38929264 PMCID: PMC11202155 DOI: 10.3390/children11060685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/27/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Approximately 10% of newborns require assistance at delivery, and heart rate (HR) is the primary vital sign providers use to guide resuscitation methods. In 2016, the American Heart Association (AHA) suggested electrocardiogram in the delivery room (DR-ECG) to measure heart rate during resuscitation. This study aimed to compare the frequency of resuscitation methods used before and after implementation of the AHA recommendations. METHODS This longitudinal retrospective cohort study compared a pre-implementation (2015) cohort with two post-implementation cohorts (2017, 2021) at our Level IV neonatal intensive care unit. RESULTS An initial increase in chest compressions at birth associated with the introduction of DR-ECG monitoring was mitigated by focused educational interventions on effective ventilation. Implementation was accompanied by no changes in neonatal mortality. CONCLUSIONS Investigation of neonatal outcomes during the ongoing incorporation of DR-ECG may help our understanding of human and system factors, identify ways to optimize resuscitation team performance, and assess the impact of targeted training initiatives on clinical outcomes.
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Affiliation(s)
- Sarah Mende
- Department of Pediatrics, College of Medicine, University of Oklahoma (OU), Oklahoma City, OK 73104, USA
| | - Syed Ahmed
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lise DeShea
- Department of Pediatrics, College of Medicine, University of Oklahoma (OU), Oklahoma City, OK 73104, USA
| | - Edgardo Szyld
- Neonatal-Perinatal Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Birju A. Shah
- Department of Pediatrics, College of Medicine, University of Oklahoma (OU), Oklahoma City, OK 73104, USA
- Neonatal-Perinatal Medicine, Oklahoma Children’s Hospital at OU Health, 1200 North Everett Drive, 7th Floor North Pavilion ETNP #7504, Oklahoma City, OK 73104, USA
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Nguyen EL, Cunanan K, Liu Y, Hilgenberg SL. Pediatric Residents' Procedural Competency Requirements: A National Needs Assessment of Program Directors and Chief Residents. Acad Pediatr 2024; 24:549-553. [PMID: 38159599 DOI: 10.1016/j.acap.2023.12.009] [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: 08/21/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND There is increased learner competition for a shrinking pool of procedural training opportunities and indications in pediatrics. This study aimed to describe pediatric residency program directors' (PDs) and chief residents' (CRs) perspectives about whether procedural requirements for pediatric residents should be reformed and individualized. METHODS This was a survey-based, mixed methods study of PDs and CRs affiliated with the Association of Pediatric Program Directors (APPD). We used descriptive statistics to analyze demographics and perspectives, logistic regressions to examine individual and program factors, and thematic analysis for qualitative data. RESULTS Forty-seven percent (95/203) of PDs and 16% (64/392) of CRs responded, representing APPD membership across program setting, size, and region (average standard mean deviation 0.28). Ninety-one percent of PD respondents considered one or more of the current Accreditation Council for Graduate Medical Education (ACGME) required procedures nonessential; 74% favored individualizing procedural training. CR responses mirrored PD responses. Program size, setting, and access to procedural teams did not significantly associate with likelihood to favor individualization. CONCLUSIONS The majority of PD and CR respondents believe that current ACGME procedures should be reformed and individualized to future career goals. This change could allow maximization of limited time in residency in this era of decreased opportunity.
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Affiliation(s)
- Elizabeth L Nguyen
- Department of Pediatrics (EL Nguyen and SL Hilgenberg), Stanford University School of Medicine, Palo Alto, Calif.
| | - Kristen Cunanan
- Division of Biomedical Informatics Research (K Cunanan and Y Liu), Stanford University School of Medicine, Palo Alto, Calif.
| | - Yuhan Liu
- Division of Biomedical Informatics Research (K Cunanan and Y Liu), Stanford University School of Medicine, Palo Alto, Calif.
| | - Sarah L Hilgenberg
- Department of Pediatrics (EL Nguyen and SL Hilgenberg), Stanford University School of Medicine, Palo Alto, Calif.
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Patel M, Gopalakrishnan M, Sundararajan S. Impact of Delayed Cord Clamping on Red Blood Cell Transfusion and Related Outcomes in Very Low Birth Weight Infants. Am J Perinatol 2024; 41:e2444-e2453. [PMID: 37348546 DOI: 10.1055/a-2115-4360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Delayed cord clamping (DCC) for 30 to 60 seconds after birth facilitates placental transfusion, increases blood volume, and decreases red blood cell (RBC) transfusion in preterm infants. Study objective was to determine (1) RBC transfusion burden over a 5-year period, (2) impact of DCC practice on RBC transfusions, and (3) association of RBC transfusion on outcomes in very low birthweight (VLBW) preterm infants. STUDY DESIGN A retrospective medical chart review was performed in 787 VLBW infants between 2016 and 2020. Demographic factors, DCC status, number of RBC transfusions, and neonatal outcomes were determined in eligible infants. Adjusted association between DCC, RBC transfusion, and outcomes were determined using logistic and linear regression methods. RESULTS Of the 538 eligible VLBW infants, 62% (N = 332) received RBC transfusions. Proportion receiving RBC transfusion were significantly higher for infants <1,000 g (N = 217, 65.4%) and gestational age (GA) <29 weeks (N = 256, 77.1%) than larger (1,001-1,250 g, N = 77, 23.2% and 1,251-1,500 g, N = 38, 11.4%) and older GA ≥ 29 weeks' infants (N = 76, 22.9%, p < 0.05). Of the 81/538 (15.1%) who received DCC, 48 (59.2%) received no RBC transfusion (p < 0.001). In multivariable logistic regression analysis, preterm infants with DCC were 55% less likely to receive RBC transfusions as compared with infants with no DCC. At any given GA, the number of RBC transfusions in preterm infants with DCC was 25% lower as compared with infants without DCC (p < 0.05). Transfusion was associated with 8-fold increased odds for bronchopulmonary dysplasia and 4-fold increased odds for medical and surgically treated patent ductus arteriosus compared with no transfusion. There was no significant association of transfusion with neonatal sepsis, laser treated retinopathy of prematurity, necrotizing enterocolitis, and intraventricular hemorrhage. CONCLUSION DCC was significantly associated with reduced RBC transfusion, but fewer preterm infants received DCC. Further research is needed to explore the feasibility of providing neonatal resuscitation during DCC in preterm infants. KEY POINTS · Delayed cord clamping significantly reduced the need for RBC transfusions.. · Fewer very preterm infants received DCC.. · Future research is needed to explore feasibility of neonatal resuscitation during DCC..
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Affiliation(s)
- Mayuri Patel
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mathangi Gopalakrishnan
- Department of Practice, Science, and Health Outcomes Research, Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Sripriya Sundararajan
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
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Shah S, Dyess NF, Myers PJ. Devaluing babies: neonatal implications of proposed changes in pediatric residency training. J Perinatol 2023; 43:1455-1458. [PMID: 37532759 DOI: 10.1038/s41372-023-01739-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Shetal Shah
- Division of Neonatology, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY, USA.
| | - Nicolle Fernández Dyess
- Division of Neonatology, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, CO, USA
| | - Patrick J Myers
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Wei Q, Chen W, Liang Q, Song S, Li J. Effect of Endotracheal Suctioning on Infants Born through Meconium-Stained Amniotic Fluid: A Meta-analysis. Am J Perinatol 2023; 40:1272-1278. [PMID: 35016248 DOI: 10.1055/s-0041-1741034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Meconium is a common finding in amniotic fluid and placental specimens, particularly in term and post-term pregnancies. The objective of this paper was to perform a meta-analysis to examine the impact of endotracheal suctioning on the occurrence of meconium aspiration syndrome (MAS), mortality, and complications. STUDY DESIGN PubMed, EMBASE, and the Cochrane library were systematically searched for comparative studies. Odds ratios (ORs), weighted mean differences (WMDs), and corresponding 95% confidence intervals (CIs) were used to compare the outcomes. RESULTS Twelve studies were included in the meta-analysis. There were no significant impacts of endotracheal suctioning on the occurrence of MAS (OR = 3.05, 95% CI: 0.48-19.56), mortality (OR = 1.25, 95% CI: 0.35-4.44), the need for mechanical ventilation (OR = 4.20, 95% CI: 0.32-54.72), the occurrence of pneumothorax (OR = 0.99, 95% CI: 0.34-2.85), persistent pulmonary hypertension of the newborn (PPHN), (OR = 1.31, 95% CI: 0.58-2.98), hypoxic-ischemic encephalopathy (HIE) (OR = 0.82, 95% CI: 0.52-1.30), and length of stay (WMD = -0.11, 95% CI: -0.99-0.77). CONCLUSION Routine endotracheal suctioning at birth is not useful in preventing MAS, mortality, mechanical ventilation, PPHN, HIE, and prolonged length of stay in neonates born through MSAF. KEY POINTS · Routine suctioning is not recommended for newborns.. · Endotracheal aspiration is not beneficial for MAS.. · Future research may focus on selected neonates..
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Affiliation(s)
- Qing Wei
- Department of Obstetrics, The Third Central Hospital of Tianjin, Hedong District, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Department of obstetrics, Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Wenjing Chen
- Department of Obstetrics, The Third Central Hospital of Tianjin, Hedong District, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Department of obstetrics, Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Qian Liang
- Department of Obstetrics, The Third Central Hospital of Tianjin, Hedong District, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Department of obstetrics, Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Shurong Song
- Department of Obstetrics, The Third Central Hospital of Tianjin, Hedong District, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Department of obstetrics, Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Jia Li
- Department of Obstetrics, The Third Central Hospital of Tianjin, Hedong District, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Department of obstetrics, Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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Saint-Fleur AL, Alcalá HE, Sridhar S. Outcomes of neonates born through meconium-stained amniotic fluid pre and post 2015 NRP guideline implementation. PLoS One 2023; 18:e0289945. [PMID: 37561740 PMCID: PMC10414582 DOI: 10.1371/journal.pone.0289945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023] Open
Abstract
A shift in the Neonatal Resuscitation Program (NRP) guidelines occurred in 2015 from routine intubation and endotracheal suctioning of all meconium-stained non-vigorous infants towards less aggressive interventions based on response to initial resuscitation. This study aims to examine the impact of this change on outcomes of non-vigorous infants born through meconium-stained amniotic fluid at a level III academic NICU encompassing years before and after the change in guideline. This single-center retrospective study compared NICU therapies and clinical outcomes of 117 non-vigorous newborns pre-guideline implementation to 106 non-vigorous newborns post-guideline implementation. Nearly two thirds of infants in the pre-guideline cohort received endotracheal suctioning with recovery of meconium compared to less than a third of infants in the post-guideline cohort (p<0.01). Though a higher proportion of the pre-guideline cohort were admitted to the NICU for respiratory issues compared to the post-guideline cohort, the two groups did not differ significantly with regard to morbidity and therapies. Despite a marked reduction in rates of intubation and endotracheal suctioning, there is no difference in outcomes between pre-guideline implementation vs post-guideline implementation in non-vigorous meconium-stained infants, supporting the recent NRP guideline change and highlighting the benefit of expectant management.
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Affiliation(s)
- Ashley L. Saint-Fleur
- Department of Pediatrics, Stony Brook Children’s Hospital, Stony Brook, New York, United States of America
| | - Héctor E. Alcalá
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, United States of America
- Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, United States of America
| | - Shanthy Sridhar
- Department of Pediatrics, Division of Neonatology, Stony Brook Children’s Hospital, Stony Brook, New York, United States of America
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B SA, Mendu SB, Pandala P, Kotha R, Yerraguntla VN. Outcomes of Neonatal Resuscitation With and Without an Intact Umbilical Cord: A Meta-Analysis. Cureus 2023; 15:e44449. [PMID: 37791162 PMCID: PMC10544125 DOI: 10.7759/cureus.44449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Around the world, very few babies require a more intensive resuscitative effort for stabilization. The optimal timing of an intact umbilical cord to help with resuscitation is controversial. Our objective in the review is to compare the outcomes of neonatal resuscitation with and without an intact umbilical cord. A search of six electronic database libraries was explored for data released between 2014 and 2023. A manual search of secondary references in relevant studies was also performed. Studies focused only on randomized controlled trials comparing the outcomes of neonatal resuscitation with and without an intact umbilical cord at any gestational age. Two reviewers retrieved data for relevant outcomes and independently evaluated trial quality and eligibility. Mortality rate and APGAR (appearance, pulse, grimace, activity, and respiration) scores were noted as common in the two studies. Four randomized control trials were assessed for the impact of delayed cord clamping on neonates. One study focused on neurodevelopmental outcomes and noted significant improvement. Other studies noted delayed clamping as beneficial for improving oxygen saturation, APGAR score, and mortality rate. The meta-analysis included three controlled trials with a total of 528 babies and tested the effects of clamping the umbilical cord either late (n = 264) or early (n = 264). The heterogeneity of mortality and APGAR score at 5 minutes were not significant, which may be because only two studies of each case were available to compare. We concluded that very few studies are available to identify a significant impact of delayed cord clamping in neonates. However, delayed clamping for up to 5 minutes is noted as beneficial to the newborn.
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Affiliation(s)
- Santosh Avinash B
- Department of Pediatrics Intensive Care, Osmania Medical College, Hyderabad, IND
| | - Suresh Babu Mendu
- Department of Pediatrics, Government Medical College, Siddipet, Siddipet, IND
| | - Paramesh Pandala
- Department of Pediatrics, Government Medical College, Jangaon, Hyderabad, IND
| | - Rakesh Kotha
- Department of Neonatology, Osmania Medical College, Hyderabad, IND
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Lamary M, Bertoni CB, Schwabenbauer K, Ibrahim J. Neonatal Golden Hour: a review of current best practices and available evidence. Curr Opin Pediatr 2023; 35:209-217. [PMID: 36722754 DOI: 10.1097/mop.0000000000001224] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Recommendations made by several scientific bodies advocate for adoption of evidence-based interventions during the first 60 min of postnatal life, also known as the 'Golden Hour', to better support the fetal-to-neonatal transition. Implementation of a Golden Hour protocol leads to improved short-term and long-term outcomes, especially in extremely premature and extreme low-birth-weight (ELBW) neonates. Unfortunately, several recent surveys have highlighted persistent variability in the care provided to this vulnerable population in the first hour of life. RECENT FINDINGS Since its first adoption in the neonatal ICU (NICU) in 2009, published literature shows a consistent benefit in establishing a Golden Hour protocol. Improved short-term outcomes are reported, including reductions in hypothermia and hypoglycemia, efficiency in establishing intravenous access, and timely initiation of fluids and medications. Additionally, long-term outcomes report decreased risk for bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP). SUMMARY Critical to the success and sustainability of any Golden Hour initiative is recognition of the continuous educational process involving multidisciplinary team collaboration to ensure coordination between providers in the delivery room and beyond. Standardization of practices in the care of extremely premature neonates during the first hour of life leads to improved outcomes. VIDEO ABSTRACT http://links.lww.com/MOP/A68 .
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Affiliation(s)
| | - C Briana Bertoni
- Division of Newborn Medicine, UPMC Magee-Womens Hospital/Children's Hospital of Pittsburgh, USA
| | - Kathleen Schwabenbauer
- Division of Newborn Medicine, UPMC Magee-Womens Hospital/Children's Hospital of Pittsburgh, USA
| | - John Ibrahim
- Division of Newborn Medicine, UPMC Magee-Womens Hospital/Children's Hospital of Pittsburgh, USA
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Dani C, Cecchi A, Ciarcià M, Miselli F, Luzzati M, Remaschi G, Bona MD, la Marca G, Boni L. Enteral and Parenteral Treatment with Caffeine for Preterm Infants in the Delivery Room: A Randomised Trial. Paediatr Drugs 2023; 25:79-86. [PMID: 36301511 PMCID: PMC9810558 DOI: 10.1007/s40272-022-00541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Early treatment with caffeine in the delivery room (DR) has been proposed to decrease the need for mechanical ventilation (MV) by limiting episodes of apnoea and improving respiratory mechanics in preterm infants. Our aim was to verify the hypothesis that intravenous or enteral administration of caffeine can be performed in the preterm infant in the DR. METHODS Infants with 25±0-29±6 weeks of gestational age were enrolled and randomised to receive 20 mg/kg of caffeine citrate intravenously, via the umbilical vein, or enterally, through an orogastric tube, within 10 min of birth. Caffeine blood level was measured at 60 ± 15 min after administration and 60 ± 15 min before the next dose (5 mg/kg). The primary endpoint was evaluation of the success rate of intravenous and enteral administration of caffeine in the DR. RESULTS Nineteen patients were treated with intravenous caffeine and 19 with enteral caffeine. In all patients the procedure was successfully performed. Peak blood level of caffeine 60 ± 15 min after administration in the DR was found to be below the therapeutic range (5 µg/mL) in 25 % of samples and above the therapeutic range in 3%. Blood level of caffeine 60 ± 15 min before administration of the second dose was found to be below the therapeutic range in 18% of samples. CONCLUSIONS Intravenous and enteral administration of caffeine can be performed in the DR without interfering with infants' postnatal assistance. Some patients did not reach the therapeutic range, raising the question of which dose is the most effective to prevent MV. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04044976; EudraCT number 2018-003626-91.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy.
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Alessandra Cecchi
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesca Miselli
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Michele Luzzati
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Giulia Remaschi
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Della Bona
- Laboratory of Clinical Chemistry and Pharmacology of the Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giancarlo la Marca
- Laboratory of Clinical Chemistry and Pharmacology of the Meyer Children's Hospital IRCCS, Florence, Italy
| | - Luca Boni
- SC Epidemiologia Clinica, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino of Genova, Genoa, Italy
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11
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Rettedal S, Kibsgaard A, Eilevstjønn J, Kvaløy JT, Bjorland PA, Markhus Pike H, Haynes J, Tysland TB, Størdal K, Holte K, Davis PG, Ersdal HL. Impact of immediate and continuous heart rate feedback by dry electrode ECG on time to initiation of ventilation after birth: protocol for a randomised controlled trial. BMJ Open 2022; 12:e061839. [PMID: 36691167 PMCID: PMC9454047 DOI: 10.1136/bmjopen-2022-061839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/21/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION 3%-8% of newborns need positive pressure ventilation (PPV) after birth. Heart rate (HR) is considered the most sensitive indicator of the newborns' condition and response to resuscitative interventions. According to guidelines, HR should be assessed and PPV initiated within 60 s after birth in non-breathing newborns. Dry electrode ECG can provide accurate feedback on HR immediately after birth and continuously during resuscitation. The impact of early and continuous HR feedback is unknown. METHOD AND ANALYSIS This single-centre randomised controlled trial seeks to determine if HR feedback by dry electrode ECG immediately after birth and continuously during newborn resuscitation results in more timely initiation of PPV, improved ventilation and short-term outcomes compared with standard HR assessment.In all newborns≥34 gestational weeks, the dry electrode ECG sensor is placed on the upper abdomen immediately after birth as an additional modality of HR assessment. The device records and stores HR signals. In intervention subjects, the HR display is visible to guide decision-making and further management, in control subjects the display is masked. Standard HR assessment is by stethoscope, gel-electrode ECG and/or pulse oximetry (PO).Time of birth is registered in the Liveborn app. Time of initiation and duration of PPV is calculated from video recordings. Ventilation parameters are retrieved from the ventilation monitor, oxygen saturation and HR from the PO and gel-electrode ECG monitors.The primary endpoint is proportion of resuscitated newborns who receive PPV within 60 s after birth. To detect a 50% increase with power of 90% using an overall significance level of 0.05 and 1 interim analysis, 169 newborns are needed in each group. ETHICS AND DISSEMINATION Approval by the Norwegian National Research Ethics Committee West (2018/338). Parental consent is sought at routine screening early in pregnancy. The results will be published in peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER NCT03849781.
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Affiliation(s)
- Siren Rettedal
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
| | - Amalie Kibsgaard
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Joar Eilevstjønn
- Strategic Research, Laerdal Medical AS, Stavanger, Rogaland, Norway
| | - Jan Terje Kvaløy
- Mathematics and Physics, Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | | | - Hanne Markhus Pike
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Joanna Haynes
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | | | - Ketil Størdal
- Department of Pediatric Research, University of Oslo, Oslo, Norway
- Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Kari Holte
- Department of Pediatrics and Adolescent Medicine, Ostfold Hospital, Gralum, Østfold, Norway
| | - Peter G Davis
- Newborn Research, The Royal Women's Hospital at Sandringham, Sandringham, Victoria, Australia
| | - Hege Langli Ersdal
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
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12
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Grover R, Singh P, Shubham S, Priyadarshi M, Chaurasia S, Basu S. Delivery Room Respiratory Stabilization of Preterm Neonates: A Randomized, Controlled Trial. Indian J Pediatr 2022; 89:793-800. [PMID: 35397090 DOI: 10.1007/s12098-022-04124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine whether heated humidified high-flow nasal cannula (HHHFNC) is noninferior to NCPAP to provide DR respiratory support to preterm neonates of gestational age (GA) 28-36 wk. METHODS This randomized, controlled, noninferiority trial included 124 spontaneously breathing preterm neonates who developed respiratory distress soon after birth and/or had a FiO2 requirement > 0.3. Primary outcome measure was treatment failure within 24 h. The absolute risk difference with 95% confidence interval (CI) were calculated with a noninferiority margin of 10%. Secondary outcome variables were temperature at admission, time to treatment failure, treatment failure at 72 h, need for surfactant, intubation, duration of respiratory support, and incidences of adverse events including mortality. Intention-to-treat analysis was done in Stata software. RESULTS Both the groups were similar in baseline characteristics. There was no statistically significant difference between the treatment failure rates with HHHFNC (13.1%, n = 61) and NCPAP (11.1%, n = 63) (risk difference 2.0%, 95% CI - 9.9% to 14.07%, p = 0.73). However, noninferiority of HHHFNC to NCPAP could not be conclusively proved as the 95% CI crossed both 0 and the noninferiority margin of 10%. There were no significant differences in secondary outcomes. CONCLUSIONS HHHFNC showed similar efficacy and safety as NCPAP irrespective of gestational age, though its noninferiority to NCPAP remained inconclusive. TRIAL REGISTRATION Clinical Trial Registry of India, Registration no: CTRI/2019/10/021633, https://ctri.icmr.org.in/.
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Affiliation(s)
- Rajat Grover
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Shantanu Shubham
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
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13
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Implementation of less-invasive surfactant administration in a Canadian neonatal intensive care unit. Arch Pediatr 2022; 29:444-447. [DOI: 10.1016/j.arcped.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/21/2022] [Accepted: 05/12/2022] [Indexed: 11/22/2022]
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14
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Tourneux P, Thiriez G, Renesme L, Zores C, Sizun J, Kuhn P. Optimising homeothermy in neonates: a systematic review and clinical guidelines from the French Neonatal Society. Acta Paediatr 2022; 111:1490-1499. [PMID: 35567516 DOI: 10.1111/apa.16407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
AIM Thermal instability is harmful on the newborn infant. We sought to draw up practical guidelines on maintaining homeothermy alongside skin-to-skin contact. METHODS A systematic analysis of the literature identified relevant studies between 2000 and 2021 in the PubMed database. Selected publications were evaluated, and their level of evidence were graded, in order to underpin the development of clinical guidelines. RESULTS We identified 7 meta-analyses and 64 clinical studies with a focus on newborn infants homeothermy. Skin-to-skin contact is the easiest and most rapidly implementable method to prevent body heat loss. Alongside skin-to-skin contact, monitoring the newborn infant's body temperature with a target of 37.0°C is essential. For newborn infants <32 weeks of gestation, a skullcap and a polyethylene bag should be used in the delivery room or during transport. To limit water loss, inhaled gases humidification and warming is recommended, and preterm infants weighing less than 1600 g should be nursed in a closed, convective incubator. With regard to incubators, there are no clear benefits for single vs. double-wall incubators as well as for air vs. skin servo control. CONCLUSION Alongside skin-to-skin contact, a bundle of practical guidelines could improve the maintenance of homeothermy in the newborn infant.
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Affiliation(s)
- Pierre Tourneux
- Neonatal Intensive Care Unit, Amiens University Hospital, Amiens, France
- PériTox Laboratory UMR_I 01, UFR de Médecine, University of Picardie Jules Verne, Amiens, France
| | - Gérard Thiriez
- Pediatric Intensive Care, Neonatology and Pediatric Emergencies Departments, Besancon University Hospital, Besancon, France
| | - Laurent Renesme
- Neonatal Intensive Care Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Claire Zores
- Neonatal Intensive Care Unit, Hôpital de Hautepierre, Strasbourg University Hospital, Strasbourg, France
- Institut des Neurosciences Cellulaires et Intégratives, UPR 3212, CNRS et Université de Strasbourg, France
| | - Jacques Sizun
- Neonatal Intensive Care Unit, Toulouse University Hospital, Toulouse, France
| | - Pierre Kuhn
- Neonatal Intensive Care Unit, Hôpital de Hautepierre, Strasbourg University Hospital, Strasbourg, France
- Institut des Neurosciences Cellulaires et Intégratives, UPR 3212, CNRS et Université de Strasbourg, France
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15
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Chiruvolu A, Wiswell TE. Appropriate Management of the Nonvigorous Meconium-Stained Newborn Meconium. Neoreviews 2022; 23:e250-e261. [PMID: 35362037 DOI: 10.1542/neo.23-4-e250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Before 2015, major changes in Neonatal Resuscitation Program (NRP) recommendations not supporting previously endorsed antepartum, intrapartum and postpartum interventions to prevent meconium aspiration syndrome were based on adequately powered multicenter randomized controlled trials. The 2015 and 2020 American Heart Association guidelines and 7th and 8th edition of NRP suggest not performing routine intubation and tracheal suctioning of nonvigorous meconium-stained newborns. However, this was given as a weak recommendation with low-certainty evidence. The purpose of this review is to summarize the evidence and explore the question of appropriate delivery room management for nonvigorous meconium-stained newborns.
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Affiliation(s)
- Arpitha Chiruvolu
- Division of Neonatology, Baylor University Medical Center, and Pediatrix Medical Group of Dallas, Dallas, TX
| | - Thomas E Wiswell
- Division of Neonatology, Kaiser Permanente Moanalua Medical Center, Honolulu, HI
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16
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Josephsen JB, Potter S, Armbrecht ES, Al-Hosni M. Umbilical Cord Milking in Extremely Preterm Infants: A Randomized Controlled Trial Comparing Cord Milking with Immediate Cord Clamping. Am J Perinatol 2022; 39:436-443. [PMID: 32894871 DOI: 10.1055/s-0040-1716484] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to assess potential benefits of umbilical cord milking (UCM) when compared with immediate cord clamping (ICC) in extremely preterm infants. STUDY DESIGN This is a single-center, randomized controlled trial of infants 240/7 to 276/7 weeks' gestation who received UCM versus ICC. In the experimental group, 18 cm of the umbilical cord was milked three times. The primary aim was to assess the initial hemoglobin and to assess the number of blood transfusions received in the first 28 days after birth. Secondary outcomes were also assessed, including intraventricular hemorrhage (IVH). A priori, neurodevelopmental follow-up was planned at 15 to 18 months corrected gestational age (CGA). RESULTS Baseline characteristics for 56 enrolled infants were similar in both groups with a mean gestational age of 26.1 ± 1.2 weeks and a mean birth weight of 815 ± 204 g. There were no differences in the mean initial hemoglobin in the UCM group when compared with the ICC group, 13.7 ± 2.0 and 13.8 ± 2.6 g/dL, respectively (p = 0.95), with no differences in median number of blood transfusions after birth between the ICC group and the UCM group, 2 (interquartile range [IQR]: 1-4) versus 2.5 (IQR: 1-5) (p = 0.40). There was also no difference in the rate of severe IVH. At 15 to 18 months CGA, there were no differences in death or disability in the ICC group compared with the UCM group (26 vs. 22%; p = 1.0) and no differences in neurodevelopmental outcomes. CONCLUSION In a randomized trial of ICC versus UCM in extremely preterm infants, no differences were seen in initial hemoglobin or number of blood transfusions. KEY POINTS · Umbilical cord milking may be an alternative to delayed cord clamping, but its safety and efficacy are not established in extremely premature infants.. · There are minimal available published data on the longer term neurodevelopmental outcomes in extremely premature infants who receive umbilical cord milking compared with immediate clamping.. · We did not find a significant difference in the primary outcomes of initial hemoglobin and blood transfusions between the groups, nor did we find a difference in severe IVH with umbilical cord milking..
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Affiliation(s)
| | - Shannon Potter
- Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University, St. Louis, Missouri
| | - Eric S Armbrecht
- Saint Louis University Center for Outcomes Research, Saint Louis University, St. Louis, Missouri
| | - Mohamad Al-Hosni
- Department of Pediatrics, Saint Louis University, St. Louis, Missouri
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17
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Chung W, Lim C. Intraoperative management for ex-utero intrapartum treatment: focusing on the fetus. Anesth Pain Med (Seoul) 2022; 16:329-337. [PMID: 35139613 PMCID: PMC8828620 DOI: 10.17085/apm.21097] [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] [Received: 09/14/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Ex-utero intrapartum treatment (EXIT) is a method of securing the airway of a fetus while maintaining umbilical circulation for newborns who are experiencing life-threatening airway obstruction. Cesarean section is completed only after ensuring the neonate's safety. However, managing the airway of a neonate while maintaining umbilical circulation is a major challenge for anesthesiologists. Anesthesiologists must understand the physiology of both the mother and fetus, and extensive discussions with obstetricians, pediatricians, otolaryngologists, and nursing staff prior to the procedure are essential. This review provides an overview of the EXIT and details of airway management for neonates.
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Affiliation(s)
- Woosuk Chung
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chaeseong Lim
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea
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18
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Abstract
BACKGROUND Endotracheal intubation is a commonly performed procedure in neonates, the risks of which are well-described. Some endotracheal tubes (ETT) are equipped with a cuff that can be inflated after insertion of the ETT in the airway to limit leak or aspiration. Cuffed ETTs have been shown in larger children and adults to reduce gas leak around the ETT, ETT exchange, accidental extubation, and exposure of healthcare workers to anesthetic gas during surgery. With improved understanding of neonatal airway anatomy and the widespread use of cuffed ETTs by anesthesiologists, the use of cuffed tubes is increasing in neonates. OBJECTIVES To assess the benefits and harms of cuffed ETTs (inflated or non-inflated) compared to uncuffed ETTs for respiratory support in neonates. SEARCH METHODS We searched CENTRAL, PubMed, and CINAHL on 20 August 2021; we also searched trial registers and checked reference lists to identify additional studies. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs, and cluster-randomized trials comparing cuffed (inflated and non-inflated) versus uncuffed ETTs in newborns. We sought to compare 1. inflated, cuffed versus uncuffed ETT; 2. non-inflated, cuffed versus uncuffed ETT; and 3. inflated, cuffed versus non-inflated, cuffed ETT. DATA COLLECTION AND ANALYSIS We used the standard methods of Cochrane Neonatal. Two review authors independently assessed studies identified by the search strategy for inclusion, extracted data, and assessed risk of bias. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We identified one eligible RCT for inclusion that compared the use of cuffed (inflated if ETT leak greater than 20% with cuff pressure 20 cm H2O or less) versus uncuffed ETT. The author provided a spreadsheet with individual data. Among 76 infants in the original manuscript, 69 met the inclusion and exclusion criteria for this Cochrane Review. We found possible bias due to lack of blinding and other bias. We are very uncertain about frequency of postextubation stridor, because the confidence intervals (CI) of the risk ratio (RR) were very wide (RR 1.36, 95% CI 0.35 to 5.25; risk difference (RD) 0.03, -0.11 to 0.18; 1 study, 69 participants; very low-certainty evidence). No neonate was diagnosed with postextubation subglottic stenosis; however, endoscopy was not available to confirm the clinical diagnosis. We are very uncertain about reintubation for stridor or subglottic stenosis because the CIs of the RR were very wide (RR 0.27, 95% CI 0.01 to 6.49; RD -0.03, 95% CI -0.11 to 0.05; 1 study, 69 participants; very low-certainty evidence). No neonate had surgical intervention (e.g. endoscopic balloon dilation, cricoid split, tracheostomy) for stridor or subglottic stenosis (1 study, 69 participants). Neonates randomized to cuffed ETT may be less likely to have a reintubation for any reason (RR 0.06, 95% CI 0.01 to 0.45; RD -0.39, 95% CI -0.57 to -0.21; number needed to treat for an additional beneficial outcome 3, 95% CI 2 to 5; 1 study, 69 participants; very low-certainty evidence). We are very uncertain about accidental extubation because the CIs of the RR were wide (RR 0.82, 95% CI 0.12 to 5.46; RD -0.01, 95% CI -0.12 to 0.10; 1 study, 69 participants; very low-certainty evidence). We are very uncertain about all-cause mortality during initial hospitalization because the CIs of the RR were extremely wide (RR 2.46, 95% CI 0.10 to 58.39; RD 0.03, 95% CI -0.05 to 0.10; 1 study, 69 participants; very low-certainty evidence). There is one ongoing trial. We classified two studies as awaiting classification because outcome data were not reported separately for newborns and older infants. AUTHORS' CONCLUSIONS Evidence for comparing cuffed versus uncuffed ETTs in neonates is limited by a small number of babies in a single RCT with possible bias. There is very low certainty evidence for all outcomes of this review. CIs of the estimate for postextubation stridor were wide. No neonate had clinical evidence for subglottic stenosis; however, endoscopy results were not available to assess the anatomy. Additional RCTs are necessary to evaluate the benefits and harms of cuffed ETTs (inflated and non-inflated) in the neonatal population. These studies must include neonates and be conducted both for short-term use (in the setting of the operating room) and chronic use (in the setting of chronic lung disease) of cuffed ETTs.
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Affiliation(s)
- Vedanta Dariya
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Luca Moresco
- Pediatric and Neonatology Unit, Ospedale San Paolo, Savona, Italy
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern at Dallas, Dallas, Texas, USA
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19
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李 开, 唐 成. A retrospective cohort study of tracheal intubation for meconium suction in nonvigorous neonates. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:65-70. [PMID: 35177178 PMCID: PMC8802384 DOI: 10.7499/j.issn.1008-8830.2109178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To study the feasibility of tracheal intubation for meconium suction immediately after birth of nonvigorous neonates born through meconium-stained amniotic fluid (MSAF). METHODS A retrospective cohort study was performed on nonvigorous neonates born through MSAF who were admitted to the Department of Neonatology, Zhecheng People's Hospital. The neonates without meconium suction who were admitted from July 1, 2017 to June 30, 2018 were enrolled as the control group. The neonates who underwent meconium suction from July 1, 2018 to June 30, 2019 were enrolled as the suction group. The two groups were compared in terms of the mortality rate and the incidence rates of neonatal meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn, pneumothorax, and pulmonary hemorrhage. RESULTS There were 80 neonates in the control group and 71 in the suction group. There were no significant differences between the two groups in the incidence rates of MAS (11% vs 7%), persistent pulmonary hypertension of the newborn (5% vs 4%), pneumothorax (3% vs 1%), and death (0% vs 1%). Compared with the control group, the suction group had a significantly lower proportion of neonates requiring oxygen inhalation (16% vs 33%, P<0.05), noninvasive respiratory support (25% vs 41%, P<0.05) or mechanical ventilation (10% vs 23%, P<0.05) and significantly shorter duration of noninvasive ventilation [(58±24) hours vs (83±41) hours, P<0.05] and length of hospital stay [6(4, 8) days vs 7(5, 10) days, P<0.05]. CONCLUSIONS Although tracheal intubation for meconium suction immediately after birth may shorten the duration of respiratory support for mild respiratory problems, it cannot reduce the incidence rate of MAS, mortality rate, or the incidence rate of serious complications in nonvigorous infants born through MSAF.
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Affiliation(s)
| | - 成和 唐
- 新乡医学院第一附属医院新生儿科,河南新乡453100
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20
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Watterberg K. Planned Home Birth. Pediatr Rev 2021; 42:526-528. [PMID: 34470875 DOI: 10.1542/pir.2020-000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Chiruvolu A, Medders A, Daoud Y. Effects of Umbilical Cord Milking on Term Infants Delivered by Cesarean Section. Am J Perinatol 2021; 38:1042-1047. [PMID: 32069483 DOI: 10.1055/s-0040-1701617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Umbilical cord milking (UCM) is an efficient way to achieve optimal placental transfusion in term infants born by cesarean section (CS). However, it is not frequently performed due to concern for short-term adverse effects of increased blood volume, such as polycythemia and hyperbilirubinemia. The aim of this study is to evaluate the short-term effects of UCM on term infants delivered by CS. STUDY DESIGN We conducted a pre- and postimplementation cohort study comparing term infants delivered by CS who received UCM five times (141 infants, UCM group) during a 6-month period (August 1, 2017 to January 31, 2018) to those who received immediate cord clamping (ICC) during the same time period (105 infants, postimplementation ICC) and during a 3-month period (October1, 2016 to December 31, 2016) prior to the implementation of UCM (141 infants, preimplementation ICC). RESULTS Mothers were older in UCM group compared with both ICC groups. There were no significant differences in other maternal or neonatal characteristics. Although this study was not powered to detect differences in outcomes, the occurrence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, NICU admissions, or readmissions for phototherapy was similar between the groups. CONCLUSION UCM intervention was not associated with increased incidence of phototherapy or symptomatic polycythemia in term infants delivered by CS.
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Affiliation(s)
- Arpitha Chiruvolu
- Department of Women and Infants, Baylor Scott and White Medical Center McKinney, Pediatrix Medical Group of Dallas, Dallas, Texas
| | - Alexis Medders
- Department of Medical Education, College of Medicine, Texas A&M University, Bryan, Texas
| | - Yahya Daoud
- Department of Quantitative Sciences, Center for Clinical Effectiveness, Baylor Scott & White Health Care System, Dallas, Texas
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22
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Engle W, Lien I, Benneyworth B, Tully JS, Barbato A, Kunkel M, Boon W, Waheed S, Hoesli S, Chua R, Singhal A, Buchh B, Winchester P, Guilfoy V, Proctor C, Sanchez M, Joyce J, He T. Placental Transfusion, Timing of Plastic Wrap or Bag Placement, and Preterm Neonates. Am J Perinatol 2021; 40:839-844. [PMID: 34255334 DOI: 10.1055/s-0041-1730437] [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: 10/20/2022]
Abstract
OBJECTIVE Compare delivery room practices and outcomes of infants born at less than 32 weeks' gestation or less than 1,500 g who have plastic wrap/bag placement simultaneously during placental transfusion to those receiving plastic wrap/bag placement sequentially following placental transfusion. STUDY DESIGN Retrospective analysis of data from a multisite quality improvement initiative to refine stabilization procedures pertaining to placental transfusion and thermoregulation using a plastic wrap/bag. Delivery room practices and outcome data in 590 total cases receiving placental transfusion were controlled for propensity score matching and hospital of birth. RESULTS The simultaneous and sequential groups were similar in demographic and most outcome metrics. The simultaneous group had longer duration of delayed cord clamping compared with the sequential group (42.3 ± 14.8 vs. 34.1 ± 10.3 seconds, p < 0.001), and fewer number of times cord milking was performed (0.41 ± 1.26 vs. 0.86 ± 1.92 seconds, p < 0.001). The time to initiate respiratory support was also significantly shorter in the simultaneous group (97.2 ± 100.6 vs. 125.2 ± 177.6 seconds, p = 0.02). The combined outcome of death or necrotizing enterocolitis in the simultaneous group was more frequent than in the sequential group (15.3 vs. 9.3%, p = 0.038); all other outcomes measured were similar. CONCLUSION Timing of plastic wrap/bag placement during placental transfusion did affect duration of delayed cord clamping, number of times cord milking was performed, and time to initiate respiratory support in the delivery room but did not alter birth hospital outcomes or respiratory care practices other than the combined outcome of death or necrotizing enterocolitis. KEY POINTS · Plastic bag placement during placental transfusion is effective in stabilization of preterms.. · Plastic bag placement after placental transfusion is effective in stabilization of preterms.. · Plastic bag placement during placental transfusion and risk of death or necrotizing enterocolitis needs additional study..
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Affiliation(s)
- William Engle
- Section of Neonatal-Perinatal Pediatrics, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Izlin Lien
- Section of Neonatal-Perinatal Pediatrics, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian Benneyworth
- Global Medical Affairs, Incretin Portfolio, Eli Lilly Corporation, Indianapolis, Indiana.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Alana Barbato
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Melissa Kunkel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Win Boon
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan
| | - Saira Waheed
- Department of Pediatrics, Ascension St Vincent Hospital, Indianapolis, Indiana
| | - Sandra Hoesli
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rosario Chua
- Department of Pediatrics, Franciscan Health Lafayette East, Lafayette, Indiana.,Department of Pediatrics, Porter Regional Hospital, Valparaiso, Indiana
| | - Abhay Singhal
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Basharat Buchh
- Department of Pediatrics, Beacon Health Memorial Hospital, South Bend, Indiana.,Department of Pediatrics, Section of Neonatal-Perinatal Pediatrics, South Bend, Indiana
| | - Paul Winchester
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Veronica Guilfoy
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cathy Proctor
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mario Sanchez
- Department of Pediatrics, Franciscan Saint Anthony Health Crown Point, Crown Point, Indiana
| | - Jeffrey Joyce
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tian He
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
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23
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Katheria A, Lee HC, Knol R, Irvine L, Thomas S. A review of different resuscitation platforms during delayed cord clamping. J Perinatol 2021; 41:1540-1548. [PMID: 33850283 PMCID: PMC8042840 DOI: 10.1038/s41372-021-01052-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 12/02/2022]
Abstract
There is a large body of evidence demonstrating that delaying clamping of the umbilical cord provides benefits for term and preterm infants. These benefits include reductions in mortality in preterm infants and improved developmental scores at 4 years of age in term infants. However, non-breathing or non-vigorous infants at birth are excluded due to the perceived need for immediate resuscitation. Recent studies have demonstrated early physiological benefits in both human and animal models if resuscitation is performed with an intact cord, but this is still an active area of research. Given the large number of ongoing and planned trials, we have brought together an international group that have been intimately involved in the development or use of resuscitation equipment designed to be used while the cord is still intact. In this review, we will present the benefits and limitations of devices that have been developed or are in use. Published trials or ongoing studies using their respective devices will also be reviewed.
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Affiliation(s)
- Anup Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital, San Diego, CA, USA.
| | - Henry C Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronny Knol
- Department of Pediatrics, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Leigh Irvine
- Foothills Medical Centre, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Sumesh Thomas
- Foothills Medical Centre, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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24
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Jahnsen J, González A, Fabres J, Bahamondes A, Estay A. Effect of two different chest compression techniques on ventilation during neonatal resuscitation. J Perinatol 2021; 41:1571-1574. [PMID: 33850287 DOI: 10.1038/s41372-021-01061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess tidal volume (Vt) and minute ventilation (MV) during cardiopulmonary resuscitation (CPR) with two different chest compressions techniques: two-finger (TFT) or two-thumb technique (TTT) in a neonatal model. METHODS Vt and MV were continuously measured during consecutive periods of resuscitation in an intubated manikin. Thirty participants performed the two compression techniques in a random order for 2-min periods while performing positive pressure ventilation using a T-piece resuscitator (TPR) or a self-inflating bag (SIB). RESULTS Vt during CPR with TFT was significantly higher than TTT with either TPR: 44.9 ± 4.3 vs 39.2 ± 5.4 ml (p < 0.001) or SIB: 39.2 ± 5.7 vs 35.6 ± 6.5 ml (p < 0.023). Similarly MV was significantly higher in TFT than TTT with either mode: 1346 ± 130 vs 1175 ± 162 ml/min, respectively, with TPR (p < 0.001) and 1177 ± 170 vs 1069 ± 196 ml/min with SIB (p < 0.03). CONCLUSIONS Chest compressions during CPR using the TFT achieved higher Vt and MV than TTT in this model of neonatal resuscitation.
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Affiliation(s)
- Johanne Jahnsen
- Department of Neonatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alvaro González
- Department of Neonatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Jorge Fabres
- Department of Neonatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Bahamondes
- Department of Neonatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alberto Estay
- Department of Neonatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Nangia S, Thukral A, Chawla D. Tracheal suction at birth in non-vigorous neonates born through meconium-stained amniotic fluid. Cochrane Database Syst Rev 2021; 6:CD012671. [PMID: 34133025 PMCID: PMC8207961 DOI: 10.1002/14651858.cd012671.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neonates born through meconium-stained amniotic fluid (MSAF) are at risk of developing meconium aspiration syndrome (MAS). Neonates who are non-vigorous due to intrapartum asphyxia are at higher risk of developing MAS. Clearance of meconium from the airways below the vocal cords by tracheal suction before initiating other steps of resuscitation may reduce the risk of development of MAS. However, conducting tracheal suction may not only be ineffective, it may also delay effective resuscitation, thus prolonging and worsening the hypoxic-ischaemic insult. OBJECTIVES: To evaluate the efficacy of tracheal suctioning at birth in preventing meconium aspiration syndrome and other complications among non-vigorous neonates born through meconium-stained amniotic fluid. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 11) in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) (1946 to 25 November 2020) for randomised controlled trials (RCTs) and quasi-randomised trials. We also searched clinical trials databases and the reference lists of retrieved articles for RCTs and quasi-randomised trials (up to November 2020). SELECTION CRITERIA We included studies enrolling non-vigorous neonates born through MSAF, if the intervention being tested included tracheal suction at the time of birth with an intent to clear the trachea of meconium before regular breathing efforts began. Tracheal suction could be performed with an endotracheal tube or a wide-gauge suction catheter. Neonates in the control group should have been resuscitated at birth with no effort made to clear the trachea of meconium. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data, consulting with a third review author about any disagreements. We used standard Cochrane methodological procedures, including assessment of risk of bias for all studies. Our primary outcomes were: MAS; all-cause neonatal mortality; and incidence of hypoxic-ischaemic encephalopathy (HIE). Secondary outcomes included: need for mechanical ventilation; incidence of pulmonary air leaks; culture-positive sepsis; and persistent pulmonary hypertension. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included four studies (enrolling 581 neonates) in the review. All four studies were conducted in tertiary care hospitals in India. Three of the four studies included neonates born at and beyond term gestation, whereas one included neonates born at and beyond 34 weeks of gestation. Due to the nature of the intervention, it was not possible to blind the healthcare personnel conducting the intervention. Tracheal suction compared to no suction in non-vigorous neonates born through MSAF In non-vigorous infants, no differences were noted in the risks of MAS (RR 1.00, 95% CI 0.80 to 1.25; RD 0.00, 95% CI -0.07 to 0.08; 4 studies, 581 neonates) or all-cause neonatal mortality (RR 1.24, 95% CI 0.76 to 2.02; RD 0.02, 95% CI -0.03 to 0.07; 4 studies, 575 neonates) with or without tracheal suctioning. No differences were reported in the risk of any severity HIE (RR 1.05, 95% CI 0.68 to 1.63; 1 study, 175 neonates) or moderate to severe HIE (RR 0.68, 95% CI 0.43 to 1.09; 1 study, 152 neonates) among non-vigorous neonates born through MSAF. We are also uncertain as to the effect of tracheal suction on other outcomes such as incidence of mechanical ventilation (RR 0.99, 95% CI 0.68 to 1.44; RD 0.00, 95% CI -0.06 to 0.06; 4 studies, 581 neonates), pulmonary air leaks (RR 1.22, 95% CI 0.38 to 3.93; RD 0.00, 95% CI -0.02 to 0.03; 3 studies, 449 neonates), persistent pulmonary hypertension (RR 1.29, 95% CI 0.60 to 2.77; RD 0.02, 95% CI -0.03 to 0.06; 3 studies, 406 neonates) and culture-positive sepsis (RR 1.32, 95% CI 0.48 to 3.57; RD 0.01, 95% CI -0.03 to 0.05; 3 studies, 406 neonates). All reported outcomes were judged as providing very low certainty evidence. AUTHORS' CONCLUSIONS We are uncertain about the effect of tracheal suction on the incidence of MAS and its complications among non-vigorous neonates born through MSAF. One study awaits classification and could not be included in the review. More research from well-conducted large trials is needed to conclusively answer the review question.
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Affiliation(s)
- Sushma Nangia
- Department of Neonatology, Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, New Delhi, India
| | - Anu Thukral
- Department of Pediatrics, Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, New Delhi, India
| | - Deepak Chawla
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
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Heo JS, Kim SY, Park HW, Choi YS, Park CW, Cho GJ, Oh AY, Jang EK, Kim HS, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 8. Neonatal resuscitation. Clin Exp Emerg Med 2021; 8:S96-S115. [PMID: 34034452 PMCID: PMC8171175 DOI: 10.15441/ceem.21.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/05/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Su Yeong Kim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Ah Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyung Jang
- Office of Patient Safety, Yonsei University Severance Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Inhaled Nitric Oxide at Birth Reduces Pulmonary Vascular Resistance and Improves Oxygenation in Preterm Lambs. CHILDREN-BASEL 2021; 8:children8050378. [PMID: 34064629 PMCID: PMC8150344 DOI: 10.3390/children8050378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
Resuscitation with 21% O2 may not achieve target oxygenation in preterm infants and in neonates with persistent pulmonary hypertension of the newborn (PPHN). Inhaled nitric oxide (iNO) at birth can reduce pulmonary vascular resistance (PVR) and improve PaO2. We studied the effect of iNO on oxygenation and changes in PVR in preterm lambs with and without PPHN during resuscitation and stabilization at birth. Preterm lambs with and without PPHN (induced by antenatal ductal ligation) were delivered at 134 d gestation (term is 147–150 d). Lambs without PPHN were ventilated with 21% O2, titrated O2 to maintain target oxygenation or 21% O2 + iNO (20 ppm) at birth for 30 min. Preterm lambs with PPHN were ventilated with 50% O2, titrated O2 or 50% O2 + iNO. Resuscitation with 21% O2 in preterm lambs and 50%O2 in PPHN lambs did not achieve target oxygenation. Inhaled NO significantly decreased PVR in all lambs and increased PaO2 in preterm lambs ventilated with 21% O2 similar to that achieved by titrated O2 (41 ± 9% at 30 min). Inhaled NO increased PaO2 to 45 ± 13, 45 ± 20 and 76 ± 11 mmHg with 50% O2, titrated O2 up to 100% and 50% O2 + iNO, respectively, in PPHN lambs. We concluded that iNO at birth reduces PVR and FiO2 required to achieve target PaO2.
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Hinder M, Tracy M. Newborn resuscitation devices: The known unknowns and the unknown unknowns. Semin Fetal Neonatal Med 2021; 26:101233. [PMID: 33773952 DOI: 10.1016/j.siny.2021.101233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infant resuscitation devices used at birth must be capable of delivering adequate and consistent ventilation in a controlled and predictable manner to a wide patient weight range, and combinations of transitional lung states. Manual inflation resuscitation devices delivering positive pressure lung inflation at birth can be classified broadly into two types: 1) flow generating, ie silicone self-inflating bags (SIB) also known as bag valve mask (BVM) and 2) flow dependent, ie anaesthetic flow inflating bag (FIB) and t-piece resuscitator (TPR) systems (eg: Neopuff, GE Panda and Draeger Resuscitaires). Globalization, lower production costs, and an expanding market need for devices, has led to a proliferation of brands (both reusable and single use) within a class type. T-piece resuscitators have become the dominant device particularly in high income countries. There remains a paucity of information on the performance characteristics of these devices and their ability to provide the required respiratory parameters for effective and safe ventilation across the full-expected weight range and lung states to which they will be applied. This review aims to inform current clinical practise on the biomechanical efficiency, reliability and efficacy of the most common devices used to apply PPV to newborns and infants ≤10 kgs.
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Affiliation(s)
- Murray Hinder
- The Westmead Hospital Neonatal Intensive Care Unit, Australia; The University of Sydney, Department of Paediatrics and Child Health, Australia
| | - Mark Tracy
- The Westmead Hospital Neonatal Intensive Care Unit, Australia; The University of Sydney, Department of Paediatrics and Child Health, Australia.
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Dubos C, Querne L, Brenac W, Tourneux P. Association between hypothermia in the first day of life and survival in the preterm infant. Arch Pediatr 2021; 28:197-203. [PMID: 33750613 DOI: 10.1016/j.arcped.2021.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/15/2020] [Accepted: 02/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hypothermia is associated with elevated mortality in the preterm infant. The preterm infant's thermoregulatory capacity is limited, and the thermal environment in an incubator is often perturbed by nursing procedures. We evaluated the incidence of a postnatal low body temperature and hypothermia in preterm infants and its association with mortality. METHODS We measured the lowest body temperature during the first 24h of life (TBody Nadir 24h) and hypothermia (TBody Nadir 24h<36.0°C) in preterm infants (gestational age: 230-316 weeks) in a neonatal intensive care unit. Prenatal and neonatal characteristics associated with mortality were identified in univariate and multivariable analyses. RESULTS A total of 102 preterm infants were included, with a mean gestational age at birth of 28.4±2.3 weeks. The incidence of hypothermia during the first 24h was 53%. A Cox multivariate regression model indicated that TBody Nadir 24h (hazard ratio (HR) [95% confidence interval]: 0.57 [0.36-0.90]; P=0.017), gestational age (0.62 [0.50-0.76]; P<0.001), and amine use (4.55 [2.01-10.28]; P=0.001) were significantly associated with mortality. When considering a threshold for TBody Nadir 24h, a value of 35.0°C had the highest HR (3.30 [1.42-7.68]; P<0.01). CONCLUSION In preterm infants, the incidence of hypothermia during the first 24h of life was 53%. TBody Nadir 24h had an influence on mortality, independently of other factors (notably birth weight and amine use). Within the framework of a quality improvement strategy, the implementation of a thermoregulation bundle is required to prevent hypothermia and decrease mortality in preterm infants.
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Affiliation(s)
- C Dubos
- Paediatric intensive care unit, Amiens university hospital, 80054 Amiens, France; PériTox Laboratory UMR_I 01, UFR de médecine, University of Picardie-Jules-Verne, 80054 Amiens, France
| | - L Querne
- INSERM U-1105, Paediatric neurology unit, Amiens university hospital, Amiens, France
| | - W Brenac
- Gynaecology-Obstetrics Unit, Amiens university hospital, 80054 Amiens, France
| | - P Tourneux
- Paediatric intensive care unit, Amiens university hospital, 80054 Amiens, France; PériTox Laboratory UMR_I 01, UFR de médecine, University of Picardie-Jules-Verne, 80054 Amiens, France.
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Discontinuing Nasal Continuous Positive Airway Pressure in Infants ≤32 Weeks of Gestational Age: A Randomized Control Trial. J Pediatr 2021; 230:93-99.e3. [PMID: 33127365 DOI: 10.1016/j.jpeds.2020.10.045] [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: 08/19/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare immediate cessation of nasal continuous positive airway pressure (NCPAP) vs a stepwise decrease in pressure on the duration of NCPAP therapy in infants born prematurely. STUDY DESIGN A single center study in infants 230-326 weeks of gestational age. NCPAP was stopped either at 5 cm H2O (control) or 3 cm H2O after a stepwise pressure wean (wean) using defined stability and failure criteria. Primary outcome is total NCPAP days. RESULTS We enrolled 226 infants; 116 were randomly assigned to control and 110 to the wean group. There was no difference in the total NCPAP days between groups (median [25th, 75th percentiles] 16 [5, 36] vs 14 [7, 33] respectively). There were no differences between groups in secondary outcomes, including duration of hospital stay, critical care days, and oxygen supplementation. A higher proportion of control infants failed the initial attempt to discontinue NCPAP (43% vs 27%, respectively; P < .01) and required ≥2 attempts (20% vs 5%, respectively; P < .01). In addition, infants 23-27 weeks of gestational age in the wean group were 2.4-times more likely to successfully stop NCPAP at the first attempt (P = .02) vs controls. CONCLUSIONS Discontinuation of NCPAP after a gradual pressure wean to 3 cm H2O did not decrease the duration of NCPAP therapy compared with stopping from 5 cm H2O in infants ≤32 weeks of gestational age. However, weaning decreased failed initial attempts to stop NCPAP, particularly among infants <28 weeks of gestational age. TRIAL REGISTRATION Clinicaltrials.gov: NCT02064712.
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Chan NHM, Merali HS, Mistry N, Kealey R, Campbell DM, Morris SK, Data S. Development of a novel mobile application, HBB Prompt, with human factors and user-centred design for Helping Babies Breathe skills retention in Uganda. BMC Med Inform Decis Mak 2021; 21:39. [PMID: 33541340 PMCID: PMC7863544 DOI: 10.1186/s12911-021-01406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Helping Babies Breathe (HBB) is a life-saving program that has helped reduce neonatal morbidity and mortality, but knowledge and skills retention after training remains a significant challenge for sustainability of impact. User-centred design (UCD) can be used to develop solutions to target knowledge and skills maintenance. METHODS We applied a process of UCD beginning with understanding the facilitators of, and barriers to, learning and retaining HBB knowledge and skills. HBB Master Trainers and frontline HBB providers participated in a series of focus group discussions (FGDs) to uncover the processes of skills acquisition and maintenance to develop a mobile application called "HBB Prompt". Themes derived from each FGD were identified and implications for development of the HBB Prompt app were explored, including feasibility of incorporating strategies into the format of an app. Data analysis took place after each iteration in Phase 1 to incorporate feedback and improve subsequent versions of HBB Prompt. RESULTS Six HBB trainers and seven frontline HBB providers participated in a series of FGDs in Phase 1 of this study. Common themes included lack of motivation to practise, improving confidence in ventilation skills, ability to achieve the Golden Minute, fear of forgetting knowledge or skills, importance of feedback, and peer-to-peer learning. Themes identified that were not feasible to address pertained to health system challenges. Feedback about HBB Prompt was generally positive. Based on initial and iterative feedback, HBB Prompt was created with four primary functions: Training Mode, Simulation Mode, Quizzes, and Dashboard/Scoreboard. CONCLUSIONS Developing HBB Prompt with UCD to help improve knowledge and skills retention was feasible and revealed key concepts, including drivers for successes and challenges faced for learning and maintaining HBB skills. HBB Prompt will be piloted in Phase 2 of this study, where knowledge and skills retention after HBB training will be compared between an intervention group with HBB Prompt and a control group without the app. Trial registration Clinicaltrials.gov (NCT03577054). Retrospectively registered July 5, 2018, https://clinicaltrials.gov/ct2/show/study/NCT03577054 .
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Affiliation(s)
- Natalie Hoi-Man Chan
- Division of Neonatology, British Columbia Women’s Hospital, 1N55-4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Hasan S. Merali
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children’s Hospital, 1280 Main Street West, HSC-2R104, Hamilton, ON L8S 4K1 Canada
| | - Niraj Mistry
- Division of Paediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Ryan Kealey
- Interactive Media Lab, University of Toronto, 5 King’s College Road, Toronto, ON M5S 3G8 Canada
- Design Research, TD Bank Group, Toronto, ON Canada
| | - Douglas M. Campbell
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON Canada
- Neonatal Intensive Care Unit, St. Michael’s Hospital, 15014 - 30 Bond St, Toronto, M5B 1W8 ON Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Shaun K. Morris
- Division of Infectious Diseases and Centre for Global Child Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, ON Canada
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
- Consortium for Affordable Medical Technologies in Uganda (CAMTech Uganda), Mbarara, Uganda
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Kim SY, Shim GH, Schmölzer GM. Is Chest Compression Superimposed with Sustained Inflation during Cardiopulmonary Resuscitation an Alternative to 3:1 Compression to Ventilation Ratio in Newborn Infants? CHILDREN-BASEL 2021; 8:children8020097. [PMID: 33540820 PMCID: PMC7913022 DOI: 10.3390/children8020097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022]
Abstract
Approximately 0.1% for term and 10-15% of preterm infants receive chest compression (CC) in the delivery room, with high incidence of mortality and neurologic impairment. The poor prognosis associated with receiving CC in the delivery room has raised concerns as to whether specifically-tailored cardiopulmonary resuscitation methods are needed. The current neonatal resuscitation guidelines recommend a 3:1 compression:ventilation ratio; however, the most effective approach to deliver chest compression is unknown. We recently demonstrated that providing continuous chest compression superimposed with a high distending pressure or sustained inflation significantly reduced time to return of spontaneous circulation and mortality while improving respiratory and cardiovascular parameters in asphyxiated piglet and newborn infants. This review summarizes the current available evidence of continuous chest compression superimposed with a sustained inflation.
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Affiliation(s)
- Seung Yeon Kim
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada; (S.Y.K.); (G.-H.S.)
- Department of Pediatrics, Eulji University Hospital, Daejeon 35233, Korea
| | - Gyu-Hong Shim
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada; (S.Y.K.); (G.-H.S.)
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul 01757, Korea
| | - Georg M. Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada; (S.Y.K.); (G.-H.S.)
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz 8036, Austria
- Correspondence: ; Tel.: +1-78-0735-5179; Fax: +1-78-0735-4072
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Decreasing Admissions to the NICU: An Official Transition Bed for Neonates. Adv Neonatal Care 2021; 21:87-91. [PMID: 32384327 DOI: 10.1097/anc.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence supports the need to decrease healthcare costs. One approach may be minimizing use of low-value care by reducing the number of unnecessary neonatal intensive care unit (NICU) admissions through the use of official neonatal transition beds. PURPOSE To evaluate whether transition beds decrease unnecessary NICU admissions and estimate the cost savings of this practice change. METHODS This retrospective chart review examined the records of all neonates of 350/7 weeks' gestational age and greater with birth weights of 2000 g and more admitted to a neonatal transition bed from January 1, 2017, to December 31, 2017. Outcomes evaluated were number of neonates returned to their mothers and an estimate of dollars saved for a 1-year period. RESULTS A total of 194 neonates were admitted to transition beds, which resulted in 144 NICU admissions averted. Respiratory distress was the most common reason for admission to transition beds. There was a statistically significant difference in length of stay in transition beds between neonates admitted to the NICU and those returned to couplet care after admission to transition beds (135.92 minutes vs 159.27 minutes; P = .047). There was no difference in gestational age based on admission to NICU or returned to couplet care (37.9 weeks vs 38 weeks; P = .772). The estimated cost savings was $3000 per neonate returned to couplet care totaling $432,000 annually. IMPLICATIONS FOR PRACTICE The use of neonatal transition beds is a potential strategy to decrease unnecessary NICU admissions and reduce low value care. IMPLICATIONS FOR RESEARCH Research regarding potential benefits of transition beds including the effect on hospital resources and low-value care at other institutions is needed. Additional research regarding potential benefits to the family including parent satisfaction and the effect of transition beds on rates of breastfeeding and skin-to-skin care is important.
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Chen YJ, Yu WH, Chen LW, Huang CC, Kang L, Lin HS, Iwata O, Kato S, Hussein MH, Lin YC. Improved Survival of Periviable Infants after Alteration of the Threshold of Viability by the Neonatal Resuscitation Program 2015. CHILDREN-BASEL 2021; 8:children8010023. [PMID: 33406755 PMCID: PMC7824697 DOI: 10.3390/children8010023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 01/11/2023]
Abstract
Periviable infants (PIs) born at 22–25 weeks gestational age (wGA) have a variable survival rate (49.7–86.2%) among hospitals. One factor involved in this difference may be the definition of the threshold of viability. The American Academy of Pediatrics revised the neonatal resuscitation program in late 2015 (NRP 2015) and altered the threshold of viability from 23 to 22 wGA. The impact on the survival of PIs after the guideline alteration has seldom been discussed. Since 2016, the unit of this study has implemented the renewed guideline for PIs. We retrospectively reviewed and analyzed the survival and clinical variables of PIs before and after implementation of the guideline, which included a 10-year cohort in a single center in Taiwan. There were 168 PIs enrolled between 2010 and 2019 (Epoch-I, 2010–2015; Epoch-II, 2016–2019), after excluding those with congenital anomalies and parent-decided comfort care. Compared to those in Epoch-I, the PIs in Epoch-II had significantly higher odds ratios (2.602) (95% confidence interval: 1.170–5.789; p = 0.019) for survival. Younger gestational age, small size for gestational age, cesarean delivery, low blood pH at birth, and surfactant therapeutic treatment were found to be significant risk factors associated with the survival of PIs (p < 0.05 for each). The altered threshold of viability by NRP 2015 may impact the survival of PIs. However, long-term follow-up for surviving PI is required in the future.
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Affiliation(s)
- Yen-Ju Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Wen-Hao Yu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Lin Kang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan;
| | - Hui-Shan Lin
- Department of Nursing, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan;
| | - Osuke Iwata
- Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi 467-8601, Japan; (O.I.); (S.K.)
| | - Shin Kato
- Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi 467-8601, Japan; (O.I.); (S.K.)
| | - Mohamed Hamed Hussein
- Department of Neonatology, Center of Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama 350-8550, Japan
- Correspondence: (M.H.H.); (Y.-C.L.); Tel.: +81-492-283-727 (M.H.H.); +886-62353535-3236 (Y.-C.L.)
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
- Correspondence: (M.H.H.); (Y.-C.L.); Tel.: +81-492-283-727 (M.H.H.); +886-62353535-3236 (Y.-C.L.)
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Shitara Y, Kakiuchi S, Mukai T, Kashima K, Kato M, Takahashi N. Case Report: Treatment of Extremely Preterm Infants With Birthweight Below 300 g: Case Series. Front Pediatr 2021; 9:758683. [PMID: 34938697 PMCID: PMC8685408 DOI: 10.3389/fped.2021.758683] [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: 08/14/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022] Open
Abstract
Reports on the birth of infants weighing <300 g are quite rare and little is known about the best practices in treating such micropreemies. Therefore, we report here on three cases of low birthweight infants weighing <300 g, of whom two infants survived. The birthweights and gestational ages were ranging 279-293 g and 22 + 6/7 - 23 + 6/7 weeks, respectively. All the infants had severe fetal growth restriction and prematurity. The infant in case 1 died of hepatic rupture, perhaps due to birth trauma, which emphasized the need for less invasive obstetric procedures including en caul delivery. The infant in case 2 managed to survive through severe prematurity secondary to hydrops fetalis. However, complications followed soon as tracheal granulation tissue was formed with neurodevelopmental impairment. The infant in case 3 was born recently and her clinical course was less remarkable without severe complications, despite having the least gestational age and birthweight among the three patients. The improved care protocols for extremely low birthweight infants over these years through experiential learning including that with cases 1 and 2 may have ensured the better outcome of case 3. Accumulating evidence and recording the experience of such cases with continuous constructive discussion can contribute to better outcomes and appropriate parental counseling for extremely small babies in the future.
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Affiliation(s)
- Yoshihiko Shitara
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Satsuki Kakiuchi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeo Mukai
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Kohei Kashima
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoto Takahashi
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
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36
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Dani C, Cecchi A, Remaschi G, Mercadante D, la Marca G, Boni L, Mosca F. Study protocol: treatment with caffeine of the very preterm infant in the delivery room: a feasibility study. BMJ Open 2020; 10:e040105. [PMID: 33277284 PMCID: PMC7722383 DOI: 10.1136/bmjopen-2020-040105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Early treatment with caffeine in the delivery room has been proposed to decrease the need for mechanical ventilation (MV) by limiting episodes of apnoea and improving respiratory mechanics in preterm infants. Thus, the purpose of this feasibility study is to verify the hypothesis that intravenous or enteral administration of caffeine can be performed in the preterm infant in the delivery room. METHODS AND ANALYSIS In this multicentre prospective study, infants with 25+0-29+6 weeks of gestational age will be enrolled and randomised to receive 20 mg/kg of caffeine citrate intravenously, via the umbilical vein, or enterally, through an orogastric tube, within 10 min of birth. Caffeine plasma level will be measured at 60±15 min after administration and 60±15 min before the next dose (5 mg/kg). The primary endpoint will be evaluation of the success rate of intravenous and enteral administration of caffeine in the delivery room. Secondary endpoints will be the comparison of success rate of intravenous versus oral administration and the evaluation of the need for MV in treated infants. In the absence of previous references, we arbitrarily decided to study 20 infants treated with intravenous caffeine and 20 infants treated with enteral caffeine. Primary endpoint will be evaluated measuring the success rate of intravenous and enteral caffeine administration which will be considered a success when it is followed by the achievement of the caffeine therapeutic level (8-25 µg/mL) 60±15 min before administration of the second dose. ETHICS AND DISSEMINATION The study has been approved by the Italian Medicines Agency (AIFA: AIFA/RSC/P/32755) and by Comitato Etico Pediatrico Regione Toscana. The results will be published in peer-reviewed academic journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT04044976; EudraCT number 2018-003626-91.
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Affiliation(s)
- Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Firenze, Italy
| | - Alessandra Cecchi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Giulia Remaschi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Domenica Mercadante
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan, University of Milan, Florence, Italy
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo la Marca
- Laboratory of Clinical Chemistry and Pharmacology of the A Meyer Pediatric Hospital of Florence, University of Florence, Florence, Italy
| | - Luca Boni
- Department of Human Pathology and Oncology, University of Florence, Florence, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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37
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Resuscitation policies for extremely preterm newborns: finally moving beyond gestational age. J Perinatol 2020; 40:1731-1733. [PMID: 33009493 DOI: 10.1038/s41372-020-00843-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/24/2020] [Accepted: 09/18/2020] [Indexed: 11/08/2022]
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38
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Alkan Ozdemir S, Ozdemir N, Aksan O, Kınalı B, Bilici Güler G, Erbil G, Ozer E, Ozer E. Effect of humic acid on oxidative stress and neuroprotection in hypoxic-ischemic brain injury: part 1. J Matern Fetal Neonatal Med 2020; 35:4580-4589. [PMID: 36062519 DOI: 10.1080/14767058.2020.1856809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Senem Alkan Ozdemir
- Izmir Health Science University Division of Neonatology, Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | | | | | | | | | - Güven Erbil
- School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Erdener Ozer
- School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Esra Ozer
- School of Medicine, Izmir Tınaztepe University, Izmir, Turkey
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39
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Reed RL, Chang C, Perlman JM. Perinatal characteristics and delivery room management of infants born through MSAF. Resuscitation 2020; 157:99-105. [PMID: 33096159 DOI: 10.1016/j.resuscitation.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
The immediate delivery room (DR) management of non-vigorous (NV) infants with meconium stained amniotic fluid (MSAF) is controversial. A recent ILCOR suggestion is not to perform routine direct laryngoscopy (DL) with or without tracheal suctioning in NV infants. Our practice is to perform DL and endotracheal (ET) suctioning in targeted NV infants. The study objective was to describe the perinatal characteristics and DR Management of infants born through MSAF and admitted to the neonatal intensive care unit (NICU). METHODS Retrospective study evaluating the DR management of infants >35 weeks delivered through MSAF. Data retrieved included fetal heart rate abnormalities (FTHR), presence of thick/thin MSAF, DR management and postnatal course. RESULTS 118 infants were resuscitated and directly admitted to the NICU, including 58 intubated for meconium, 29 receiving immediate PPV (n = 25) or CPAP (n = 4) and 31 (17%) initially stable developed delayed respiratory symptoms and administered CPAP. Sixty-four (35.2%) infants initially stable in the DR were subsequently admitted to NICU. ET suctioning was performed in 58/182 infants with meconium obtained in 41/58; meconium aspiration syndrome (MAS) was diagnosed in 21 infants. ET suctioning was positive in 10/21 cases. FHRT abnormalities (n = 50) were noted with thick meconium and associated with a 2.8-fold increased risk for meconium below the cords, and 3.1-fold increased risk of MAS. CONCLUSION NV infants delivered through thick versus thin meconium were more likely to be intubated with a high yield of recovery. Serious pulmonary morbidity was uncommon. Most respiratory symptomatology were not related to MAS.
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Affiliation(s)
- Rachel L Reed
- Department of Pediatrics Division of Newborn Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, Komansky Children's Hospital, 525 East 68thStreet, New York, NY 10065, United States
| | - Catherine Chang
- Department of Pediatrics Division of Newborn Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, Komansky Children's Hospital, 525 East 68thStreet, New York, NY 10065, United States
| | - Jeffrey M Perlman
- Department of Pediatrics Division of Newborn Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, Komansky Children's Hospital, 525 East 68thStreet, New York, NY 10065, United States.
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40
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Aziz K, Lee HC, Escobedo MB, Hoover AV, Kamath-Rayne BD, Kapadia VS, Magid DJ, Niermeyer S, Schmölzer GM, Szyld E, Weiner GM, Wyckoff MH, Yamada NK, Zaichkin J. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S524-S550. [DOI: 10.1161/cir.0000000000000902] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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41
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Hitchings L, Rodriguez M, Persaud R, Gomez L. The effect of delayed cord clamping on blood sugar levels on 34-36 week neonates exposed to late preterm antenatal steroids. J Matern Fetal Neonatal Med 2020; 35:3587-3594. [PMID: 33043779 DOI: 10.1080/14767058.2020.1832074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neonatal hypoglycemia is a known side effect of antenatal betamethasone (BMZ) given for fetal maturation. We sought to investigate if delayed cord clamping (DCC) has an impact on neonatal hypoglycemia induced by antenatal late preterm BMZ administration. MATERIAL AND METHODS Retrospective cohort study (January 2019-May 2019) of pregnancies undergoing delivery at 34-0/7 to 36-6/7 weeks at a single center included in two groups: DCC + BMZ and BMZ-only (no DCC). The primary outcome was the occurrence of neonatal hypoglycemia at the first hour after delivery. RESULTS A total of 62/188, 32.98% (DCC + BMZ group) and 45/100, 45% (DCC-only group) infants presented with hypoglycemia at 1-h after birth (adjusted p = .06; OR 0.73, 95% CI 0.54-1.01). When stratified according to gestational age at delivery, DCC was associated with a 46% reduction in the occurrence of neonatal hypoglycemia among those born at 35-0/7 to 35-6/7 weeks (adjusted p = .033; OR 0.54, 95% CI 0.33-0.88) and 35% reduction among those born at 36-0/7 to 36-67 weeks (adjusted p = .046; OR 0.65, 95% CI 0.43-0.97). CONCLUSION In our cohort, delayed cord clamping in infants receiving late preterm BMZ born between 35-0/7 and 36-6/7 weeks' gestation protects from early neonatal hypoglycemia.
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Affiliation(s)
- Laura Hitchings
- Children's National Health System, Prenatal Pediatric Institute, Washington, DC, USA
| | - Marcella Rodriguez
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Inova Health Systems, Falls Church, VA, USA.,Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Reva Persaud
- Children's National Health System, Prenatal Pediatric Institute, Washington, DC, USA
| | - Luis Gomez
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Inova Health Systems, Falls Church, VA, USA.,Division of Maternal Fetal Medicine, Perinatal associates of Northern Virginia, Fairfax, VA, USA
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42
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Dariya V, Moresco L, Bruschettini M, Brion LP. Cuffed versus uncuffed endotracheal tubes for neonates. Cochrane Database Syst Rev 2020. [DOI: 10.1002/14651858.cd013736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Vedanta Dariya
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine; University of Texas Southwestern Medical Center; Dallas Texas USA
| | - Luca Moresco
- Pediatric and Neonatology Unit; Ospedale San Paolo; Savona Italy
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics; Lund University, Skåne University Hospital; Lund Sweden
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine; University of Texas Southwestern at Dallas; Dallas Texas USA
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43
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Perretta LJ, Spaight M, Yap V, Perlman J. Randomized Study of Delayed Cord Clamping of 30 to 60 Seconds in the Larger Infant Born Preterm. J Pediatr 2020; 224:153-157. [PMID: 32651013 DOI: 10.1016/j.jpeds.2020.04.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/10/2020] [Accepted: 04/23/2020] [Indexed: 10/23/2022]
Abstract
In a randomized study of infants born preterm (gestational age 28-34 6/7 weeks), we evaluated delayed cord clamping for 30 (n = 50) vs 60 (n = 55) seconds. The primary outcome of initial hematocrit differed by 2.8% (P = .006), being greater with 60 seconds. There were no differences in secondary outcomes and no adverse consequences between groups. These findings should serve as a stimulus to many centers that are reluctant to implement delayed cord clamping in this targeted larger premature population.
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Affiliation(s)
- Laura J Perretta
- Division of Newborn Medicine, Department of Pediatrics, New York Presbyterian-Weill Cornell Medicine, New York, NY
| | - Morgan Spaight
- Division of Newborn Medicine, Department of Pediatrics, New York Presbyterian-Weill Cornell Medicine, New York, NY
| | - Vivien Yap
- Division of Newborn Medicine, Department of Pediatrics, New York Presbyterian-Weill Cornell Medicine, New York, NY
| | - Jeffrey Perlman
- Division of Newborn Medicine, Department of Pediatrics, New York Presbyterian-Weill Cornell Medicine, New York, NY.
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44
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Goel D, Shah D, Hinder M, Tracy M. Laryngeal mask airway use during neonatal resuscitation: a survey of practice across newborn intensive care units and neonatal retrieval services in Australian New Zealand Neonatal Network. J Paediatr Child Health 2020; 56:1346-1350. [PMID: 32949203 DOI: 10.1111/jpc.15110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 01/01/2023]
Abstract
This is an Australia New Zealand Neonatal Network (ANZNN) wide survey to identify current practice and guide future practice improvement for the use of laryngeal mask airway (LMA) during neonatal resuscitation. An online questionnaire containing 13 questions was sent out to all tertiary neonatal centres (n = 29 units) and neonatal transport units (n = 4) within ANZNN. The non-tertiary (level-II) centres were not included. Response from a senior neonatologist at each centre was received and evaluated. Twenty-two services (67%) had LMA available; of that only, 40% felt the competency of staff to be adequate; and 59% had routine training in LMA use. During neonatal resuscitation, 68% units reported using LMA if endotracheal intubation was unsuccessful after two or more failed intubation attempts and only 18% used it before intubation if face mask ventilation was inadequate. This survey highlighted variations in practice across the tertiary neonatal centres in ANZNN network. One-third of the units lack LMA availability and the units with LMA, face concerns of underutilisation and lack of skills for its use.
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Affiliation(s)
- Dimple Goel
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Dept Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dharmesh Shah
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Dept Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Murray Hinder
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Dept Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Tracy
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Dept Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
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45
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Effect of Delayed Cord Clamping on Umbilical Blood Gas Values in Term Newborns: A Systematic Review. Obstet Gynecol 2020; 135:576-582. [PMID: 32028488 DOI: 10.1097/aog.0000000000003663] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare the effect of delayed cord clamping on cord blood gas values in vaginally delivered, healthy, term singletons. DATA SOURCE We used MEDLINE, CINAHL, CENTRAL, EMBASE, and ClinicalTrials.gov databases. METHODS OF STUDY SELECTION Eligible studies included randomized controlled trials (RCTs) comparing cord blood gas values obtained from early compared with delayed cord clamping groups and observational studies using serial cord blood gas from the same umbilical cord. We described the difference in means of cord blood gas parameters and comparative descriptive statistics when a difference in means was not available. We used a domain-based risk bias tool to extract methodologic details and assess potential risk of bias. TABULATION, INTEGRATION, AND RESULTS This review included two RCTs and three observational studies. These studies included a total of 234 newborns with early cord clamping and 218 newborns with delayed cord clamping. The observational studies showed that 45-90 seconds delayed cord clamping was associated with mean decreases in umbilical arterial pH (0.02-0.03), HCO3 (0.3-0.8 mmol/L) and increases in base deficit (0.3-1.3 mmol/L) compared with early cord clamping. One observational study showed that delayed cord clamping was associated with decreases in umbilical venous pH (0.01) and HCO3 (0.2 mmol/L) and increase in venous base deficit (0.1-0.3 mmol/L) compared with early cord clamping. These changes were not observed in the two RCTs. CONCLUSION Delayed cord clamping up to 120 seconds has either no effect or only a small effect on cord blood acid-base balance; overall, the magnitude of these changes is not clinically significant in vaginally delivered, healthy, term singletons. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42019135779.
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46
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Weydig H, Ali N, Kakkilaya V. Noninvasive Ventilation in the Delivery Room for the Preterm Infant. Neoreviews 2020; 20:e489-e499. [PMID: 31477597 DOI: 10.1542/neo.20-9-e489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A decade ago, preterm infants were prophylactically intubated and mechanically ventilated starting in the delivery room; however, now the shift is toward maintaining even the smallest of neonates on noninvasive respiratory support. The resuscitation of very low gestational age neonates continues to push the boundaries of neonatal care, as the events that transpire during the golden minutes right after birth prove ever more important for determining long-term neurodevelopmental outcomes. Continuous positive airway pressure (CPAP) remains the most important mode of noninvasive respiratory support for the preterm infant to establish and maintain functional residual capacity and decrease ventilation/perfusion mismatch. However, the majority of extremely low gestational age infants require face mask positive pressure ventilation during initial stabilization before receiving CPAP. Effectiveness of face mask positive pressure ventilation depends on the ability to detect and overcome mask leak and airway obstruction. In this review, the current evidence on devices and techniques of noninvasive ventilation in the delivery room are discussed.
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Affiliation(s)
- Heather Weydig
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Noorjahan Ali
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Venkatakrishna Kakkilaya
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
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47
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Sintayehu Y, Desalew A, Geda B, Tiruye G, Mezmur H, Shiferaw K, Mulatu T. Basic neonatal resuscitation skills of midwives and nurses in Eastern Ethiopia are not well retained: An observational study. PLoS One 2020; 15:e0236194. [PMID: 32706775 PMCID: PMC7380629 DOI: 10.1371/journal.pone.0236194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/30/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Neonatal resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. Worldwide, four million neonate deaths happen annually, and birth asphyxia accounts for one million deaths. Improving providers' neonatal resuscitation skills is critical for delivering quality care and for morbidity and mortality reduction. However, retention of these skills has been challenging in developing countries, including Ethiopia. Hence, this study aimed to assess neonatal resuscitation skills retention and associated factors among midwives and nurses in Eastern Ethiopia. METHODS An institution-based cross-sectional study was conducted using a pre-tested, structured, observational checklist. A total of 427 midwives and nurses were included from 28 public health facilities by cluster sampling and simple random sampling methods. Data were collected on facility type, availability of essential resuscitation equipment, socio-demographic characteristics of participants, current working unit, years of professional experience, whether a nurse or midwife received refresher training, and skills and knowledge related to neonatal resuscitation. Binary logistic regression was used to analyse the association between neonatal resuscitation skill retention and independent variables. RESULTS About 11.2% of nurses and midwives were found to have retention of neonatal resuscitation skills. Being a midwife (AOR, 7.39 [95% CI: 2.25, 24.24]), ever performing neonatal resuscitation (AOR, 3.33 [95% CI: 1.09, 10.15]), bachelor sciences degree or above (AOR, 4.21 [95% CI: 1.60, 11.00]), and good knowledge of neonatal resuscitation (AOR, 3.31 [95% CI: 1.41, 7.73]) were significantly associated with skill retention of midwives and nurses. CONCLUSION Basic neonatal resuscitation skills of midwives and nurses in Eastern Ethiopia are not well retained. This could increase the death of neonates due to asphyxia. Being a midwife, Bachelor Sciences degree or above educational status, ever performing neonatal resuscitation, and good knowledge were associated with skill retention. Providers should be encouraged to upgrade their educational level to build their skill retention and expose themselves to NR. Further, understanding factors affecting how midwives and nurses gain and retain skills using high-level methodology are essential.
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Affiliation(s)
- Yitagesu Sintayehu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Assefa Desalew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getahun Tiruye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haymanot Mezmur
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teshale Mulatu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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48
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Sawyer T. Educational Perspectives: Educational Strategies to Improve Outcomes from Neonatal Resuscitation. Neoreviews 2020; 21:e431-e441. [PMID: 32611561 DOI: 10.1542/neo.21-7-e431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since 1987, the Neonatal Resuscitation Program (NRP) course has taught the cognitive, technical, and behavioral skills required to effectively resuscitate newborns. To remain relevant and effective, the NRP course needs to continually evolve and embrace evidence-based educational strategies proven to improve outcomes from resuscitation. In this Educational Perspectives article, 6 educational strategies that can be applied to neonatal resuscitation education are reviewed. These educational strategies include mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, and innovative educational strategies Then knowledge translation and implementation of these educational strategies through passive and active knowledge translation, change theory, design thinking, performance measurement, deadoption strategies, continuous quality improvement, incentive and penalties, and psychological marketing are explored. Finally, ways to optimize faculty development of NRP instructors, including both initial instructor training and ongoing instructor development, are examined. The goal of this review is to help NRP program developers and instructors use evidence-based educational strategies to improve neonatal resuscitation outcomes.
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Affiliation(s)
- Taylor Sawyer
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
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49
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Patel S, Cheung PY, Lee TF, Pasquin MP, Lu M, O'Reilly M, Schmölzer GM. Asynchronous ventilation at 120 compared with 90 or 100 compressions per minute improves haemodynamic recovery in asphyxiated newborn piglets. Arch Dis Child Fetal Neonatal Ed 2020; 105:357-363. [PMID: 31123054 DOI: 10.1136/archdischild-2018-316610] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/08/2019] [Accepted: 03/22/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether different chest compression (CC) rates during continuous CC with asynchronous ventilations (CCaV) reduce time to return of spontaneous circulation (ROSC) and improved haemodynamic recovery in piglets aged 24-72 hours with asphyxia-induced asystole. METHODS Thirty piglets (aged 24-72 hours) were anaesthetised, intubated, instrumented and exposed to 30 min normocapnic hypoxia followed by asphyxia. Piglets were randomised into four groups: CCaV with CC rate of 90 (CCaV+90, n=8), 100 (CCaV+100, n=8) or 120 compressions per minute (CCaV+120, n=8), and a sham-operated group (n=6). Cardiac function, carotid blood flow, cerebral and renal oxygenation and respiratory parameters were continuously recorded. Cerebral cortical tissue was harvested and assayed for inflammatory and injury markers. RESULTS All three intervention groups had a similar number of piglets achieving ROSC (6/8, 5/8 and 5/8 for CCaV+120, CCaV+100 and CCaV+90, respectively) and mean ROSC time (120, 90 and 90 s for CCaV+120, CCaV+100 and CCaV+90, respectively). The haemodynamic recovery (indicated by carotid flow, cerebral and renal perfusion) was similar between CCaV+120 and sham by the end of experiment. In comparison, CCaV+90 and CCaV+100 had significantly reduced haemodynamic recovery compared with sham operated (p≤0.05). Inflammatory (interleukin [IL]-6 and IL-1β) and injury markers (lactate) were significantly higher in the frontoparietal cortex of CCaV+90 and CCaV+100 compared with sham, whereas brain injury markers were similar between CCaV+120 and sham. CONCLUSIONS Although there was no difference between the groups in achieving ROSC, the haemodynamic recovery of CCaV+120 was significantly improved compared with CCaV+90 and CCaV+100, which were also associated with higher cerebral inflammatory and brain injury markers.
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Affiliation(s)
- Sparsh Patel
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Po-Yin Cheung
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tze-Fun Lee
- Neonatal Research Unit, Centre of the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Matteo P Pasquin
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Min Lu
- Neonatal Research Unit, Centre of the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Megan O'Reilly
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Abstract
The American Academy of Pediatrics (AAP) believes that current data show that hospitals and accredited birth centers are the safest settings for birth in the United States. The AAP does not recommend planned home birth, which has been reported to be associated with a twofold to threefold increase in infant mortality in the United States. The AAP recognizes that women may choose to plan a home birth. This statement is intended to help pediatricians provide constructive, informed counsel to women considering home birth while retaining their role as child advocates and to summarize appropriate care for newborn infants born at home that is consistent with care provided for infants born in a medical care facility. Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care consistent with that highlighted in this statement, which is more completely described in other publications from the AAP, including Guidelines for Perinatal Care and the Textbook of Neonatal Resuscitation All health care clinicians and institutions should promote communications and understanding on the basis of professional interaction and mutual respect.
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Affiliation(s)
- Kristi Watterberg
- Department of Pediatrics, The University of New Mexico, Albuquerque, New Mexico
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