G562(P) Lifestart resuscitation platform to enable deferred cord clamping in preterm infants <32 weeks

Abstract

The primary outcome measure was numbers of culture positive EOS cases where the calculator did not recommend empirical antibiotics. If the NICE guidelines would not have recommended treatment either this was not classified as a 'miss'. Risk of bias was assessed using QUADAS-2.Data were pooled using a random effect meta-analysis, quantifying heterogeneity using I². A subgroup analysis was performed using data from studies of babies exposed to chorioamnionitis. Results Eleven studies were eligible. There were 75 EOS cases and a minimum of 14, and a maximum of 22 cases where use of the calculator would have resulted in delayed or missed treatment, compared to if NICE guidelines were followed.The probability of 'calculator' delayed or missed treatment for an EOS case (additional to cases missed by following NICE guidelines) were best case 0.19 [95% confidence intervals 0.11 -0.29,I² 0%], worst case 0.31 [95% CI 0.17 -0.49, I² 37%].The probability of missing cases was significantly (p=0.03) more in babies exposed to chorioamnionitis, up to 0.56 [95% CI: [0.25, 0.82], I² 0%].All included studies had a low/moderate probability of bias. Conclusion A substantial proportion of EOS cases were missed by the calculator. Further evaluation of the calculator is recommended before it could be safely introduced into UK clinical practice.

Stabilisation and resuscitation with intact cord circulation is feasible using a wide variety of approaches; a scoping review

“…Most papers did provide clear descriptions of the position of the professionals around the operating theatre table, including the neonatal team. Some papers described the neonatal team being positioned alongside the mothers’ thighs, seven papers included a figure or photo of their set‐up 12,14,21,26,28,29,33 and three referred to supplementary videos 20,27,30 …”

“…The 18 studies were published in journal issues between 2014 and 2023. However, some papers appeared online before their formal publication date, and that is how we included them in our review up to 14 November 2022 12–14,19–33 . We searched for all papers published since the inception of the databases we used, but the two earliest articles identified in this scoping review were published in 2014.…”

“…There were four studies from the United States, three from the United Kingdom, two each from Australia, India and Italy and one each from China, France, the Netherlands, New Zealand and Taiwan. Seven studies were randomised controlled trials, 12,13,19–23 one was a quality improvement/method development study, 24 seven were observational studies 14,25–30 and three were case reports 31–33 (Table 1).…”

“…However, some papers appeared online before their formal publication date, and that is how we included them in our review up to 14 November 2022. [12][13][14][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] We searched for all papers published since the inception of the databases we used, but the two earliest articles identified in this scoping review were published in 2014. The studies were all quantitative, peer-reviewed, singlecountry studies, which were published in English and conducted in 10 different countries.…”

“…Different platforms were used to perform ICR/S on neonates born by C-section. We found that 164 neonates in five studies were stabilised or resuscitated on commercially available Lifestart trolleys (Inspiration Healthcare), 19,21,24,27,33 while 134 neonates in seven studies were placed on bedding, such as mattresses, drapes or towels. 13,14,20,22,26,30,31 Five papers reported that they used locally developed and assembled trolleys for a total of 88 neonates.…”