Heart rate changes during positive pressure ventilation after asphyxia-induced bradycardia in a porcine model of neonatal resuscitation

Espinoza, Maria Liza; Cheung, Po–Yin; Lee, Tze-Fun; O’Reilly, Megan; Schmölzer, Georg M.

doi:10.1136/archdischild-2017-314637

Cited by 10 publications

(10 citation statements)

References 5 publications

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“…However in contrast to the NRP, Espinoza et al showed that adequate PPV does not increase HR within 15 s of ventilation in piglets with asphyxia-induced bradycardia; after 30 s of PPV only half of piglets had an increase in HR. This study challenges the current NRP statement and suggests that clinicians should not expect an increase in HR after 15 s of PPV if there is severe bradycardia [42].…”

Section: Hemodynamicscontrasting

confidence: 70%

See 1 more Smart Citation

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

O’Reilly¹,

Cheung²,

Lee³

et al. 2020

Animal Models in Medicine and Biology

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Two to three million newborn infants worldwide need extensive cardiopulmonary resuscitation (CPR), and approximately one million of these infants die annually worldwide. Therefore, resuscitation techniques require further refinement to provide better outcomes. To investigate the effectiveness of various interventions and to understand the pathophysiology and pharmacology of neonatal CPR, it is important to have animal models that reliably reproduce features observed in neonates who require resuscitation. Herein, we describe an experimental animal model in newborn piglets that simulates neonatal asphyxia and enables us to examine resuscitation interventions, reoxygenation, and recovery processes. The newborn piglet has several advantages including similar development to a human fetus at 36-38 week's gestation, and comparable body systems and body size, allowing for surgical instrumentation, monitoring, and collection of biological samples. Furthermore, using this model of neonatal asphyxia, we are also able to describe an increasingly important clinical situation in the laboratory setting-pulseless electrical activity (PEA). Since the integration of electrocardiogram into the neonatal resuscitation guidelines, there has been an increased awareness of PEA in newborn infants. The animal model we describe can therefore serve as a valuable tool to bridge the knowledge gap and improve the outcome of asphyxiated newborns in the delivery room.

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Section: Hemodynamicscontrasting

confidence: 70%

“…Espinoza et al examined the changes in HR during adequate PPV following severe bradycardia in the porcine model of hypoxia-asphyxia [42]. The Neonatal Resuscitation Program (NRP) states that if adequate PPV is given for low HR, then the infant's HR should increase within the first 15 s of PPV.…”

Section: Hemodynamicsmentioning

confidence: 99%

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

O’Reilly¹,

Cheung²,

Lee³

et al. 2020

Animal Models in Medicine and Biology

Self Cite

View full text Add to dashboard Cite

show abstract

“…PEA is a phenomenon that occurs when cardiac output is zero but the ECG still displays an HR. PEA involves cardiac electrical activity in the absence of a detectable pulse and has been reported in adults and children, most commonly after hypoxia, severe volume loss, sepsis, tension pneumothorax or following cardiac arrest [7]. There is increasing evidence that PEA occurs in the delivery room [15].…”

Section: Pulseless Electrical Activitymentioning

confidence: 99%

“…Espinoza et al used a post-transition asphyxia-induced bradycardia term piglet model and observed an increase in HR >100 bpm in only 6/30 (20%) piglets after 30 s of adequate PPV [7]. The current NRP recommendation contrasts this observation, stating that 15 s of PPV at birth should result in an increase in HR [4].…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Assessment during Neonatal Resuscitation

Johnson

Schmölzer

2020

Healthcare

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Approximately 10% of newborn infants require some form of respiratory support to successfully complete the fetal-to-neonatal transition. Heart rate (HR) determination is essential at birth to assess a newborn’s wellbeing. Not only is it the most sensitive indicator to guide interventions during neonatal resuscitation, it is also valuable for assessing the infant’s clinical status. As such, HR assessment is a key step at birth and throughout resuscitation, according to recommendations by the Neonatal Resuscitation Program algorithm. It is essential that HR is accurate, reliable, and fast to ensure interventions are delivered without delay and not prolonged. Ineffective HR assessment significantly increases the risk of hypoxic injury and infant mortality. The aims of this review are to summarize current practice, recommended techniques, novel technologies, and considerations for HR assessment during neonatal resuscitation at birth.

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“…While these data suggest that an increase in HR might be delayed despite adequate ventilation, the Neonatal Resuscitation Program textbook states that once PPV is started, an increase in HR should be observed within 15 s [47]. However, in severe bradycardic asphyxiated newborn piglets, HR increased only in 50% of piglets after 30 s of adequate PPV [48]. Saugstad et al [49] reported that the HR of asphyxiated newborn infants was mean (SD) 93 (33) and 113 (30) at 60 and 90 s after birth, respectively.…”

Section: Respiratory Supportmentioning

confidence: 99%

Delivery Room Management of Asphyxiated Term and Near-Term Infants

et al. 2021

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Approximately 800,000 newborns die annually due to birth asphyxia. The resuscitation of asphyxiated term newly born infants often occurs unexpected and is challenging for healthcare providers as it demands experience and knowledge in neonatal resuscitation. Current neonatal resuscitation guidelines often focus on resuscitation of extremely and/or very preterm infants; however, the recommendations for asphyxiated term newborn infants differ in some aspects to those for preterm infants (i.e., respiratory support, supplemental oxygen, and temperature management). Since the update of the neonatal resuscitation guidelines in 2015, several studies examining various resuscitation approaches to improve the outcome of asphyxiated infants have been published. In this review, we discuss current recommendations and recent findings and provide an overview of delivery room management of asphyxiated term newborn infants.

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Heart rate changes during positive pressure ventilation after asphyxia-induced bradycardia in a porcine model of neonatal resuscitation

Abstract: In contrast to NRP recommendation, adequate PPV does not increase HR within 15 s after ventilation in piglets with asphyxia-induced bradycardia.

Cited by 10 publications

References 5 publications

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

Heart Rate Assessment during Neonatal Resuscitation

Delivery Room Management of Asphyxiated Term and Near-Term Infants

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