Part 13: Neonatal Resuscitation

Wyckoff, Myra H.; Aziz, Khalid; Escobedo, Marilyn; Kapadia, Vishal; Kattwinkel, John; Perlman, Jeffrey M.; Simon, Wendy; Weiner, Gary M.; Zaichkin, Jeanette

doi:10.1161/cir.0000000000000267

Cited by 609 publications

(359 citation statements)

References 226 publications

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“…The inter-rater reliability of stimulation was also admittedly low in previous studies of the data [16]. Correct tactile stimulation is hard to define, and guidelines only recommend that it should be one of the initial steps, and do not describe in detail how it should be performed [27]. …”

Section: Discussionmentioning

confidence: 99%

“…This has lately been refuted. If strictly following international guidelines from 2015, routine suction of the lower airways should never be performed, even in cases of depressed infants with meconium-stained fluids, and it should only be considered if there is apparent obstruction of the airway [27]. On the contrary, unnecessary suctioning of the lower airways can possibly harm the infant by causing injury or preventing breathing and reducing the heart rate.…”

Section: Discussionmentioning

confidence: 99%

“…In HBB, it is stated that ‘clearing the airway’ is needed if the baby is not crying or breathing well after drying. The section describes only shallow suctioning of the mouth and nose up to 5 cm beyond the lips using a bulb syringe, which is also recommended in international guidelines where ventilation is indicated [27]. However, if deep suctioning of the lower airways has been practised for a long period of time at the facility, such a cautious statement in the protocol might not be enough to change the clinical practice of frequent deep suctioning.…”

Section: Discussionmentioning

confidence: 99%

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Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings

Wrammert

Zetterlund

et al. 2017

Global Health Action

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Background: The global burden of stillbirth and neonatal deaths remains a challenge in low-income countries. Training in neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality. Previous results demonstrate that infants who previously would have been registered as stillbirths are successfully resuscitated after such training, suggesting that there is a process of selection for resuscitation that needs to be explored. Objective: To compare neonatal resuscitation of low birth weight and normal birth weight infants born at a facility in a low-income setting. Methods: Motion-triggered video cameras were installed above the resuscitation tables at a maternity health facility during an intervention study (ISRCTN97846009) employing the Helping Babies Breathe resuscitation protocol in Kathmandu, Nepal. Recordings were analysed, noting crying, stimulation, ventilation, suctioning and oxygen administration during resuscitation. Birth weight, Apgar scores and sex of the infant were retrieved from matched hospital registers. The results were analysed by chi-square and logistic regression. Results: A total of 2253 resuscitation cases were recorded. Low birth weight infants in need of resuscitation had higher odds of receiving ventilation (aOR 1.73, 95% CI 1.24–2.42) and lower odds of receiving suctioning (aOR 0.53, 95% CI 0.34–0.82) after adjustment for the Helping Babies Breathe intervention, sex of the infant and place of resuscitation within the facility. The rates of stimulation and administration of oxygen were the same in both groups. Conclusions: Low birth weight was associated with more ventilation and less suctioning during neonatal resuscitation in a low-income setting. As ventilation is the most important intervention when the infant does not initiate breathing after birth, low birth weight was not a predictor for the decision to withhold resuscitation. Frequent routine use of suctioning of the lower airways continues to be a problem in the studied context, even after the introduction of the Helping Babies Breathe protocol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings

Wrammert

Zetterlund

et al. 2017

Global Health Action

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“…However, such data may not be wholly applicable to the neonatal population because the most common cause of cardiovascular collapse in the adult is ventricular fibrillation, not asphyxia [8]. Furthermore, the current guidelines recommend a 3: 1 C:V ratio using 120 events/min comprising 90 CC and 30 inflations [5, 6]. Manikin and animal data have compared 3: 1 C:V with other C:V ratios (e.g., 9: 3 or 15: 2) with a focus of allowing higher ventilation rates [9-12].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia

et al. 2018

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Background: High-quality chest compression is essential during neonatal cardiopulmonary resuscitation (CPR). However, the optimal compression to ventilation ratio (C:V) that should be used during neonatal CPR to optimize coronary and cerebral perfusion while providing adequate ventilation remains unknown. Objective: We hypothesized that different C:V ratios (e.g., 2: 1 or 4: 1) will reduce the time to return of spontaneous circulation (ROSC) in severely asphyxiated piglets. Methods: Thirty-one newborn piglets (1–4 days old) were anesthetized, intubated, instrumented, and exposed to 50-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into 4 groups: 2: 1 (n = 8), 3: 1 (n = 8), 4: 1 (n = 8) C:V ratio, or a sham group (n = 7). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Results: Thirty-one piglets were included in the study, and there was no difference in the duration of asphyxia or the degree of asphyxiation (as indicated by pH, PaCO₂, and lactate) among the different groups. The median (IQR) time to ROSC was similar between the groups with 127 (82–210), 96 (88–126), and 119 (83–256) s in the 2: 1, 3: 1, and 4: 1 C:V ratio groups, respectively (p = 0.67 between groups). Similarly, there was no difference in 100% oxygen requirement or epinephrine administration between the experimental groups. Conclusions: Different C:V ratios resulted in similar ROSC, mortality, oxygen, and epinephrine administration during resuscitation in a porcine model of neonatal asphyxia.

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“…Even when the infant is full term, the American Academy of Pediatrics estimates that about 1 in 10 newly born infants will require some resuscitation intervention [3]. Therefore, rapid response times of neonatal resuscitation teams responding to emergencies in delivery rooms are essential, potentially impacting the eventual outcomes of these infants [4,5].…”

Section: Introductionmentioning

confidence: 99%

Potential Structural Obstacles to Effective Implementation of Neonatal Intensive Care Unit Rapid Response Teams

P¹,

Pham²,

Fletcher³

et al. 2017

Clinics Mother Child Health

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Background: In-hospital rapid response teams are critical to the prompt management of neonatal emergencies occurring in hospital delivery rooms. However, structural obstacles that exist within health care facilities may hinder the successful implementation of these teams. This study examined the prevalence of structural obstacles potentially impeding neonatal rapid response team movements between neonatal intensive care units and delivery rooms in hospitals with pediatric residency programs across the United States.

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Part 13: Neonatal Resuscitation

Cited by 609 publications

References 226 publications

Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings

Resuscitation practices of low and normal birth weight infants in Nepal: an observational study using video camera recordings

Comparison of Different Compression to Ventilation Ratios (2: 1, 3: 1, and 4: 1) during Cardiopulmonary Resuscitation in a Porcine Model of Neonatal Asphyxia

Potential Structural Obstacles to Effective Implementation of Neonatal Intensive Care Unit Rapid Response Teams

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