Perinatal predictors of clinical instability at birth in late-preterm and term infants

Abstract

To identify characteristics associated with delivery room clinical instability in at-risk infants. Prospective cohort study. Two perinatal centres in Melbourne, Australia. Infants born at ≥ 35+0 weeks’ gestation with a first-line paediatric doctor requested to attend. Clinical instability defined as any one of heart rate < 100 beats per minute for ≥ 20 s in the first 10 min after birth, maximum fraction of inspired oxygen of ≥ 0.70 in the first 10 min after birth, 5-min Apgar score of < 7, intubated in the delivery room or admitted to the neonatal unit for respiratory support. Four hundred and seventy-three infants were included. The median (IQR) gestational age at birth was 39+4 (38+4—40+4) weeks. Eighty (17%) infants met the criteria for clinical instability. Independent risk factors for clinical instability were labour without oxytocin administration, presence of a medical pregnancy complication, difficult extraction at birth and unplanned caesarean section in labour. Decision tree analysis determined that infants at highest risk were those whose mothers did not receive oxytocin during labour (25% risk). Infants at lowest risk were those whose mothers received oxytocin during labour and did not have a medical pregnancy complication (7% risk).Conclusions: We identified characteristics associated with clinical instability that may be useful in alerting less experienced clinicians to call for senior assistance early. The decision trees provide intuitive visual aids but require prospective validation. What is Known: • First-line clinicians attending at-risk births may need to call senior colleagues for assistance depending on the infant’s condition.• Delays in effectively supporting a compromised infant at birth is an important cause of neonatal morbidity and infant-mother separation. What is New: • This study identifies risk factors for delivery room clinical instability in at-risk infants born at ≥ 35+0 weeks’ gestation.• The decision trees presented provide intuitive visual tools to aid in determining the need for senior paediatric presence.

Blood pressure and cerebral oxygenation with physiologically-based cord clamping: sub-study of the BabyDUCC trial

“…19 The decision to provide resuscitation and the type of support provided were at the discretion of the attending first-line doctor trained in the Australian and New Zealand Committee on Resuscitation Neonatal Resuscitation Guidelines. 20,21 Respiratory support was commenced with a Giraffe stand-alone resuscitation system (GE Healthcare, Chicago, Illinois) set to pressures of 30/5 cmH 2 O in 21% FiO 2 .…”

Heart Rate Changes following Facemask Placement in Infants Born at ≥32+0 Weeks of Gestation

“…We evaluated the following pre-specified variables based on previous studies and clinical experience that might modify the effect of facemask placement on decrease in HR [2, 3, 15]:Gestational age: <37 +0 weeks versus ≥37 +0 weeks;Positive pressure ventilation (PPV) versus continuous positive airway pressure (CPAP) at the time of facemask placement;Mean SpO 2 <10th centile (based on the percentiles published by Dawson et al [16] from infants who had immediate cord clamping) versus mean SpO 2 ≥10th centile in the 15 s before facemask placement;Deferred versus early cord clamping;Vaginal versus caesarean birth;Mean HR: ≥120 bpm versus <120 bpm in the 15 s before facemask placement.…”

“…We evaluated the following pre-specified variables based on previous studies and clinical experience that might modify the effect of facemask placement on decrease in HR [2,3,15]…”

Blood Pressure and Cerebral Oxygenation with Physiologically-based Cord Clamping: A Sub-Study of the BabyDUCC Trial

“…The decision to provide resuscitation and the type of support provided were at the discretion of the attending first-line doctor trained in the Australian and New Zealand Committee on Resuscitation Neonatal Resuscitation Guidelines. 20,21 Respiratory support was commenced with a Giraffe stand-alone resuscitation system (GE Healthcare, United States of America) set to pressures of 30/5 cmH 2 O in 21% FiO 2 .…”