Positioning of term infants during delivery room routine handling – analysis of videos

Abstract

BackgroundDelivery room management (DR) of the newly born infant should be performed according to international guidelines, but no recommendations are available for an infant’s position immediately after birth. The present study was performed to answer the following questions: 1. How often is DR-management performed in term infants in side position? 2. Is routine DR-management possible in side position? 3. Is there any benefit of side position with respect to agitation or vital parameters?MethodsCross-sectional study of video-recorded DR-management in term newborns delivered by C-section in 2012. Videos were analysed for infant’s position, administered interventions, vital parameters and agitation.Results187 videos were analysed. The Main Position (defined as position spent more than 70% of the time) was “supine” in 91, “side” in 63 and “not determinable” in 33 infants. “Supine” infants received significantly (p < 0.001) more often stimulation (12.5% of the total time) than “side” infants (3.9% of time). There were no differences between both groups with regard to suctioning; CPAP was exclusively (98%) administered in supine position. Newborns on side were less agitated than those on supine. There was a trend towards a better oxygenation in “side” positioned infants (p = 0.055) and significantly (p = 0.04) higher saturation values in “left-sided” infants than “right-sided” infants at 8th minute. “Side” positioned infants reached oxygen saturation values >90% earlier than “supine” positioned infants (p = 0.16).ConclusionsDR-management is feasible in the side position in term infants. Side position seems to be associated with reduced agitation and improved oxygenation. However, it remains unclear whether this represents a causal relationship or an association. The study supports the need for a randomized controlled trial.

Suctioning habits in the delivery room and the influence on postnatal adaptation – a video analysis

“…The section of the recorded image was chosen in such a way as to hide the identity of the caretaker. In the present study, all recordings of planned c-section of term and preterm infants born between January 2012 and April 2013 were analyzed [11,12].…”

“…The video analysis of the recorded videos was performed using the software Interact (Mangold International GmbH, Arnstorf, Germany), an observation-based software [11,12]. Analysis started with the arrival of the newborn at the reanimation table.…”

“…Video recording of DR management was performed by two webcameras (Microsoft Corporation, Redmond, USA) as described previously [11,12]. One camera was attached on the upper left side of the radiant warmer and one in front of the pulse oximeter monitor.…”

A randomised trial of placing preterm infants on their back or left side after birth

“…In a retrospective study of video recordings of newly born term infants in the delivery room (DR), Kostantelos found a trend to higher oxygen saturation (SpO 2 ) and less agitation in infants placed on their side compared with their back 15. The effect of position on oxygenation of newborns in the DR has not previously been evaluated in a randomised controlled trial.…”

Placing preterm infants on their side at birth does not increase 5 min SpO2

“…Placing preterm infants on their side appears to improve oxygenation and breathing patterns after1 2 and at birth 3. Current neonatal guidelines do not recommend any particular position,4 but previous guidelines5 6 suggested that infants could either be placed on their back or their sides during resuscitation or stabilisation.…”