Providing newborn resuscitation at the mother’s bedside: assessing the safety, usability and acceptability of a mobile trolley

Abstract

BackgroundDeferring cord clamping at very preterm births may be beneficial for babies. However, deferring cord clamping should not mean that newborn resuscitation is deferred. Providing initial care at birth at the mother’s bedside would allow parents to be present during resuscitation, and would potentially allow initial care to be given with the cord intact. The aim of this study was to evaluate the usability of a new mobile trolley for providing newborn resuscitation by describing the range of resuscitation procedures performed on a group of babies, to assess the acceptability to clinicians compared with standard equipment, based on a questionnaire survey, to assess safety from post resuscitation temperature measurements and serious adverse event reports and to assess whether the trolley allowed resuscitation with the umbilical cord intact by assessing the proportion of babies that could be placed on the trolley to allow resuscitation with the cord intact.MethodsThe trolley was used when the attendance of a clinician trained in newborn life support was required at a birth. Clinicians were asked to complete a questionnaire about their experience of using the trolley. Serious adverse events were reported.Results78 babies were managed on the trolley. Median (range) gestation was 34 weeks (24 to 41 weeks). Median (range) birth weight was2470 grams (520 to 4080 grams). The full range of resuscitation procedures has been successfully provided, although only one baby required emergency umbilical venous catheterisation. 77/78 babies had a post resuscitation temperature above 36°C. There were no adverse events. Most clinicians rated the trolley as ‘the same’, ‘better’ or ’much better’ than conventional resuscitation equipment. In most situations, the baby could be resuscitated with umbilical cord intact, although on 18 occasions the cord was too short to reach the trolley.ConclusionsImmediate stabilisation at birth and resuscitation can be performed successfully and safely at the bedside using this trolley. In most cases this could be achieved with an intact umbilical cord.

Delayed cord clamping in the compromised baby

“…The Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support (BASICS) trolley can be lowered between the woman's legs or over an operating table and provides heat, suction and ventilation . When trialled, the trolley was able to be successfully used for resuscitation and cord integrity was maintained in most cases (Thomas et al, 2014). Neonatal temperature was maintained and practitioners reported better communication with parents, while parents gave positive feedback.…”

Protecting the premature brain: current evidence-based strategies for minimising perinatal brain injury in preterm infants

“…Concerns about delayed resuscitation, thermal care and technical difficulties are being addressed through the development and trialling of new equipment to allow transition to be assisted closer to the mother with the cord intact 75 76. Studies have shown DCC to be feasible, safe and to have significant benefit to preterm infants, with no detriment from the risks above 20 77…”

What is new in the European and UK neonatal resuscitation guidance?

“…In many instances, existing equipment is not designed for this and in some cases placental abruption or maternal conditions will prevent it. While the potential clearly exists, many questions remain about the impact especially on mothers and babies and equipment and staff requirements 31. These need to be answered before this approach can be accepted or implemented routinely.…”