Sustained inflations during delivery suite stabilisation in prematurely-born infants – A randomised trial

Hunt, Katie; Ling, Rebecca; White, MK; Ali, Kamal; Dassios, Theodore; Milner, Anthony; Greenough, Anne

doi:10.1016/j.earlhumdev.2019.01.005

Cited by 14 publications

(15 citation statements)

References 20 publications

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“…There is no new evidence to support or refute the practice of inflations less than 5 seconds immediately after birth. Hunt et al 67 was excluded from this systematic review because the control group received short duration sustained inflations (5 inflations of 2À 3 seconds each) and the intervention group received sustained inflations of 15 seconds duration (and thus did not meet predefined inflation duration criteria for the comparator group).…”

Section: Justification and Evidence-to-decision Framework Highlightsmentioning

confidence: 99%

Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Wyckoff¹,

Wyllie²,

Aziz³

et al. 2020

Resuscitation

102

114

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This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With TreatmentRecommendations (CoSTR) for neonatal life support includes evidence from 7 systematic reviews, 3 scoping reviews, and 12 evidence updates.The Neonatal Life Support Task Force generally determined by consensus the type of evidence evaluation to perform; the topics for the evidence updates followed consultation with International Liaison Committee on Resuscitation member resuscitation councils. The 2020 CoSTRs for neonatal life support are published either as new statements or, if appropriate, reiterations of existing statements when the task force found they remained valid.Evidence review topics of particular interest include the use of suction in the presence of both clear and meconium-stained amniotic fluid, sustained inflations for initiation of positive-pressure ventilation, initial oxygen concentrations for initiation of resuscitation in both preterm and term infants, use of epinephrine (adrenaline) when ventilation and compressions fail to stabilize the newborn infant, appropriate routes of drug delivery during resuscitation, and consideration of when it is appropriate to redirect resuscitation efforts after significant efforts have failed.All sections of the Neonatal Resuscitation Algorithm are addressed, from preparation through to postresuscitation care. This document now forms the basis for ongoing evidence evaluation and reevaluation, which will be triggered as further evidence is published.Over 140 million babies are born annually worldwide (https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100). If up to 5% receive positive-pressure ventilation, this evidence evaluation is relevant to more than 7 million newborn infants every year. However, in terms of early care of the newborn infant, some of the topics addressed are relevant to every single baby born.

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Section: Justification and Evidence-to-decision Framework Highlightsmentioning

confidence: 99%

Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Wyckoff¹,

Wyllie²,

Aziz³

et al. 2020

Resuscitation

102

114

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“…27 However, we did not find any studies in which researchers examined these short duration SIs with a no-SI strategy. The studies by Hunt et al 21 (included in the Foglia et al systematic review) and Harling et al 47 were excluded from this systematic review because they compared an intervention group that received longer SIs with a control group that received IPPV with intermittent inflations .1 second. The prespecified gestational age subgroups also differ between our systematic review and Foglia et al In addition, the Foglia et al review (by design) did not include the quasirandomized trial by El-Chimi et al 30 or the study by La Verde et al 32,49 .…”

Section: Discussionmentioning

confidence: 99%

“…46 Two trials were excluded because the control group received IPPV with inflations lasting longer than 1 second. 21,47 One trial was excluded because SI was part of a package of multiple interventions. 48 Cohen k was 0.67 (good) at the abstract stage and 1.0 (full agreement) at the full-text stage.…”

Section: Literature Search and Study Selectionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14] Researchers of multiple observational studies have shown that SI at birth is associated with a reduction in delivery room intubations, improved heart rate, and reduced duration of mechanical ventilation. 1,[15][16][17][18][19][20][21][22] However, in other observational studies, researchers have questioned the effectiveness of SI in infants who do not take spontaneous breaths. [23][24][25] Internationally, guidelines vary in recommendations regarding the inflation time and pressure for the first few breaths.…”

mentioning

confidence: 99%

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Sustained Lung Inflations During Neonatal Resuscitation at Birth: A Meta-analysis

et al. 2021

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CONTEXT: The International Liaison Committee on Resuscitation prioritized review of sustained inflation (SI) of the lung at birth. OBJECTIVE: To complete a systematic review and meta-analysis comparing strategies using 1 or more SI ≥1 second with intermittent inflations <1 second for newborns at birth. DATA SOURCES: Medline, Embase, and Evidence-Based Medicine Reviews were searched from January 1, 1946, to July 20, 2020. STUDY SELECTION: Studies were selected by pairs of independent reviewers in 2 stages. DATA EXTRACTION: Reviewers extracted data, appraised risk of bias, and assessed certainty of evidence for each outcome. RESULTS: Ten trials enrolling 1502 preterm newborns were included. Five studies included newborns who did not receive assisted ventilation at the outset. There were no differences between SI and control groups for death before discharge or key morbidities. For death within the first 2 days, comparing SI with the controls, risk ratio was 2.42 (95% confidence interval = 1.15–5.09). In subgroup analysis of preterm infants ≤28 + 0 weeks’ gestation, for death before discharge, risk ratio was 1.38 (95% confidence interval = 1.00–1.91). Together, these findings suggest the potential for harm of SI. LIMITATIONS: The certainty of evidence was very low for death in the delivery room and low for all other outcomes. CONCLUSIONS: In this systematic review, we did not find benefit in using 1 or more SI >5 seconds for preterm infants at birth. SI(s) may increase death before discharge among the subgroup born ≤28 + 0 weeks’ gestation. There is insufficient evidence to determine the likely effect of SI(s) on other key morbidities.

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“…Es gibt ebenfalls keine randomisierten Studien, die die Verwendung von initialen Beatmungshüben von ≤ 1 s und von 2 bis 3 s vergleichen. Eine kürzlich durchgeführte RCT mit 60 Frühgeborenen vor 34 Schwangerschaftswochen, bei welchen die initialen Beatmungen mit einer verlängerten Inspirationszeit von 2 bis 3 s oder mit einer einzelnen verlängerten Inspirationszeit von 15 s durchgeführt wurden, zeigte keine Unterschiede im Minutenvolumen oder im endtidalen CO 2 [ 201 ]. Neugeborene, die verlängerte Inspirationen erhielten, zeigten früher eine Atemanstrengung (Median 3,5 [Range 0,2–59] gegenüber Median 12,8 [Range 0,4–119] Sekunden, p = 0,001).…”

Section: Wissenschaftliche Grundlagen Auf Deren Basis Die Empfehlungen Für Die Praxis Zur Versorgung Und Reanimation Des Neugeborenen Berunclassified

Versorgung und Reanimation des Neugeborenen nach der Geburt

Madar

Roehr

Ainsworth³

et al. 2021

Notfall Rettungsmed

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Die vorliegenden Leitlinien des European Resuscitation Council zur Versorgung und Reanimation des Neugeborenen nach der Geburt beruhen auf dem International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support (NLS). Sie beinhalten Empfehlungen zur Versorgung und Reanimation des reifen Neugeborenen und zur Stabilisierung des Frühgeborenen. Sie umfassen den aktualisierten Algorithmus zur Reanimation des Neugeborenen, die Vorbereitungen vor der Versorgung eines Neugeborenen, die Themen Training und Ausbildung, Wärmemanagement, Empfehlungen zum Abnabeln, die initiale Beurteilung und Einschätzung des Neugeborenen, das Atemwegsmanagement, inklusive einer Notfallbeatmung, und die Kreislaufunterstützung im Falle einer vollen Reanimation. Darüber hinaus finden sich Empfehlungen zur Kommunikation mit den Eltern und ethische Überlegungen, in welchen Situationen erwogen werden soll, auf Reanimationsmaßnahmen zu verzichten bzw. Reanimationsmaßnahmen nicht fortzuführen. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s10049-021-00894-w) enthalten.

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Sustained inflations during delivery suite stabilisation in prematurely-born infants – A randomised trial

Cited by 14 publications

References 20 publications

Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Sustained Lung Inflations During Neonatal Resuscitation at Birth: A Meta-analysis

Versorgung und Reanimation des Neugeborenen nach der Geburt

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