Timing of Interventions in the Delivery Room: Does Reality Compare with Neonatal Resuscitation Guidelines?

McCarthy, Laura; Morley, Colin J; Davis, Peter G; Kamlin, C. Omar F.; O’Donnell, Colm P.

doi:10.1016/j.jpeds.2013.06.007

Cited by 68 publications

(61 citation statements)

References 22 publications

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“…Guideline compliance was comparable to previous studies with both over-and undertreatment [8][9][10][11] . Previous studies have mostly been performed on subgroups of high-risk neonates, and their results are not necessarily applicable to other systems of care.…”

Section: Discussionsupporting

confidence: 81%

“…There is limited knowledge about the incidence of initial stabilization and resuscitation measures and adherence to guidelines in unselected normal-risk populations, although there are some studies indicating deviation from guidelines [8][9][10][11] . The urgency and unpredictability need for neonatal stabilization and resuscitation create challenges in preparing and training a large number of health care providers with varying experience.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway

et al. 2015

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Background: Most newborns manage the transition from intra- to extrauterine life without interventions, yet neonatal morbidity caused by failure of transition remains an important health problem. Objective: To determine the incidence of neonatal stabilization and resuscitation measures and guideline compliance during the first minutes after birth. Methods: This is a prospective, observational study of all births in three Norwegian hospitals. All interventions performed, including suctioning, use of pulse oximetry, continuous positive airway pressure (CPAP), positive pressure ventilation (PPV), supplemental oxygen, intubation, and administration of drugs, were registered at every on-call team shift during the study period. Results: A total of 1,507 live-born infants were included, of whom 264 (18%) were brought to the resuscitation crib. Oropharyngeal suctioning was performed in 77 (5%), deep blind suctioning was carried out in 10 (1%) and 84 (6%) were monitored using pulse oximetry. PPV was provided in 58 cases (4%) - 8 (21%) of <34 weeks and 50 (3%) of ≥34 weeks of gestation. Sustained inflation is not routinely used in these departments. CPAP (without PPV) was provided in 17 cases (1%) - 4 (0.3%) were intubated and ventilated through the endotracheal tube. Supplemental oxygen was given to 39 infants (3%) - 9 without pulse oximetry monitoring. The median (interquartile range) birth weight and gestational age of the newborns requiring PPV and/or CPAP were 3,220 g (2,643-3,858) and 39 weeks (37-41), respectively. Conclusion: In this study, the need for resuscitation and/or stabilization measures was commonly considered, and 4% of all newborns received PPV. Despite strong guideline emphasis on the use of pulse oximetry to guide oxygen administration, many infants received oxygen treatment without pulse oximetry monitoring.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway

et al. 2015

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“…A recent study has demonstrated that these interventions are often not managed in time. At 30 and 60 s, heart rate auscultation was performed in only 7 and 47%, respectively, of 189 babies between 27 and 43 weeks of gestation [13]. Table 1 shows the most important procedures to be performed in the delivery room for infants of 27-36 weeks of gestational age and the median time at which some of these procedures were achieved.…”

Section: Delivery Room Tasks During the First Minute Of Lifementioning

confidence: 99%

“…A recent randomized trial of immediate occlusive wrap for heat loss prevention of infants born at 24-27 weeks of gestation included 801 infants from 39 Vermont Oxford centers [36]. The infants were wrapped in plastic at a mean age of 24 s after birth - earlier than reported by McCarthy et al [13]. The wrap was removed at a mean time of 84 min of age.…”

Section: Thermal Controlmentioning

confidence: 99%

Delivery Room Management of Term and Preterm Newly Born Infants

Saugstad¹

2015

Neonatology

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Delivery room management, especially in the first ‘golden' minute, is of the utmost importance. An exact and universal definition of when a baby is born is needed to obtain agreement on what is meant by the first minute of life. Education of young girls is a basic requirement to optimize the health of the mother and baby. Interventions in pregnancy should as far as possible be evidence based. Antenatal care, the selection of birth mode and antenatal steroid therapy when indicated also contribute to obtaining the best outcome. Delayed cord clamping is recommended for both preterm and term infants. However, more data are needed regarding the most immature infants. Routine suctioning of the mouth and airways is not required. Thermal control is important - keep the temperature in the delivery room at 26°C and wrap infants <28 weeks of gestation in plastic. However, this procedure does not reduce mortality. Since delayed cord clamping increases mean birth weight by approximately 30 g/kg, the present birth weight charts based on early clamping need to be corrected. Preterm infants in need of ventilatory support should start with CPAP from the first breath. A T-piece device seems to have some advantages compared to self-inflating bags. Surfactant instillation is often not needed prophylactically provided the mother has received antenatal steroids. Less invasive methods for administering surfactant may be useful. If ventilatory support is needed, start with air in term and near-term infants. For babies of 29-33 weeks of gestation start with 21-30% oxygen and for infants <29 weeks start with 30% oxygen and adjust according to the response obtained.

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“…It has been found that most newborns requiring resuscitation do not receive interventions according to a recommended timeline (RT) and the median time taken to perform all tasks is greater than the recommendations 7. Exposure to this and other complex delivery room scenarios is limited in real life but can be augmented with finely orchestrated teamwork and deliberate practice optimally achieved in the simulated environment.…”

Section: Introductionmentioning

confidence: 99%

Resuscitative interventions during simulated asystole deviate from the recommended timeline

McKinsey

Perlman

2015

Arch Dis Child Fetal Neonatal Ed

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Critical resuscitation steps during intensive resuscitation often occur later than the RT. Identifying asystole by auscultation is difficult, takes time and can delay responses. Even a trained team during a simulation code took over 7 min to administer the initial dose of intravenous adrenaline. Recommendations related to discontinuation of resuscitation should clearly delineate what constitutes effective resuscitation (minimum of early intubation, intravenous adrenaline). We recommend the 'timer' to discontinuation of resuscitation only starts following the first dose of intravenous adrenaline.

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Timing of Interventions in the Delivery Room: Does Reality Compare with Neonatal Resuscitation Guidelines?

Cited by 68 publications

References 22 publications

Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway

Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway

Delivery Room Management of Term and Preterm Newly Born Infants

Resuscitative interventions during simulated asystole deviate from the recommended timeline

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