Physical stimulation of newborn infants in the delivery room

ObjectiveNeonatal resuscitation guidelines recommend that newborn infants are stimulated to assist with the establishment of regular respirations. The mode, site of application and frequency of stimulations are not stipulated in these guidelines. The effectiveness of stimulation in improving neonatal transition outcomes is poorly described.MethodsWe conducted a retrospective review of video recordings of neonatal resuscitation at a tertiary perinatal centre. Four different types of stimulation (drying, chest rub, back rub and foot flick) were defined a priori and the frequency and infant response were documented.ResultsA total of 120 video recordings were reviewed. Seventy-five (63%) infants received at least one episode of stimulation and 70 (58%) infants were stimulated within the first minute after birth. Stimulation was less commonly provided to infants <30 weeks’ gestation (median (IQR) number of stimulations: 0 (0–1)) than infants born ≥30 weeks’ gestation (1 (1–3); p<0.001). The most common response to stimulation was limb movement followed by infant cry and facial grimace. Truncal stimulation (drying, chest rub, back rub) was associated with more crying and movement than foot flicks.ConclusionLess mature infants are stimulated less frequently compared with more mature infants and many very preterm infants do not receive any stimulation. Most infants were stimulated within the first minute as recommended in resuscitation guidelines. Rubbing the trunk may be most effective but this needs to be confirmed in prospective studies.

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3-lead electrocardiogram is more reliable than pulse oximetry to detect bradycardia during stabilisation at birth of very preterm infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2016-311492 ◽

2017 ◽

Vol 103 (3) ◽

pp. F233-F237 ◽

Cited By ~ 11

Author(s):

Beatriz Iglesias ◽

María José Rodríguez ◽

Esther Aleo ◽

Enrique Criado ◽

Jose Martínez-Orgado ◽

...

Keyword(s):

Heart Rate ◽

Pulse Oximetry ◽

Preterm Infants ◽

Study Design ◽

Neonatal Resuscitation ◽

Delivery Room ◽

Very Preterm Infants ◽

Very Preterm ◽

Video Recordings ◽

Resuscitation Guidelines

ObjectivesCurrent neonatal resuscitation guidelines suggest the use of ECG in the delivery room (DR) to assess heart rate (HR). However, reliability of ECG compared with pulse oximetry (PO) in a situation of bradycardia has not been specifically investigated. The objective of the present study was to compare HR monitoring using ECG or PO in a situation of bradycardia (HR <100 beats per minute (bpm)) during preterm stabilisation in the DR.Study designVideo recordings of resuscitations of infants <32 weeks of gestation were reviewed. HR readings in a situation of bradycardia (<100 bpm) at any moment during stabilisation were registered with both devices every 5 s from birth.ResultsA total of 29 episodes of bradycardia registered by the ECG in 39 video recordings were included in the analysis (n=29). PO did not detect the start of these events in 20 cases (69%). PO detected the start and the end of bradycardia later than the ECG (median (IQR): 5 s (0–10) and 5 s (0–7.5), respectively). A decline in PO accuracy was observed as bradycardia progressed so that by the end of the episode PO offered significantly lower HR readings than ECG.ConclusionsPO detects the start and recovery of bradycardia events slower and less accurately than ECG during stabilisation at birth of very preterm infants. ECG use in this scenario may contribute to an earlier initiation of resuscitation manoeuvres and to avoid unnecessary prolongation of resuscitation efforts after recovery.

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Delivery Room Management of Asphyxiated Term and Near-Term Infants

Neonatology ◽

10.1159/000516429 ◽

2021 ◽

pp. 1-13

Author(s):

Marlies Bruckner ◽

Gianluca Lista ◽

Ola D. Saugstad ◽

Georg M. Schmölzer

Keyword(s):

Preterm Infants ◽

Newborn Infants ◽

Neonatal Resuscitation ◽

Birth Asphyxia ◽

Delivery Room ◽

Temperature Management ◽

Term Infants ◽

Term Newborn ◽

Resuscitation Guidelines ◽

Delivery Room Management

Approximately 800,000 newborns die annually due to birth asphyxia. The resuscitation of asphyxiated term newly born infants often occurs unexpected and is challenging for healthcare providers as it demands experience and knowledge in neonatal resuscitation. Current neonatal resuscitation guidelines often focus on resuscitation of extremely and/or very preterm infants; however, the recommendations for asphyxiated term newborn infants differ in some aspects to those for preterm infants (i.e., respiratory support, supplemental oxygen, and temperature management). Since the update of the neonatal resuscitation guidelines in 2015, several studies examining various resuscitation approaches to improve the outcome of asphyxiated infants have been published. In this review, we discuss current recommendations and recent findings and provide an overview of delivery room management of asphyxiated term newborn infants.

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Pulseless electrical activity: a misdiagnosed entity during asphyxia in newborn infants?

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-314907 ◽

2018 ◽

Vol 104 (2) ◽

pp. F215-F217 ◽

Cited By ~ 15

Author(s):

Sparsh Patel ◽

Po-Yin Cheung ◽

Anne Lee Solevåg ◽

Keith J Barrington ◽

C Omar Farouk Kamlin ◽

...

Keyword(s):

Blood Flow ◽

Newborn Infants ◽

Neonatal Resuscitation ◽

Pulseless Electrical Activity ◽

Heart Sounds ◽

Carotid Blood Flow ◽

Neonatal Piglets ◽

Resuscitation Guidelines ◽

Recent Case Report ◽

The Right

BackgroundThe 2015 neonatal resuscitation guidelines added ECG as a recommended method of assessment of an infant’s heart rate (HR) when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room.ObjectivesTo compare accuracy of ECG with auscultation to assess asystole in asphyxiated piglets.MethodsNeonatal piglets had the right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe and HR was continuously measured and recorded using ECG. This set-up allowed simultaneous monitoring of HR via ECG and carotid blood flow (CBF). The piglets were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. Asystole was defined as zero carotid blood flow and was compared with ECG traces and auscultation for heart sounds using a neonatal/infant stethoscope.ResultsOverall, 54 piglets were studied with a median (IQR) duration of asphyxia of 325 (200-491) s. In 14 (26%) piglets, CBF, ECG and auscultation identified asystole. In 23 (43%) piglets, we observed no CBF and no audible heart sounds, while ECG displayed an HR ranging from 15 to 80/min. Sixteen (30%) piglets remained bradycardic (defined as HR of <100/min) after 10 min of asphyxia, identified by CBF, ECG and auscultation.ConclusionClinicians should be aware of the potential inaccuracy of ECG assessment during asphyxia in newborn infants and should rather rely on assessment using a combination of auscultation, palpation, pulse oximetry and ECG.

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Oxygen in the First Minutes of Life in Very Preterm Infants

Neonatology ◽

10.1159/000516261 ◽

2021 ◽

pp. 1-7

Author(s):

Ola Didrik Saugstad ◽

Vishal Kapadia ◽

Ju Lee Oei

Keyword(s):

Heart Rate ◽

Relevant Literature ◽

Newborn Infants ◽

Adverse Outcomes ◽

Delivery Room ◽

Positive Pressure ◽

Very Preterm Infants ◽

Liaison Committee ◽

Very Preterm ◽

Increased Risk

Even a few minutes of exposure to oxygen in the delivery room in very preterm and immature infants may have detrimental effects. The initial oxygenation in the delivery room should therefore be optimized, but knowledge gaps, including initial fraction of oxygen (FiO2) and how FiO2 should be changed to reach an optimal oxygen saturation measured by pulse oximetry (SpO2) target within the first 5–10 min of life, remain. In order to answer this question, we therefore reviewed relevant literature. For newly born infants with gestational age (GA) <32 weeks in need of positive pressure ventilation (PPV) immediately after birth, we identified 2 fundamental issues: (1) the optimal initial FiO2 and (2) the target SpO2 within the first 5–10 min of life. For newly born infants between 29 and 31 weeks of GA, an initial FiO2 of 0.3 hit the target defined by the International Liaison Committee on Resuscitation (ILCOR) best. Newborn infants with GA <29 weeks in need of PPV and supplementary oxygen, we suggest starting with FiO2 0.3 and adjusting the FiO2 to reach SpO2 of 80% within 5 min of life for best outcomes. Prolonged bradycardia (heart rate <100 bpm for >2 min) is associated with increased risk of adverse outcomes, including death. The combination of strict control of development of SpO2 in the first 10 min of life and a heart rate >100 bpm represents the best tool today to achieve the most optimal outcome in the delivery room of very preterm and immature newborn infants.

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Is Chest Compression Superimposed with Sustained Inflation during Cardiopulmonary Resuscitation an Alternative to 3:1 Compression to Ventilation Ratio in Newborn Infants?

Children ◽

10.3390/children8020097 ◽

2021 ◽

Vol 8 (2) ◽

pp. 97

Author(s):

Seung Yeon Kim ◽

Gyu-Hong Shim ◽

Georg M. Schmölzer

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Newborn Infants ◽

Neonatal Resuscitation ◽

Spontaneous Circulation ◽

Delivery Room ◽

Sustained Inflation ◽

Resuscitation Guidelines ◽

High Incidence ◽

Reduced Time

Approximately 0.1% for term and 10–15% of preterm infants receive chest compression (CC) in the delivery room, with high incidence of mortality and neurologic impairment. The poor prognosis associated with receiving CC in the delivery room has raised concerns as to whether specifically-tailored cardiopulmonary resuscitation methods are needed. The current neonatal resuscitation guidelines recommend a 3:1 compression:ventilation ratio; however, the most effective approach to deliver chest compression is unknown. We recently demonstrated that providing continuous chest compression superimposed with a high distending pressure or sustained inflation significantly reduced time to return of spontaneous circulation and mortality while improving respiratory and cardiovascular parameters in asphyxiated piglet and newborn infants. This review summarizes the current available evidence of continuous chest compression superimposed with a sustained inflation.

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Cardiac arrest with pulseless electrical activity rhythm in newborn infants: a case series

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2018-316087 ◽

2019 ◽

Vol 104 (6) ◽

pp. F572-F574 ◽

Cited By ~ 10

Author(s):

Deandra Luong ◽

Po-Yin Cheung ◽

Keith J Barrington ◽

Peter G Davis ◽

Jennifer Unrau ◽

...

Keyword(s):

Heart Rate ◽

Cardiopulmonary Resuscitation ◽

Electrical Activity ◽

Activity Rhythm ◽

Healthcare Providers ◽

Newborn Infants ◽

Case Series ◽

Neonatal Resuscitation ◽

Pulseless Electrical Activity ◽

Resuscitation Guidelines

The 2015 neonatal resuscitation guidelines added ECG to assess an infant’s heart rate when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. We report four cases of pulseless electrical activity during neonatal cardiopulmonary resuscitation in levels II–III neonatal intensive care units in Canada (Edmonton [n=3] and Winnipeg [n=1]).Healthcare providers should be aware that pulseless electrical activity can occur in newborn infants during cardiopulmonary resuscitation. We propose an adapted neonatal resuscitation algorithm to include pulseless electrical activity. Furthermore, in compromised newborns, heart rate should be assessed using a combination of methods/techniques to ensure accurate heart rate assessment. When ECG displays a heart rate but the infant is unresponsive, pulseless electrical activity should be suspected and chest compression should be started.

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How do different brands of size 1 laryngeal mask airway compare with face mask ventilation in a dedicated laryngeal mask airway teaching manikin?

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-312766 ◽

2017 ◽

Vol 103 (3) ◽

pp. F271-F276 ◽

Cited By ~ 6

Author(s):

Mark Brian Tracy ◽

Archana Priyadarshi ◽

Dimple Goel ◽

Krista Lowe ◽

Jacqueline Huvanandana ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Newborn Infants ◽

Neonatal Resuscitation ◽

Peak Inspiratory Pressure ◽

Face Mask ◽

Ease Of Use ◽

Laryngeal Mask ◽

Mask Ventilation ◽

Resuscitation Guidelines ◽

Bag Mask Ventilation

BackgroundInternational neonatal resuscitation guidelines recommend the use of laryngeal mask airway (LMA) with newborn infants (≥34 weeks’ gestation or >2 kg weight) when bag-mask ventilation (BMV) or tracheal intubation is unsuccessful. Previous publications do not allow broad LMA device comparison.ObjectiveTo compare delivered ventilation of seven brands of size 1 LMA devices with two brands of face mask using self-inflating bag (SIB).Design40 experienced neonatal staff provided inflation cycles using SIB with positive end expiratory pressure (PEEP) (5 cmH2O) to a specialised newborn/infant training manikin randomised for each LMA and face mask. All subjects received prior education in LMA insertion and BMV.Results12 415 recorded inflations for LMAs and face masks were analysed. Leak detected was lowest with i-gel brand, with a mean of 5.7% compared with face mask (triangular 42.7, round 35.7) and other LMAs (45.5–65.4) (p<0.001). Peak inspiratory pressure was higher with i-gel, with a mean of 28.9 cmH2O compared with face mask (triangular 22.8, round 25.8) and other LMAs (14.3–22.0) (p<0.001). PEEP was higher with i-gel, with a mean of 5.1 cmH2O compared with face mask (triangular 3.0, round 3.6) and other LMAs (0.6–2.6) (p<0.001). In contrast to other LMAs examined, i-gel had no insertion failures and all users found i-gel easy to use.ConclusionThis study has shown dramatic performance differences in delivered ventilation, mask leak and ease of use among seven different brands of LMA tested in a manikin model. This coupled with no partial or complete insertion failures and ease of use suggests i-gel LMA may have an expanded role with newborn resuscitation as a primary resuscitation device.

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Pain Behavioural Response to Acoustic and Light Environmental Changes in Very Preterm Infants

Children ◽

10.3390/children8121081 ◽

2021 ◽

Vol 8 (12) ◽

pp. 1081

Author(s):

Audrey Marchal ◽

Meggane Melchior ◽

André Dufour ◽

Pierrick Poisbeau ◽

Claire Zores ◽

...

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Environmental Changes ◽

Well Being ◽

Light Illumination ◽

Very Preterm Infants ◽

Very Preterm ◽

Video Recordings ◽

Light Levels ◽

Before And After

Noise and high light illumination in the neonatal intensive care unit (NICU) are recognized as stressors that could alter the well-being and development of vulnerable preterm infants. This prospective observational study evaluated the pain behaviours of very preterm infants (VPIs) to sound peaks (SPs) and light levels variations (LLVs) in the NICU. We measured spontaneously occurring SPs and LLVs in the incubators of 26 VPIs over 10 h. Their behavioural responses were analysed through video recordings using the “Douleur Aigue du Nouveau-né” (DAN) scale. We compared the maximum DAN scores before and after environmental stimuli and the percentage of VPIs with a score ≥ 3 according to the type of stimuli. A total of 591 SPs and 278 LLVs were analysed. SPs of 5 to 15 dBA and LLVs significantly increased the maximum DAN scores compared to baseline. The occurrence of DAN scores ≥ 3 increased with both stressors, with a total of 16% of SPs and 8% of LLVs leading to quantifiable pain behaviour. Altogether, this study shows that VPIs are sensitive to SPs and LLVs, with a slighter higher sensitivity to SPs. The mechanisms leading to pain behaviours induced by noise and light changes should be evaluated further in the context of VPIs brain development. Our results provide further arguments to optimize the NICU sensory environment of neonatal units and to adapt it to the expectations and sensory abilities of VPIs.

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