Abstract 170: Temperature Maintenance and Oxygen Use in Newborns at Birth: A Surveillance of Clinical Practice and Compliance with Neonatal Resuscitation Guidelines

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Georg M Schmölzer ◽  
Roxanne Pinson ◽  
Marion Molesky ◽  
Heather Chinnery ◽  
Karen Foss ◽  
...  
Keyword(s):  
Body Temperature ◽  
Knowledge Transfer ◽  
Oxygen Saturation ◽  
Neonatal Resuscitation ◽  
Positive Pressure ◽  
Respiratory Therapists ◽  
Vaginal Deliveries ◽  
Resuscitation Guidelines ◽  
The Right ◽  
Continuous Positive Pressure

Background: Guidelines of neonatal resuscitation are revised regularly. Gaps in knowledge transfer commonly occur when the guidelines are communicated to the clinical practitioners. Maintaining body temperature and supporting oxygenation are main goals that clinical practitioners aim to achieve in assisting newborns during the feto-neonatal transition at birth. Objectives: In this study, we aim to examine the compliance to guidelines in neonatal resuscitation regarding the temperature maintenance and oxygen use in newborns at birth. Methods: From October to November 2013, a prospective questionnaire surveillance was conducted in all attended deliveries at all four hospitals in Edmonton, Alberta, Canada. All clinical practitioners (registered nurses, physicians and respiratory therapists) were requested to complete the questionnaires immediately after the attended delivery regarding temperature maintenance and oxygenation monitoring. Descriptive statistics were used with mean±SD (range) and % presented. Results: During the 14-days study period, data was obtained in 518 of 712 (73%) attended deliveries of newborns with gestational age 38.6±2.0 (23-42) weeks and birth weight 3324±589 (348-6168) g. Of these deliveries, 58% were normal vaginal deliveries and 29% were cesarean sections. There were 8.8% and 8.4% newborns who required positive pressure ventilation and continuous positive pressure, respectively. Radiant warmer heat was used in 81% (419/518) with 63% (266/419) turned to full power. Room temperature was 21.6±1.6 (17-31)°C. Body temperature at 30-60 min after birth was 36.8±0.5 (32.4-38.1)°C with hypothermia (<36.5°C) in 17%. Percutaneous oxygen saturation was measured in 15% newborns and 96% had sensors placed at the right wrist. At the initiation of resuscitation, 21% oxygen was used in 76% and the oxygen concentration was adjusted according to an oxygen saturation chart in 17%. In 70% of the cases, clinical practitioners commented that this chart was not helpful. Conclusions: Gaps in knowledge transfer contribute to non-compliance in the guidelines of neonatal resuscitation for temperature maintenance and oxygen use. Caution is needed to avoid hypothermia and hyperoxia in at-risk populations such as prematurity.

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

2018 ◽  
Vol 104 (2) ◽  
pp. F215-F217 ◽  
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.

Erythropoietin levels with treatment of obstructive sleep apnea

1995 ◽  
Vol 79 (4) ◽  
pp. 1278-1285 ◽  
Author(s):  
C. Cahan ◽  
M. J. Decker ◽  
J. L. Arnold ◽  
E. Goldwasser ◽  
K. P. Strohl
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oxygen Saturation ◽  
Sleep Apnea Syndrome ◽  
Positive Pressure ◽  
Nasal Cpap ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
The Mean ◽  
Continuous Positive Pressure

The effect of nasal continuous positive pressure (CPAP) treatment on erythropoietin (EPO) was examined by measuring diurnal serum EPO levels before and twice (over the 3rd day and over 1 day on recall after > or = 1 mo of therapy) after initiation of treatment in 12 obstructive sleep apnea syndrome patients with normal hemoglobin, hematocrit, creatinine, blood urea nitrogen, and albumin levels. Over each study day, oxygen saturation was measured by an ambulatory pulse oximetry system. Patients spent 27 +/- 9% (SE) of time below oxygen saturation of 88% vs. 2.1 +/- 0.6% after initiation of nasal CPAP treatment (P < 0.01). The number of desaturation events per hour of sleep before nasal CPAP treatment was 62 +/- 6 vs. 9 +/- 2 with nasal CPAP (P < 0.01). EPO levels measured by radioimmunoassay were drawn every hour before and at 3 days (n = 9) and before and at recall (n = 0) after initiation of CPAP therapy. The mean serum EPO level was higher before treatment (61 +/- 14 mU/ml) than that at 3 days (38 +/- 10 mU/ml, P < 0.01) or at recall (32 +/- 7 mU/ml, P < 0.01). We conclude that nasal CPAP treatment of sleep-disordered breathing will reduce diurnal levels of EPO.

Continuous positive-pressure ventilation does not alter ventricular pressure-volume relationship

1981 ◽  
Vol 240 (6) ◽  
pp. H821-H826 ◽  
Author(s):  
J. E. Fewell ◽  
D. R. Abendschein ◽  
C. J. Carlson ◽  
E. Rapaport ◽  
J. F. Murray
Keyword(s):  
Mechanical Properties ◽  
Positive Pressure Ventilation ◽  
Venous Return ◽  
Intermittent Positive Pressure Ventilation ◽  
Left Ventricular ◽  
Positive Pressure ◽  
Volume Relationship ◽  
Pressure Volume Relationship ◽  
The Right ◽  
Continuous Positive Pressure

To determine whether alterations in the mechanical properties (i.e., stiffening) of the right and left ventricles contribute to the decrease in right and left ventricular end-diastolic volumes during continuous positive-pressure ventilation (CPPV), we studied six dogs anesthetized with chloralose urethane and ventilated with a volume ventilator. We varied ventricular volumes by withdrawing or infusing blood. Pressure-volume curves, constructed by plotting transmural ventricular end-diastolic pressures against ventricular end-diastolic volumes, did not change during CPPV (12 cmH2O positive end-expiratory pressure) compared to intermittent positive-pressure ventilation (IPPV, 0 cmH2O end-expiratory pressure). We conclude that decreased ventricular end-diastolic volumes during CPPV result primarily from a decrease in venous return. Alterations in the mechanical properties of the ventricles do not play a significant role in this response.

scholarly journals 1805 Oxygen Saturation Monitoring at Birth: Feasibility of the 2010 Neonatal Resuscitation Guidelines

2012 ◽  
Vol 97 (Suppl 2) ◽  
pp. A511-A511
Author(s):  
V. D. Cengio ◽  
M. Parotto ◽  
P. Zanella ◽  
N. Rizzo ◽  
C. Zacchettin ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Neonatal Resuscitation ◽  
Resuscitation Guidelines

scholarly journals Randomised trial of epinephrine dose and flush volume in term newborn lambs

2021 ◽  
pp. fetalneonatal-2020-321034 ◽  
Author(s):  
Deepika Sankaran ◽  
Praveen K Chandrasekharan ◽  
Sylvia F Gugino ◽  
Carmon Koenigsknecht ◽  
Justin Helman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Peak Plasma ◽  
Geometric Mean ◽  
Randomised Trial ◽  
Neonatal Resuscitation ◽  
Positive Pressure ◽  
Plasma Epinephrine ◽  
Epinephrine Administration ◽  
Resuscitation Guidelines ◽  
Epinephrine Dose

ObjectivesNeonatal resuscitation guidelines recommend 0.5–1 mL saline flush following 0.01–0.03 mg/kg of epinephrine via low umbilical venous catheter for persistent bradycardia despite effective positive pressure ventilation (PPV) and chest compressions (CC). We evaluated the effects of 1 mL vs 3 mL/kg flush volumes and 0.01 vs 0.03 mg/kg doses on return of spontaneous circulation (ROSC) and epinephrine pharmacokinetics in lambs with cardiac arrest.DesignForty term lambs in cardiac arrest were randomised to receive 0.01 or 0.03 mg/kg epinephrine followed by 1 mL or 3 mL/kg flush after effective PPV and CC. Epinephrine (with 1 mL flush) was repeated every 3 min until ROSC or until 20 min. Haemodynamics, blood gases and plasma epinephrine concentrations were monitored.ResultsTen lambs had ROSC before epinephrine administration and 2 died during instrumentation. Among 28 lambs that received epinephrine, 2/6 in 0.01 mg/kg-1 mL flush, 3/6 in 0.01 mg/kg-3 mL/kg flush, 5/7 in 0.03 mg/kg-1 mL flush and 9/9 in 0.03 mg/kg-3 mL/kg flush achieved ROSC (p=0.02). ROSC was five times faster with 0.03 mg/kg epinephrine compared with 0.01 mg/kg (adjusted HR (95% CI) 5.08 (1.7 to 15.25)) and three times faster with 3 mL/kg flush compared with 1 mL flush (3.5 (1.27 to 9.71)). Plasma epinephrine concentrations were higher with 0.01 mg/kg-3 mL/kg flush (adjusted geometric mean ratio 6.0 (1.4 to 25.7)), 0.03 mg/kg-1 mL flush (11.3 (2.1 to 60.3)) and 0.03 mg/kg-3 mL/kg flush (11.0 (2.2 to 55.3)) compared with 0.01 mg/kg-1 mL flush.Conclusions0.03 mg/kg epinephrine dose with 3 mL/kg flush volume is associated with the highest ROSC rate, increases peak plasma epinephrine concentrations and hastens time to ROSC. Clinical trials evaluating optimal epinephrine dose and flush volume are warranted.

A39 Oxygen saturation monitoring at birth: feasibility of the 2010 neonatal resuscitation guidelines

2012 ◽  
Vol 88 ◽  
pp. S113
Author(s):  
V. Dal Cengio ◽  
N. Rizzo ◽  
M. Parotto ◽  
D. Trevisanuto ◽  
M. Negro ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Neonatal Resuscitation ◽  
Resuscitation Guidelines

scholarly journals Randomized Trial of Oxygen Saturation Targets during and after Resuscitation and Reversal of Ductal Flow in an Ovine Model of Meconium Aspiration and Pulmonary Hypertension

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 594
Author(s):  
Amy L. Lesneski ◽  
Payam Vali ◽  
Morgan E. Hardie ◽  
Satyan Lakshminrusimha ◽  
Deepika Sankaran
Keyword(s):  
Blood Flow ◽  
Pulmonary Hypertension ◽  
Oxygen Saturation ◽  
Ductus Arteriosus ◽  
Neonatal Resuscitation ◽  
Meconium Aspiration Syndrome ◽  
Ovine Model ◽  
Neurodevelopmental Outcomes ◽  
Meconium Aspiration ◽  
Blood Flows

Neonatal resuscitation (NRP) guidelines suggest targeting 85–95% preductal SpO2 by 10 min after birth. Optimal oxygen saturation (SpO2) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our objective was to compare the time to reversal of ductal flow from fetal pattern (right-to-left), to left-to-right, and to evaluate pulmonary (QPA), carotid (QCA)and ductal (QDA) blood flows between standard (85–94%) and high (95–99%) SpO2 targets during and after resuscitation. Twelve lambs asphyxiated by endotracheal meconium instillation and cord occlusion to induce MAS and PPHN were resuscitated per NRP guidelines and were randomized to either standard (85–94%) or high (95–99%) SpO2 targets. Out of twelve lambs with MAS and PPHN, six each were randomized to standard and high SpO2 targets. Median [interquartile range] time to change in direction of blood flow across the ductus arteriosus from right-to-left, to left-to-right was significantly shorter with high SpO2 target (7.4 (4.4–10.8) min) compared to standard SpO2 target (31.5 (21–66.2) min, p = 0.03). QPA was significantly higher during the first 10 min after birth with higher SpO2 target. At 60 min after birth, the QPA, QCA and QDA were not different between the groups. To conclude, targeting SpO2 of 95–99% during and after resuscitation may hasten reversal of ductal flow in lambs with MAS and PPHN and transiently increase QPA but no differences were observed at 60 min. Clinical studies comparing low and high SpO2 targets assessing hemodynamics and neurodevelopmental outcomes are warranted.

Effects Of Normobaric Hypoxia And Exercise On Cold-induced Vasodilation, Body Temperature, And Oxygen Saturation

2017 ◽  
Vol 49 (5S) ◽  
pp. 241
Author(s):  
Hayden Gerhart ◽  
Brittany Followay ◽  
Jeremiah Vaughan ◽  
Jacob E. Barkley ◽  
Ellen L. Glickman
Keyword(s):  
Body Temperature ◽  
Oxygen Saturation ◽  
Normobaric Hypoxia
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