Resuscitation of Term Infants in the Delivery Room

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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Delivery room resuscitation of near-term infants: Role of the laryngeal mask airway

Resuscitation ◽

10.1016/j.resuscitation.2009.11.005 ◽

2010 ◽

Vol 81 (3) ◽

pp. 327-330 ◽

Cited By ~ 22

Author(s):

Vincenzo Zanardo ◽

Gary Weiner ◽

Massimo Micaglio ◽

Nicoletta Doglioni ◽

Ramona Buzzacchero ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Laryngeal Mask ◽

Delivery Room ◽

Term Infants ◽

Near Term

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Use of Volume Expansion During Delivery Room Resuscitation in Near-Term and Term Infants

PEDIATRICS ◽

10.1542/peds.2004-0913 ◽

2005 ◽

Vol 115 (4) ◽

pp. 950-955 ◽

Cited By ~ 64

Author(s):

M. H. Wyckoff ◽

J. M. Perlman ◽

A. R. Laptook

Keyword(s):

Volume Expansion ◽

Delivery Room ◽

Term Infants ◽

Near Term

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Suctioning habits in the delivery room and the influence on postnatal adaptation – a video analysis

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0188 ◽

2015 ◽

Vol 43 (6) ◽

Cited By ~ 7

Author(s):

Dimitrios Konstantelos ◽

Sascha Ifflaender ◽

Jürgen Dinger ◽

Mario Rüdiger

Keyword(s):

Total Duration ◽

Face Mask ◽

Delivery Room ◽

Respiratory Support ◽

Term Infants ◽

Postnatal Adaptation ◽

Recorded Delivery ◽

Preterm Newborns ◽

Time Point ◽

Delivery Room Management

AbstractTo determine how often infants are suctioned during delivery and how it affects the neonate.Single-center analysis of video-recorded delivery room management after c-section from January 2012 until April 2013. Time point, duration, and frequency of suctioning in term and preterm newborns were analyzed along with vital parameters (heart rate (HR) and saturation values).Three hundred forty-six videos were analyzed. Twenty-three percent of term and 66% of preterm newborns were suctioned. Newborns were suctioned up to 14 times; total duration spent for suctioning was between 2 and 154 s. Suctioning before face mask application occurred in 31% of the suctioned newborns requiring respiratory support. No severe bradycardia (<60 bpm) was noticed. Suctioning did not have an effect on HR and saturation in preterm infants but was associated with significantly higher HR in term infants requiring respiratory support. Term infants who did not require respiratory support showed significantly higher saturation values at 3, 5, 6, 7, 8, 9, and 10 min if they were not suctioned.Suctioning of newborns in the delivery room does not adhere to recommendations of international guidelines. However, previously described side effects of suctioning could not be confirmed.

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Positioning of term infants during delivery room routine handling – analysis of videos

BMC Pediatrics ◽

10.1186/1471-2431-14-33 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 14

Author(s):

Dimitrios Konstantelos ◽

Heidrun Gurth ◽

Renate Bergert ◽

Sascha Ifflaender ◽

Mario Rüdiger

Keyword(s):

Delivery Room ◽

Term Infants ◽

Routine Handling

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Feasibility of non-invasive cardiac output monitoring at birth using electrical bioreactance in term infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-318244 ◽

2020 ◽

pp. fetalneonatal-2019-318244

Author(s):

Karen Nora McCarthy ◽

Andrea Pavel ◽

Aisling A Garvey ◽

Ana-Louise Hawke ◽

Criona Levins ◽

...

Keyword(s):

Cardiac Output ◽

Elective Caesarean Section ◽

Maternity Hospital ◽

Delivery Room ◽

Cardiac Output Monitoring ◽

Term Infants ◽

Non Invasive ◽

Output Monitoring ◽

Continuous Estimation ◽

Median Birth Weight

BackgroundNon-invasive cardiac output monitoring (NICOM) provides continuous estimation of cardiac output. This has potential for use in the delivery suite in the management of acutely depressed term infants. This study aims to measure cardiac output in term infants at delivery and in the first hours of life.MethodsParents of term infants due to be born by elective caesarean section or vaginal delivery at Cork University Maternity Hospital, Ireland were approached in the antenatal period to participate. Cardiac output was measured using a CHEETAH NICOM device, which uses electrical bioreactance technology, at birth and at 2 hours of life.ResultsForty-nine newborns were included. The median gestational age was 39 (IQR: 39–40) weeks and the median birth weight was 3.50 (IQR: 3.14–3.91) kg. Cardiac output measurements were obtained at a median of 8 (IQR: 5–12) min of life. The mean (SD) cardiac output was 101 (24) mL/kg/min in the delivery room and 89 (22) mL/kg/min at 2 hours of life. There was a statistically significant decrease in cardiac output from birth to 2 hours of life (difference in mean (95% CI): 13.5 (9.2 to 17.9) mL/kg/min, p<0.001, n=47). There were no adverse effects associated with NICOM.DiscussionThis technique is feasible and safe in the delivery room. Mean cardiac output measures using NICOM are lower than those found in studies which used echocardiography to determine cardiac output at birth.

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Understanding the Risks and Benefits of Delivery Room CPAP for Term Infants

PEDIATRICS ◽

10.1542/peds.2019-1720 ◽

2019 ◽

Vol 144 (3) ◽

pp. e20191720

Author(s):

Colleen C. Claassen ◽

Marya L. Strand

Keyword(s):

Delivery Room ◽

Term Infants ◽

Risks And Benefits

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NeoBeat offers rapid newborn heart rate assessment

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-320901 ◽

2021 ◽

pp. fetalneonatal-2020-320901

Author(s):

Jessica Brittany Bush ◽

Victoria Cooley ◽

Jeffrey Perlman ◽

Catherine Chang

Keyword(s):

Heart Rate ◽

Pulse Oximetry ◽

Real Time ◽

Neonatal Resuscitation ◽

Design Methods ◽

Delivery Room ◽

Term Infants ◽

Dry Electrode ◽

Device Placement ◽

Small Cohort

BackgroundHeart rate (HR) is used to guide interventions during delivery room (DR) neonatal resuscitation. Dry electrode ECG (NeoBeat) may detect HR more rapidly than pulse oximetry (PO) and portable ECG, but real-time comparisons of these devices are lacking.Design/methodsPO, ECG and NeoBeat were placed sequentially on newborns in the DR. Time for device placement and time to accurate HR acquisition were noted.ResultsDR resuscitations of 28 preterm/term infants were observed. The NeoBeat was placed faster (ie, 3 s) than PO (20 s, p=<0.0001) and ECG (16 s, p=<0.0001). Total time from initiation of device placement to HR acquisition was fastest with NeoBeat (13 s) versus ECG (42 s, p<0.0001) and PO (105 s, p<0.0001) (duration values=median).ConclusionsThese observations in a small cohort of relatively well neonates demonstrate that the NeoBeat is significantly faster to place and consistently acquires HR faster than PO and ECG.

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Peak Inspiratory Pressure During Delivery Room Resuscitation for Infants Born at Less Than 500 Grams.

10.46940/sjnp.02.1011 ◽

2020 ◽

pp. 1-4

Keyword(s):

Preterm Infants ◽

Neonatal Resuscitation ◽

Peak Inspiratory Pressure ◽

Delivery Room ◽

Inspiratory Pressure ◽

Temperature Management ◽

Pulmonary Mechanics ◽

Term Infants ◽

Extremely Preterm ◽

Extremely Preterm Infants

Introduction: With the advent of technological advancement and better scientific understanding it is possible now to successfully resuscitate and save babies born at less than 500 grams. Stabilization of these infants in the delivery room (DR) is one of the goals of the golden hour management. While some factors, including temperature management and airway care have standards, there is paucity of data on the optimal peak inspiratory pressure (PIP). The Neonatal Resuscitation Program (NRP) recommends using the same inflation pressure of 20 cm to 25 cm H2O for preterm infants as used for term infants. Preterm lungs are not the same as term infants. Due to the smaller lung volume, capacities and dynamic pulmonary mechanics, these preterm infants are prone to pulmonary complications including pneumothorax. Therefore, there is need to use PIP judiciously in the DR. Methods and Results: In this brief report we present two cases of newborn infants that were born at less than 500 grams and were successfully resuscitated with a lower PIP. The success criteria in the DR were heart rate greater than 100 per minute and adequate oxygen saturations minute by minute per NRP guidelines with minimal use of supplemental oxygen. Conclusion: While we need good prospectively designed studies to document the ideal PIP for these extreme preterm infants, we suggest a PIP lower than the currently recommended may be sufficient for some extremely preterm infants.

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Evaluation of a Comprehensive Delivery Room Neonatal Resuscitation and Adaptation Score (NRAS) Compared to the Apgar Score

Global Pediatric Health ◽

10.1177/2333794x15598293 ◽

2015 ◽

Vol 2 ◽

pp. 2333794X1559829 ◽

Cited By ~ 3

Author(s):

Shadi R. Jurdi ◽

Archana Jayaram ◽

Adam P. Sima ◽

Karen D. Hendricks Muñoz

Keyword(s):

Apgar Score ◽

Interrater Reliability ◽

Neonatal Resuscitation ◽

Delivery Room ◽

Term Infants ◽

Component Reliability ◽

Gestation Age ◽

Clinical Scenarios ◽

Perceived Importance ◽

Objective Tool

This study evaluated the interrater reliability and perceived importance of components of a developed neonatal adaption score, Neonatal Resuscitation Adaptation Score (NRAS), for evaluation of resuscitation need in the delivery room for extremely premature to term infants. Similar to the Apgar, the NRAS highest score was 10, but greater weight was given to respiratory and cardiovascular parameters. Evaluation of provider (N = 17) perception and scoring pattern was recorded for 5 clinical scenarios of gestational ages 23 to 40 weeks at 1 and 5 minutes and documenting NRAS and Apgar score. Providers assessed the tool twice within a 1-month interval. NRAS showed superior interrater reliability ( P < .001) and respiratory component reliability ( P < .001) for all gestational ages compared to the Apgar score. These findings identify an objective tool in resuscitation assessment of infants, especially those of smaller gestation age, allowing for greater discrimination of postbirth transition in the delivery room.

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