Neonatal resuscitation monitoring: A low-cost video recording setup for quality improvement in the delivery room at the resuscitation table.

The following guidelines are an interpretation of the evidence presented in the 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations 1 ). They apply primarily to newly born infants undergoing transition from intrauterine to extrauterine life, but the recommendations are also applicable to neonates who have completed perinatal transition and require resuscitation during the first few weeks to months following birth. Practitioners who resuscitate infants at birth or at any time during the initial hospital admission should consider following these guidelines. For the purposes of these guidelines, the terms newborn and neonate are intended to apply to any infant during the initial hospitalization. The term newly born is intended to apply specifically to an infant at the time of birth. Approximately 10% of newborns require some assistance to begin breathing at birth. Less than 1% require extensive resuscitative measures. 2,3 Although the vast majority of newly born infants do not require intervention to make the transition from intrauterine to extrauterine life, because of the large total number of births, a sizable number will require some degree of resuscitation. Those newly born infants who do not require resuscitation can generally be identified by a rapid assessment of the following 3 characteristics: ● Term gestation? ● Crying or breathing? ● Good muscle tone? If the answer to all 3 of these questions is “yes,” the baby does not need resuscitation and should not be separated from the mother. The baby should be dried, placed skin-to-skin with the mother, and covered with dry linen to maintain temperature. Observation of breathing, activity, and color should be ongoing. If the answer to any of these assessment questions is “no,” the infant should receive one or more of the following 4 categories of action in sequence:

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ECG monitoring: One step closer to the modernization of the delivery room

Training, experience and need of booster courses in neonatal cardiopulmonary resuscitation. Survey to pediatricians

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

Background: Neonatal resuscitation is the set of interventions provided at the time of birth to support the establishment of breathing and circulation. 136 million births annually, (approx. 5-10%) require simple stimulation at birth to help them breath like rubbing and drying. Basic resuscitation with a bag-and-mask is required for an estimated 6 million (approx. 3-6%) of these babies each year, and is sufficient to resuscitate most neonates with secondary apnea. Methods: A Descriptive cross-sectional design is used through the present study in order to :To assess the nurses knowledge concerning cardiopulmonary resuscitation to neonatal and To find out the relationship between the knowledge scores of the nurses and their selected demographic variables of age, gender, level of education, years of experience, and training session. The period of the study is from The study was carried out from 20th December 2018 up to march 28th, 2019. A Non-probability (purposive ) sample of (60) nurses who are working in the delivery rooms in (Al-Zahra Hospital, AL-Forat general Hospital Al-Hakeem general Hospital and Al- Manathera hospital ) are included in the study sample. The data are collected through using a well-designed questionnaire that consist of (2) parts: Part I: Demographic data. This part consists of (8) items, including age, gender, Marital Status, years of experience, Level of education, Economic state, Residency, Training course in cardiopulmonary resuscitation ,and number of training courses. And Part 2: Information of the Nurses Knowledge toward Neonatal Resuscitation in the Delivery Rooms: This part of the questionnaire is consisting of ( 22) questions about Neonatal Resuscitation in the Delivery Rooms . the validity through (12) experts from different specialties (Face Validity) for reviewing the study instrument. The data was analyzed through using of the descriptive and inferential statistical analysis approaches. Results: The findings of the present study indicate that the Overall assessment for nurses Knowledge about the neonatal cardiopulmonary resuscitation are Fair. Also there is a there is a highly significant association between the nurses Knowledge concerning cardiopulmonary resuscitation to neonatal and their (Years of Experience, Hospital Name, No. of training course), while there is a non-significant relationship with the remaining demographic and clinical data

The efficacy of mask ventilation has traditionally been judged by evaluating clinical signs alone (eg, assessment of heart rate, chest movements, skin color), which can be misleading. Despite the recent introduction of extended noninvasive monitoring, neonatal resuscitation remains challenging. This article discusses the current evidence on clinical assessment and monitoring during noninvasive mask ventilation in the delivery room. Potential pitfalls during mask ventilation are discussed, which may be identified with structured neonatal resuscitation courses, video recording, or extended physiological monitoring. Successful placement of a correctly positioned endotracheal tube by junior medical staff is <50%, and accidental esophageal intubation is common. Clinical signs are subjective and can be misleading, and recognition of esophageal placement of the endotracheal tube, by using clinical assessment alone, can take up to several minutes. Because carbon dioxide is exhaled at much higher concentrations than inhaled, it can be detected with semiquantitative colorimetric devices, or devices that display numeric or graphic values. In the section on carbon dioxide detectors, the current evidence (along with limitations) concerning these devices is discussed.

Part 11: Neonatal Resuscitation

The following guidelines are intended for practitioners responsible for resuscitating neonates. They apply primarily to neonates undergoing transition from intrauterine to extrauterine life. The recommendations are also applicable to neonates who have completed perinatal transition and require resuscitation during the first few weeks to months following birth. Practitioners who resuscitate infants at birth or at any time during the initial hospital admission should consider following these guidelines. The terms newborn and neonate are intended to apply to any infant during the initial hospitalization. The term newly born is intended to apply specifically to an infant at the time of birth. Approximately 10% of newborns require some assistance to begin breathing at birth. About 1% require extensive resuscitative measures. Although the vast majority of newly born infants do not require intervention to make the transition from intrauterine to extrauterine life, because of the large number of births, a sizable number will require some degree of resuscitation. Those newly born infants who do not require resuscitation can generally be identified by a rapid assessment of the following 4 characteristics: If the answer to all 4 of these questions is “yes,” the baby does not need resuscitation and should not be separated from the mother. The baby can be dried, placed directly on the mother’s chest, and covered with dry linen to maintain temperature. Observation of breathing, activity, and color should be ongoing. If the answer to any of these assessment questions is “no,” there is general agreement that the infant should receive one or more of the following 4 categories of action in sequence:

Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal. An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups. In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate's temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate's transportation out of the delivery room. Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.

Healthcare providers (HCPs) working in labour and delivery rooms need to undergo regular refresher courses to maintain their neonatal resuscitation skills, which are shown to decline over time. However, due to their irregular schedules and limited time, HCPs encounter difficulties in readily accessing refresher programs. RETAIN is a digital game that simulates a delivery room to facilitate neonatal resuscitation training for HCPs. This study aims to ascertain whether participants enjoyed the RETAIN digital game simulator and whether it was at least as good as a video lecture at refreshing and maintaining participants' neonatal resuscitation knowledge. In this randomized controlled simulation trial, n = 42 labour and delivery room HCPs were administered a pre-test of neonatal resuscitation knowledge using a manikin. Then, they were randomly assigned to a control or a treatment group. For 20-30 min, participants in the control group watched a neonatal resuscitation lecture video, while those in the treatment group played the RETAIN digital game simulator of neonatal resuscitation scenarios. Then, all participants were administered a post-test identical to the pre-test. Additionally, participants in the treatment group completed a survey of attitudes toward the RETAIN simulator that provided a measure of enjoyment of the RETAIN game simulator. After two months, participants were administered another post-test identical to the pre-test. For the primary outcome (neonatal resuscitation performance), an analysis of variance revealed that participants significantly improved their neonatal resuscitation performance over the first two time points, with a significant decline to the third time point, the same pattern of results across conditions, and no differences between conditions. For the secondary outcome (attitudes toward RETAIN), participants in the treatment condition also reported favourable attitudes toward RETAIN. Labour and delivery room healthcare providers in both groups (RETAIN simulator or video lecture) significantly improved their neonatal resuscitation performance immediately following the intervention, with no group differences. The findings suggest that participants enjoyed interacting with the RETAIN digital game simulator, which provided a similar boost in performance right after use to the more traditional intervention.

A one-day “Helping Babies Breathe” course improves simulated performance but not clinical management of neonates

Positive end-expiratory pressure during resuscitation at birth in very-low-birth-weight infants: A randomized controlled pilot trial

The majority of newborn infants successfully make the transition from foetal to neonatal life without any help 1. However, an estimated 10% of newborns need help to establish effective ventilation, which remains the most critical step of neonatal resuscitation. Fortunately, the need for chest compression (CC) or medications in the delivery room (DR) is rare. Approximately 0.8% term neonates and up to 10% of preterm neonates require CC at birth 1, 2. In term infants, these interventions result in approximately 1 million newborn deaths annually worldwide 3. The current resuscitation techniques, which are revised by the International Liaison Committee On Resuscitation (ILCOR) every 5 years, are based on current understanding and latest evidence 4. If a newborn infants needs chest compression, ILCOR recommends to deliver a CC to ventilation (C:V) ratio of 3 CC and 1 ventilation (3:1 C:V ratio) 4. The recommendation of a ratio of 3:1 C:V is based on expert opinion and consensus rather than strong scientific evidence. Rationales for using a 3:1 C:V ratio include the higher physiological heart rate of 120–160/min and breathing rates of 40–60/min in newborns compared with adults. Furthermore, profound bradycardia or cardiac arrest in newborns is usually caused by hypoxia rather than primary cardiac compromise; therefore, providing ventilation is more likely to be beneficial in neonatal CPR compared with adult CPR 1. Successful resuscitation requires the delivery of high-quality CC, encompassing several factors including (A) optimal C:V ratio, (B) adequate rate, (C) depth of CC and (D) full recoil between compressions 3. Although there is an agreement that these factors are all important for a successful resuscitation, neither has been extensively studied to optimise coronary and cerebral perfusion while providing adequate ventilation of an asphyxiated newborn. In this issue of Acta paediatrica, Boldingh et al. 5 examined two of these important factors (factors A and C) in a manikin model. Factor A: Current neonatal resuscitation guidelines recommend 3:1 C:V ratio; however, the most effective C:V ratio in newborns remains controversial. Unfortunately, during clinical observation not even experienced resuscitators do always comply with the current algorithm of neonatal CPR 6. These observations are further supported by manikin studies that participants did not manage to deliver the intended number of ventilations during CPR at the 3:1 C:V ratio 7. In particular, compliance with the current algorithm is poor in simulated neonatal CPR with providers, irrespective of experience, performing CC at a significantly higher rate than the recommended 90 CC per minute 8. In the current study, Boldingh et al. reported similar observations, although the CC and ventilation were within the target range and CC rate and number of CC/min were below the target 5. These deviations from the current suggested 3:1 C:V ratio might be attributed to increased stress level during these situations and that this deviation from the guidelines is not exceptional. Current neonatal resuscitation guidelines recommend an external CC depth of ~33% of the anterior–posterior (AP) chest diameter 4. In addition, there is a positive correlation between receiving adequate CC and improved outcomes (e.g. to achieve adequate cardiac output) 9. In contrary, over-compressing of the chest will result in inadequate residual chest depth during CPR and could lead to rib fractures, cardiac contusion and other thoracic injuries. Despite the importance of delivering appropriate CC, adequate CC AP depth has not been rigorously evaluated in neonates. Further, CC depth should be tailored to produce a palpable pulse and sufficient diastolic blood pressure during CPR. A recent computer tomography study reported the AP diameter to be 90 mm in newborn infants 10. This would suggest that CC depth should be ~30 mm. Boldingh et al. reported a similar depth in their current study. Participants had higher and more consistent CC depth during 3:1 C:V CPR, and the depth decay during CC was significantly higher during continuous CC with asynchronised ventilation 5. Similar results have been reported form several other manikin studies 11, 12. Overall using a 3:1 C:V ratio compared with continuous CC with asynchronised ventilation seems to allow some fatigue recovery. However, the current study by Boldingh et al. in addition to the already published studies strongly suggests that during neonatal resuscitation, operators should change every 2–3 minutes to avoid fatigue, which could lead to a lower AP diameter during CC. This potentially could cause increased mortality. Overall, the study by Boldingh et al. supports the currently recommended 3:1 C:V ratio. However, more studies are needed to investigate different chest compression ratios to optimise neonatal resuscitation. Dr. Schmölzer is a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation and a Heart and Stroke Scholarship.

Pediatrics residents are expected to demonstrate preparedness for neonatal resuscitation, yet research has shown gaps in residents' readiness to perform this skill. To evaluate procedural skills and team performance of pediatrics residents during neonatal resuscitation (NR) using a high-fidelity mannequin, and to assess residents' confidence in their NR skills before and after training. Two teams of residents (all had completed NR program training) participated in 2 separate, 90-minute sessions (2 to 3weeks apart) in an off-site delivery room during their neonatal intensive care rotation. Residents' confidence in assisting and leading NR was surveyed before each session. Teams participated in a scenario (adapted from the NR program), which required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration). Video recording was used for debriefing and scoring. Skills were scored for technique and timeliness, and team behaviors were scored for communication, management, and leadership. Twenty-six residents (11 teams) completed 2 paired sessions. Self-confidence scores increased between the 2 sessions but were not correlated with performance. Gaps in procedural skill performance were observed, and timeliness for most skills did not meet expectations. Significant improvement in team communication was noted. Important gaps in procedural skill performance, particularly timeliness, were detected by NR simulation training; residents' improvements in self-confidence did not reflect gains in actual performance. Their relative unpreparedness for NR (despite prior certification) highlights the need for deliberate practice and specific team training before and during neonatal intensive care delivery room rotations.