Abstract
In current resuscitation guidelines, tactile stimulation is recommended for infants with insufficient respiratory efforts after birth. No recommendations are made regarding duration, onset, and method of stimulation. Neither is mentioned how tactile stimulation should be applied in relation to the gestational age. The aim was to review the physiological mechanisms of respiratory drive after birth and to identify and structure the current evidence on tactile stimulation during neonatal resuscitation. A systematic review of available data was performed using PubMed, covering the literature up to April 2021. Two independent investigators screened the extracted references and assessed their methodological quality. Six studies were included. Tactile stimulation management, including the onset of stimulation, overall duration, and methods as well as the effect on vital parameters was analyzed and systematically presented. Tactile stimulation varies widely between, as well as within different centers and no consensus exists which stimulation method is most effective. Some evidence shows that repetitive stimulation within the first minutes of resuscitation improves oxygenation. Further studies are warranted to optimize strategies to support spontaneous breathing after birth, assessing the effect of stimulating various body parts respectively within different gestational age groups.
Highlights
Historical overview Approximately 5–10% of the newborns and the majority of premature infants need interventions to assist the neonatal transition and ~1% receive intensive resuscitation during delivery room management.[1–3] In the past decades, many papers have been published describing practices used in the delivery room to stimulate and support breathing
Blundell described in 1834 the need for rapid and routine neonatal intubation to stabilize the depressed infant as early as possible, which made the use of physical stimulation to support spontaneous breathing fade into the background.[8]
An initial search through PubMed resulted in 271 references of Stimulation rate
Summary
Historical overview Approximately 5–10% of the newborns and the majority of premature infants need interventions to assist the neonatal transition and ~1% receive intensive resuscitation during delivery room management.[1–3] In the past decades, many papers have been published describing practices used in the delivery room to stimulate and support breathing. Many papers have been published describing practices used in the delivery room to stimulate and support breathing. Applying invasive mechanical ventilation to preterm infants resulted in irreversible lung injury and worse neurological outcome.[18–20]. This led to reconsiderations of respiratory support in the delivery room. The approach has changed to non-invasive breathing support using continuous positive airway pressure for spontaneously breathing infants and positive pressure ventilation (PPV) for infants with inadequate breathing.[21,22]. This change in practice increased the need for other medical and non-medical interventions to stimulate spontaneous breathing. It became clear from animal studies that tactile stimulation (TS) could
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