Infants In Delivery Room Research Articles

Neonatal Resuscitation Practices in Romania: A Survey of the Romanian Association of Neonatology (ANR) and the Union of European Neonatal and Perinatal Societies (UENPS).

This study is part of a European survey on delivery room practices endorsed by the Union of European Neonatal and Perinatal Societies (UENPS) and the Romanian Association of Neonatology (ANR). The aim of our study was to evaluate the current neonatal resuscitation practices in Romanian maternity hospitals and to compare the results between level III and level II centers. The questionnaire was distributed through ANR by email link to heads of neonatal departments of 53 Romanian maternity hospitals with more than one thousand of births per year between October 2019 and September 2020, having 2018 as the reference year for data collection. The overall response rate to the questionnaire was 62.26% (33/53), 83.33% (15/18) for level-III centers and 51.43% (18/35) for level-II centers. Of the responding centers, 18 (54,54%) were academic hospitals, 15 (83,33%) were level III and 3 (16,67%) level II hospitals. In 2018, responding centers reported 81.139 births representing 42.66% of all Romanian births (190.170). There were significant differences between level-III and level-II maternity hospitals regarding the number of births in 2018 (3028.73±1258.38 vs 1983.78±769.99; P=0.006), lowest GA of routinely assisted infants in delivery room (25.07±3.03 weeks vs 30.44±3.28, P<0.001), inborn infants with BW<1500 admitted to neonatal intensive care unit (NICU) in 2018 (66.86±39.14 g vs 22.87±31.50 g; P=0.002), and antenatal counseling of parents before the delivery of a very preterm infant or an infant with expected problems (60% vs 22.2%; P=0.027). There were no significant differences of thermal and umbilical cord management, positive pressure delivery, heart rate assessment between responding centers. The adherence to new guidelines was high among responding centers regarding thermal and umbilical cord management, initial FiO2, but aspects like antenatal counseling, EKG monitoring, laryngeal mask, and heated/humidified gases availability and administration, and simulation-based training require further implementation.

Regional pulmonary oxygen saturations immediately after birth

BackgroundPartial oxygen saturation (SpO2) increases within minutes during transition from the intrauterine to extrauterine life. This study aims to determine the postnatal course of pulmonary regional oxygen saturation (rSO2) measured by Near-Infrared Spectroscopy (NIRS). MethodsWe conducted an observational study at the delivery room in infants above 35 weeks of gestation who did not need resuscitation and did not develop respiratory distress. Preductal pulse oximetry (Covidien NellcorTM) and right pulmonary apex oxygen saturation (raSO2) and basal oxygen saturation (rbSO2) (Covidien INVOSTM) were measured, starting from the postnatal third minute of life, until the 15th minute. The correlations between SpO2 and pulmonary rSO2 were analyzed. ResultsOf the 110 infants included in the study, 87 were term and 23 were late preterms. The gestational age and birth weight were 38.5 ± 1.36 weeks and 3285 ± 508 g, respectively. Median (5th–95th percentile) raSO2 and rbSO2 were 79% (58–95%) and 78% (46–95%) at the third minute, respectively. The rSO2 values measured from both sides increased and reached a steady-state around postnatal 9 min, similar to SpO2 values. The pulmonary NIRS values were significantly higher for babies born by C-Section compared to babies born by vaginal delivery (p < 0.05). ConclusionWe found that rSO2 measurements increased within minutes in the postnatal period in late preterm and term babies without respiratory distress and reached a plateau at the postnatal 9th minute. The normal values obtained from this preliminary study may be used to predict the prognosis of cases with respiratory distress.

Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants.

Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants.

Percentiles of Oxygen Saturations (SpO2) and Heart Rates (HR) in Premature Infants in the Delivery Room

Background: The aim was to describe reference values of oxygen saturation (SpO2) and heart rate (HR) in preterm infants immediately after birth. Methods: The preterm (< 35 gestational age) infants who did not require any intervention were included in the study. The recordings were taken by pulse oximetry during the first 15 minutes of life. Results: Totally 151 infants were analyzed. At 1 minute, the median (IQR) preductal SpO2 and HR were 61% (57 - 66) and 100 (90 - 107.3) bpm, rising at 5, 10 and 15 minutes to 80% (75 - 84) and 155 (142 - 164) bpm, 90% (88 - 92) and 155 (150 - 160) bpm, 96% (94 - 98) and 155 (149 - 162) bpm respectively. Conclusions: Oxygen saturation levels of preterm infants in delivery room are lower than reported in NRP guidelines. Clinicians who use pulse oximetry in HR follow up of premature babies should know HR may be < 100 bpm in first minutes of life and should avoid unnecessary positive pressure ventilation.

1802 Randomised Trial of Single Nasal Prong or Face Mask for Respiratory Support for Preterm Infants in Delivery Room (ISRCTN59061709)

BackgroundILCOR recommends that newborns with inadequate breathing or HR < 100 bpm be given respiratory support via a face mask in the delivery room (DR); however, it may be more...

Postnatal thermal adaptation and the effects of seasonal variations on temperature trends leading to cold stress in newborn infants in rural India

Background: Transitional adaptation of newborns delivered in controlled environments of developed countries has been studied extensively but there is a gap in knowledge regarding the thermal adaptation of the newborn immediately after birth delivered in resource poor conditions prevailing in developing countries. Objective: To observe the thermal adaptation of newborn infants by studying the temperature changes in central - abdominal skin temperature (Ta) and peripheral - sole of the foot temperature (Tf) in healthy term newborns in the delivery room and postnatal ward for the first 12 hours of life. Study Design: The study was conducted in KLE University Hospital, Belgaum, India, during the seasons (rainy and spring) that cause hypothermia due to the ambient conditions in these regions. The data was collected from two groups of infants - Group A (Rainy season) and Group B (Spring season) consisting of 20 and 31 infants respectively. The body temperature data was collected to observe variations at different locations of neonatal care in the hospital during the study period. Additionally the ambient temperature and humidity were also monitored to understand the prevailing conditions that the infants encounter. Result: Mean Ta was 35.9 ◦ C and 35.8 ◦ C in the delivery room in infants from Groups A and B, respectively. The major variations were observed around six hours of life. The mean Ta and Tf were 35.63 ◦ C and 30.38 ◦ C in Group A and 35.95 ◦ C and 32.51 ◦ C in Group B during this period. Conclusion: Healthy term infants are subjected to severe thermal stress during the first 12 hours of life in developing countries with no control over the environmental temperature in delivery room and postnatal ward that is also influenced by seasonal variation. These findings underscore the need to control the environmental temperature, ensure proper clothing and use of Kangaroo care to prevent hypothermia in healthy term infants.

Evaluation of prophylaxis against hepatitis B in a large municipal hospital

Perinatal transmission of hepatitis B can be interrupted by the administration of hepatitis B vaccine and hepatitis B globulin to the infants of carrier mothers. Universal screening of pregnant women makes this strategy possible. To evaluate the implementation of universal hepatitis B surface antigen screening of women giving birth at Kings County Hospital Center during 1988, we reviewed laboratory records to find all women with a positive test result who might give birth. We also randomly reviewed records of women who gave birth to live infants to determine the percentage of screening in the population. Infants' charts were reviewed for documentation of maternal hepatitis B surface antigen status and administration of hepatitis B immune globulin and vaccine. Sixty infants who lived long enough to receive antihepatitis B prophylaxis were distinguished out of a total of 5146 births. Screening was done for from 66.8% to 80.4% (95% confidence interval) of the mothers of these infants. Although 44 of 60 infants received hepatitis B immune globulin and 39 of 60 infants received vaccine, only 27 of 60 received vaccine within 12 hours in combination with immune globulin (Centers for Disease Control-recommended therapy). Documentation of hepatitis B surface antigen in the infant's delivery room record was present in 23 of 60 infants. Those infants all received hepatitis B immune globulin and vaccine; 21 received hepatitis B immune globulin within 12 hours. Hepatitis B immune globulin was given within 12 hours to 8 of 37 infants who lacked documentation of hepatitis B surface antigen status on the delivery room record. These differences were highly significant (p less than 0.001) even when only the 40 patients who had documented prenatal screening at Kings County Hospital Center (21/23 vs 4/17). Prenatal care did not have any effect on outcome.