Neonatal Cardiopulmonary Resuscitation Research Articles

Assessment of optimal chest compression depth during neonatal cardiopulmonary resuscitation: a randomised controlled animal trial

AimThe study aimed to examine the optimal anterior-posterior depth which will reduce the time to return of spontaneous circulation and improve survival during chest compressions. Asphyxiated neonatal piglets receiving chest...

Novedades en las recomendaciones de reanimación cardiopulmonar pediátrica y líneas de desarrollo en España

ObjectivesTo analyse the 2020 international and European recommendations for paediatric cardiopulmonary resuscitation (CPR), highlight the most important changes and propose lines of development in Spain. MethodsCritical analysis of the paediatric cardiopulmonary resuscitation recommendations of the European Resuscitation Council. ResultsThe most relevant changes in the CPR recommendations for 2020 are in basic CPR the possibility of activating the emergency system after performing the five rescue ventilations with the mobile phone on loudspeaker, and in advanced CPR, bag ventilation between two rescuers if possible, the administration of epinephrine as soon as a vascular access is obtained, the increase in the respiratory rate in intubated children between 10 and 25bpm according to their age and the importance of controlling the quality and coordination of CPR. In CPR training, the importance of training non-technical skills such as teamwork, leadership and communication and frequent training to reinforce and maintain competencies is highlighted. ConclusionsIt is essential that training in paediatric CPR in Spain follows the same recommendations and is carried out with a common methodology, adapted to the characteristics of health care and the needs of the students. The Spanish Paediatric and Neonatal Cardiopulmonary Resuscitation Group should coordinate this process, but the active participation of all paediatricians and health professionals who care for children is also essential.

Assessment of Nurses’ Knowledge toward Neonatal Resuscitation

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

Perimortem Caesarean section because of alive fetus: case report and literature review.

Perimortem Caesarean section (PMCS) is arare surgical procedure that is potentially lifesaving for mother and child. To describes alive fetus 1h after maternal cardiac arrest and arare hospital surgical event, PMCS. We report on a22-year-old gravida 1para 1woman who had aconvulsive loss of consciousness at 31weeks' gestation. Aconvulsive loss of consciousness was accompanied by profuse vomiting of gastric contents. Cardiopulmonary resuscitation was initiated. Fetal heartbeats were recorded and the patient was referred to the Clinic for Gynecology and Obstetrics. Perimortem Caesarean section was performed. Neonatal cardiopulmonary resuscitation was initiated, but the infant was pronounced dead after 60 min of attempted resuscitation. Maternal cardiopulmonary resuscitation was without success and it was abandoned following discussion with family members. Acooperative team approach is the key factor to producing agood perinatal outcome.

Pediatric Emergency Medical Care in Yerevan, Armenia: A Knowledge and Attitudes Survey of Out-of-hospital Emergency Nurses

BackgroundEmergency Medical Services (EMS) system in Armenia follows the Franco-German model in which physician - nurse dyads staff ambulances. This study aims to evaluate the knowledge and attitudes of EMS nurses regarding pediatric rapid assessment and resuscitation. MethodsThis is a cross-sectional, anonymous, self-administered survey study of a convenience sample of 200 out-of-hospital emergency nurses in June and July 2015. ResultsResponse rate was 87.5%. Half of respondents failed to achieve the pre-defined passing score of 70% on the 10-question knowledge test (sample mean 6.32 ± 1.85 SD). Test score was positively correlated with pediatric training, current pediatric continuing medical education (CME), years with EMS and female gender. Questions regarding recognition of shock and initiation of neonatal and pediatric cardiopulmonary resuscitation were most frequently missed. Nurses were least confident in their ability to care for neonates and infants. 79.4% indicated that they would benefit from further pediatric training, and 86.1% indicated that knowledge from the Anglo-American model of emergency medicine could improve pediatric emergency care (PEC) in Armenia. ConclusionsThere is a need for additional PEC training and continuing education for EMS nurses in Yerevan, Armenia. Training EMS nurses would improve first responder awareness of pediatric acute management and resuscitation and enhance the quality of emergency care of children.

Evaluation of the pediatric life support instructors courses

ObjectiveTo evaluate the results and quality of pediatric cardiopulmonary resuscitation (CPR) instructor training courses.MethodsA retrospective analysis was performed of the results of 24 pediatric CPR instructor courses held over 21 years (1999 to 2019). The results of participants’ evaluation of theory and practice sessions were analyzed. In addition, participants were asked to answer an anonymous survey to assess their opinion on the quality of theory and practice lessons, course organization and methodology, and instructor training. The results were compared by professional groups.ResultsA total of 560 participants completed the instructor course. Of them, 554 passed theory and practice tests (98.9 %). The mean score obtained in theory tests was 9.2 (0.8) out of 10. The mean score obtained in all practice tests was > 3.5 out of 5. Participants evaluated all the aspects of the course (theory and practice content, organization, teaching methodology, and instructors) with mean scores over 8 out of 10.ConclusionsSpecific pediatric and neonatal CPR instructor courses are a cornerstone in the process of CPR training and ensuring the homogeneity and quality of training. Most of the participants obtained the qualification of instructors and their evaluation of the course was very positive.

Pharmacology education on women's health, pregnancy, childbirth and breastfeeding in Midwifery education

Midwives are responsible professionals who support the sexual and reproductive health, rights, and welfare of individuals, families, and communities. In particular, midwives work in partnership with women to provide the necessary support, care and advice needed during pregnancy, childbirth and the postpartum period. Midwives conduct normal births on her own responsibility, support breastfeeding, provide care for newborns and infants, and fully release mother-infant's latent strengths. Midwives also contribute in adopting appropriate preventative measures to promote normal birth and breastfeeding, detecting early signs of complications, and carrying out emergency measures or transferring the patient to other medical care or assistance as needed. In order to provide the best care to mother and infant, midwives should first learn the biological foundations of women's health, pregnancy, childbirth, postpartum, breastfeeding, and infant health. They must also understand the in vivo mechanisms and actions of the key hormones and neurotransmitters in play during the reproductive period. Additionally, midwives need to learn pharmaceutical treatments to complement and support biological function in cases of disorders or impairments occurring in women and infants. Midwives should also be competent in life support skills in obstetrics and neonatal cardiopulmonary resuscitation. The directors of Japanese Maternity Centers sign a contract with obstetricians that permits them to purchase and use emergency medicines. We facilitate midwifery students in their studies of medicine and pharmacology in order to train them to cope with such emergency situations. In this revision of the midwifery curriculum and the continuing education, we hope to create a new midwifery educational program focusing on personalized, client-centered pharmacology, with the ultimate objective to support and maintain the health of women, mothers, infants, child-rearing families, and communities.

新生児蘇生法（NCPR）一次コース講習会を看護学生に導入した実践報告 ─専門学校看護学科学生における取り組み─

新生児蘇生法（NCPR）一次コース講習会を看護学生に導入した実践報告 ─専門学校看護学科学生における取り組み─

1199: Cardiopulmonary Resuscitation in Neonates and Infants by NICU Providers: NRP or PALS?

1199: Cardiopulmonary Resuscitation in Neonates and Infants by NICU Providers: NRP or PALS?

Development of self-skill training and e-learning system for neonatal resuscitation

Purpose of the study: The Japanese Society of Perinatal and Neonatal Medicine established the Neonatal Cardio-Pulmonary Resuscitation (NCPR) training course for perinatal medical staff in 2007. Since it is difficult to maintain and improve resuscitation skills and knowledge, we considered using a self-training system to learn in low-dose and high-frequency. We have developed a self-training system to keep their skills and knowledge of neonatal resuscitation.

院内発生の妊婦心肺停止症例に対応するための体制整備(System development and simulation training for management of in–hospital maternal cardiac arrest)

要旨【目的】妊婦が心肺停止に至ったときに，母体救命のため 死戦期帝王切開PMCD（perimortem cesarean delivery）を行うことが考慮される。当院は院外症例の受け入れ体制は整っていたが，院内症例の体制整備はされておらず，心停止から5分以内にPMCDを実施することが可能な体制をつくることとした。【対象】産科病棟で発生したと想定し，問題点の抽出をした。実施場所に関して，手術室で行うには手術申込みや入室認証が必要であったため，少しでも時間を短縮させるため分娩室とした。実施までのフローシート，連絡経路も事前に作成した。PMCDの適応や効果に関して教育を行い，PMCD器材と，新生児蘇生器材とに分けて準備し，シミュレーションを行った。【結果】第1回目のシミュレーションは救急科医の到着を待って，分娩室に移動しPMCDを実施したが，実施までに14分かかった。2回目は，心肺停止を覚知後すぐに患者を分娩室に移動させPMCDを実施し，4分で行うことができた。除細動の適応波形の場合にはどうするべきか，などの新たな問題点が抽出された。【結語】院内発生の妊婦心肺停止症例では，心停止から医療従事者接触までの時間が短く救命できる可能性が高い反面，短時間でPMCD実施の決断や実行が求められるため，シミュレーショントレーニングは重要と考えられる。

Effects of sustained inflation pressure duringneonatal cardiopulmonary resuscitation of asphyxiated piglets.

Sustained inflation (SI) during chest compression (CC = CC+SI) has been recently shown as an alternative method during cardiopulmonary resuscitation in neonates. However, the optimal peak inflation pressure (PIP) of SI during CC+SI to improve ROSC and hemodynamic recovery is unknown. To examine if different PIPs of SI during CC+SI will improve ROSC and hemodynamic recovery in severely asphyxiated piglets. Twenty-nine newborn piglets (1-3 days old) were anesthetized, intubated, instrumented and exposed to 30-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into four groups: CC+SI with a PIP of 10 cmH2O (CC+SI_PIP_10, n = 8), a PIP of 20 cmH2O (CC+SI_PIP_20, n = 8), a PIP of 30 cmH2O (CC+SI_PIP_30, n = 8), and a sham-operated control group (n = 5). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Baseline parameters were similar between all groups. There was no difference in asphyxiation (duration and degree) between intervention groups. PIP correlated positively with tidal volume (VT) and inversely with exhaled CO2 during cardiopulmonary resuscitation. Time to ROSC and rate of ROSC were similar between piglets resuscitated with CC+SI_PIP_10, CC+SI_PIP_20, and CC+SI_PIP_30 cmH2O: median (IQR) 75 (63-193) sec, 94 (78-210) sec, and 85 (70-90) sec; 5/8 (63%), 7/8 (88%), and 3/8 (38%) (p = 0.56 and p = 0.12, respectively). All piglets that achieved ROSC survived to four hours post-resuscitation. Piglets resuscitated with CC+SI_PIP_30 cmH2O exhibited increased concentrations of pro-inflammatory cytokines interleukin-1β and tumour necrosis factor-α in the frontoparietal cerebral cortex (both p<0.05 vs. sham-operated controls). In asphyxiated term newborn piglets resuscitated by CC+SI, the use of different PIPs resulted in similar time to ROSC, but PIP at 30 cmH2O showed a larger VT delivery, lower exhaled CO2 and increased tissue inflammatory markers in the brain.

Rescuer Exertion and Fatigue Using Two-Thumb vs. Two-Finger Method During Simulated Neonatal Cardiopulmonary Resuscitation.

Background: Rescuer fatigue during neonatal CPR can affect CPR quality leading to reduced cerebral and myocardial perfusion.Aim: To investigate rescuer fatigue during simulated neonatal CPR using both objective (heart rate and cardiac output) and subjective measures.Methods: A randomized crossover manikin study performed. Nineteen doctors working in neonatology were randomized to (a) two-thumb term, (b) two-finger term, (c) two-thumb preterm, or (d) two-finger preterm group. Cardiac output and heart rate were measured with a non-invasive cardiac output monitor. A Likert scale assessed participants' level of perceived exertion.Results: In the preterm group, the mean change in HR from rest to 5 min in the TT group was 11.58 bpm (SD 6.22) vs. 9.94 bpm (SD 8.48), (p-value 0.36). There was no difference in change in CO, 2.10 (SD 1.15) in the TT group vs. 1.39 (SD 1.63) in TF group (p value 0.23). There was no difference in BORG RPE rating. In the term group, the mean change in HR from rest to 5 min was 15 bpm (SD 8.40) in TT group and 13 bpm (SD 7.86) in TF group, (p-value 0.416). The median change in CO from rest to 5 min was 1.50 (0.78 to 2.42 IQR) in TT group vs. 1.60 (0.65 to 3.0 IQR) in TF group.Conclusion: Providing chest compressions is associated with an increase in both heart rate and cardiac output. We did not identify difference between objective and subjective measures of fatigue between either technique in a preterm or term model.

WITHDRAWN: Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings

Abstract This report highlights details on a pregnant case of COVID-19 who unfortunately did not survive. This 27-year-old woman at her 30 and 3/7 weeks’ gestation was referred to our center with fever, myalgia, and cough. The laboratory investigations showed leukopenia and lymphopenia as well as increased creatinine and CRP levels. The first chest X-ray (faint bilateral patchy opacities) and CT scan (some faint subpleural ground-glass opacities associated with pleural thickening) were not typical for initial COVID-19 pulmonary infection, however, the treatment for COVID-19 was started. Due to respiratory distress, she was intubated and put under mechanical ventilation. After a while, the fetus was born with Apgar score of 0 and did not react to the neonatal cardiopulmonary resuscitation protocol. Finally, due to deterioration in the clinical and imaging findings, the patient was expired as a result of multi-organ failure. Following the death, autopsy was performed and the histopathologic evaluations of the lungs showed evidence of viral pneumonia (viral cytopathic effect and a mild increase in alveolar wall thickness) and ARDS (hyaline membrane). Also, reverse transcription-polymerase chain reaction (RT-PCR) confirmed SARS-CoV-2 infection in the lungs. To our knowledge, this is the first report of maternal death with confirmed COVID-19 infection.

Summary of Japanese Neonatal Cardiopulmonary Resuscitation Guidelines 2015.

The Japan Resuscitation Council joined the International Liaison Committee on Resuscitation (ILCOR) as a member of the Resuscitation Council of Asia in 2006. In 2007, the Japan Society of Perinatal and Neonatal Medicine (JSPNM), which is a member of an affiliated body, launched the Neonatal Cardiopulmonary Resuscitation (NCPR) program as an authorized project to ensure that all staff involved in perinatal and neonatal medicine can learn and practice neonatal cardiopulmonary resuscitation based on the Consensus on Science with Treatment Recommendations developed by ILCOR. The content of courses in the NCPR program is based on the NCPR guidelines. These guidelines are revised by the Japan Resuscitation Council according to the Consensus on Science with Treatment Recommendations, which is updated by ILCOR every 5years. The latest updated edition in Japanese was published in 2016 and we translated these Japanese guidelines to English in 2018. Here, we introduce a summary of the NCPR guidelines 2015 in Japan. The NCPR 2015 algorithm has two flows, "lifesaving flow" and "stabilization of breathing flow" at the first branching point after the initial step of resuscitation.

Effect of the 2010 Japan Resuscitation Council Guidelines for neonatal cardiopulmonary resuscitation on respiratory support and pulmonary air leak of term infants

Effect of the 2010 Japan Resuscitation Council Guidelines for neonatal cardiopulmonary resuscitation on respiratory support and pulmonary air leak of term infants

A survey of emergency medical services personnel who attended the neonatal cardio-pulmonary resuscitation training course

A survey of emergency medical services personnel who attended the neonatal cardio-pulmonary resuscitation training course

Effect of Peers’ Application of Modified Peyton’s Four –Step Approach Versus Traditional Learning on Pediatric Nursing Students' Performance

Background : Effective learner-centric innovative learning strategies are now being utilized to encourage active student participation, creative thinking and improve the problem-solving abilities of them . One of these strategies is modified Peyton’s four-step approach, in which students, learn from their peers through repeated observations of the procedure. It involves active student participation, where the student takes responsibility for their peers learning. It helps students mastering the academic skills, encourages more positive attitudes toward learning, gains a deeper understanding of the subject area, develops a more positive self-image, and improves their attitudes toward faculty and teachers. Aim: The aim of this study was to determine the effect of peers’ application of modified Peyton’s four-step approach versus traditional learning on pediatric nursing students' performance. Setting: The study was carried out in pediatric nursing laboratories at the Faculty of Nursing, Alexandria University. Subjects: The subjects of present study comprised of "78" students divided randomly into "study and control" groups 36 students in each, in addition to 6 students who act as tutors and teach their peers. Tools: Three tools were used, namely, Neonatal Cardiopulmonary Resuscitation (CPR) Performance Observational Checklist, Modified Peyton’s Four-Step Approach Tutors' Satisfaction Assessment Scale and Modified Peyton’s Four-Step Approach Tutees' Satisfaction Assessment Scale. Results: The study revealed a statistical significant difference between the study and control groups in relation to performing neonatal CPR procedure immediately after applying modified Peyton’s four-step approach by peers (P= 0.000*). Conclusion: It can be concluded that applying modified Peyton’s four-step approach by peers as a method of teaching has a positive effect on the clinical performance of pediatric nursing students. Recommendation: The main recommendation of current study was to apply modified Peyton’s four-step approach by peers as an innovative method of teaching in all academic nursing departments at the Faculty of Nursing, Alexandria University and Damanhour University. Keywords : Modified Peyton’s four-step approach, Tutees, Tutors, Peer Learning, Pediatric Nursing, Students’ Performance, Neonatal Cardio-Pulmonary Resuscitation. DOI : 10.7176/JHMN/69-09 Publication date: December 31 st 2019

Is Supplemental Oxygen Needed in Cardiac Compression?-The Influence of Oxygen on Cerebral Perfusion in Severely Asphyxiated Neonates With Bradycardia or Cardiac Asystole.

Background: Previous studies have investigated hemodynamic recovery using 21% vs. 100% oxygen during cardiopulmonary resuscitation (CPR) with chest compression (CC) in term infants. Animal studies indicate that systemic circulatory recovery is the same whether 21 or 100% oxygen is used during neonatal CPR. One of the main goals of resuscitation is to maintain cerebral oxygen delivery and prevent cerebral hypo- and hyperoxygenation. Oxygen delivery to the brain depends on cerebral hemodynamics, concentration of inhaled oxygen and blood oxygen content. The aim of this paper was to synthesize available research about cerebral oxygen delivery during CPR using different oxygen concentrations. Our research questions included how do different oxygen concentrations during CPR with CC influence cerebral perfusion and oxygen delivery, and how do cerebral hemodynamics during CC influence outcomes.Methods: A search in Medline Ovid using the search terms hypoxia AND oxygen AND cerebrovascular circulation AND infant, newborn. Inclusion criteria included studies of hypoxia and resuscitation of term infants. Studies were excluded if no measures of cerebral blood flow (CBF), oxygenation, or perfusion were reported.Results: The search retrieved 21 papers. None of the studies directly fulfilled our inclusion criteria. The reference lists of some of the retrieved papers provided relevant animal studies with slightly conflicting results regarding blood flow and oxygen delivery to the brain using 21 or 100% oxygen. No study in term infants was identified, but we included one study in preterm infants. Studies in asphyxiated animals indicate that 100% oxygen increases CBF and oxygenation during and after CC with a potential increase in oxidative stress.Conclusion: In asphyxia, cerebral autoregulation may be impaired. Pure oxygen administration during CC may result in cerebral hyperperfusion and increased cerebral oxygen delivery, which may be associated with oxidative stress-related damage to the brain tissue. As systemic circulatory recovery is the same whether 21 or 100% oxygen is used during neonatal CPR, it is important to investigate whether brain damage could be aggravated when 100% oxygen is used.

Umbilical vein catheterization through Wharton's jelly: A possibility for a fast and safe way to deliver treatments in the delivery room?

Fast and safe venous access can be a critical issue in the delivery room during neonatal cardiopulmonary resuscitation or before endotracheal intubation. Here, we describe a new method to inject drugs using the umbilical vein, directly punctured through Wharton's jelly, performed in ten newborns between November 2016 and May 2018. The umbilical vein was identified and punctured easily and a reflux was obtained in all patients. The treatments were efficient in all but two patients, which was imputable to the method in one patient. We describe a new route for administration of drugs that has been successfully used in neonates.