Neonatal Depression Research Articles

Different doses of epidural morphine combined with multimodal analgesia strategies for postpartum pain management: study protocol for a single-centre, double-blind randomised, pragmatic clinical trial

IntroductionThe neuraxial morphine has been regarded as the gold standard for postpartum analgesia. However, the recent advancements in patient-controlled analgesia and various regional nerve blocks have led to the implementation...

Bibliometric Analysis on of the Impact of Screening to Minimize Maternal Mental Health on Neonatal Outcomes: A Systematic Review.

(1) Background: Prenatal depression, maternal anxiety, puerperal psychosis, and suicidal thoughts affect child welfare and development and maternal health and mortality. Women in low-income countries suffer maternal mental health issues in 25% of cases during pregnancy and 20% of cases thereafter. However, MMH screening, diagnosis, and reporting are lacking. The primary goals of the present study are twofold, as follows: firstly, to evaluate the importance of screening maternal mental health to alleviate perinatal depression and maternal anxiety, and, secondly, to analyze research patterns and propose novel approaches and procedures to bridge the current research gap and aid practitioners in enhancing the quality of care offered to women exhibiting symptoms of perinatal depression. (2) Methods: We conducted a bibliometric analysis to analyze the research topic, using the bibliometric tools Biblioshiny and VOSviewer, as well as the R statistical programming language. To accomplish our goal, we obtained a total of 243 documents from the Scopus and PubMed databases and conducted an analysis utilizing network, co-occurrence, and multiple correlation approaches. (3) Results: Most of the publications in the field were published between the years 2021 and 2024. The results of this study highlight the significance of shifting from conventional screening methods to digital ones for healthcare professionals to effectively manage the symptoms of maternal mental health associated with postpartum depression. Furthermore, the results of the present study suggest that digital screening can prevent maternal physical morbidity, contribute to psychosocial functioning, and enhance infant physical and cognitive health. (4) Conclusions: The research indicates that it is crucial to adopt and include a computerized screening practice to efficiently and immediately detect and clarify the signs of prenatal to neonatal depression. The introduction of digital screening has led to a decrease in scoring errors, an improvement in screening effectiveness, a decrease in administration times, the creation of clinical and patient reports, and the initiation of referrals for anxiety and depression therapy.

Analysis of anesthetic protocols during cesarean section in dogs: a systematic review

There are many problems associated with uncontrolled artificial breeding of dogs, which lead to anatomical abnormalities. In the literature, there is a tendency for dog breeds to appear that have anatomical and physiological changes that lead to the development of pathological childbirth. In populations of breeds with a particularly high risk of dystocia, such as the English Bulldog, the frequency of planned cesarean sections can approach 80%, therefore it is necessary to take a responsible approach to the formation of anesthetic protocols. Thus, the survival rate of newborns and the state of the maternal body depend on this. Anesthesia protocols adopted for cesarean section should provide adequate muscle relaxation, anesthesia and anesthesia to ensure optimal working conditions. The use of opioid analgesics helps to ensure adequate pain control during cesarean section. One of the most commonly used opioids during this surgery in dogs is morphine. The dosage of morphine may vary depending on the size of the dog and the degree of pain. When performing a cesarean section, it is recommended to use drugs that do not cause neonatal depression. It is noted that epidural anesthesia reduces the need for intraoperative analgesics without causing severe neonatal depression. The main drugs that can be used in the preparation of an anesthesiological protocol during cesarean section are propofol, isoflurane, sevoflurane, lidocaine, morphine, fentanyl. The results of the analysis of the literature data showed the effectiveness of the use of drugs from different groups of medicines.

Analysis of Heart Rate Variability in Newborns Dogs with Different Types of Delivery during the First 35 Days of Life.

The present study aimed to evaluate the influence of the autonomic nervous system on cardiovascular function during the first 35 days of life in different types of delivery, using heart rate variability (HRV) indices. Thirty newborns were equally divided into two groups based on delivery type: eutocic delivery (EG) and emergency cesarean section (CG). Electrocardiographic evaluation was performed at birth (T0), 24 h postpartum (T1), and at 7, 14, 21, 28, and 35 days of life (T2 to T6). Physical parameters, neonatal reflexes, and Apgar scores were recorded. Over 35 days, the values of the time domain indices were higher in the GE group and increased with age. In the frequency domain, the low frequency (LF) index was higher in the CG, and the opposite occurred for the high frequency (HF) index. Since the CG presented lower HRV than the EG, it was shown that the type of delivery should be considered for the assessment of autonomic nervous system activity in neonates. Thus, as predictive factors of vitality, HRV and Apgar scores can help in the face of neonatal depression, demonstrating that delivery by emergency cesarean section can predispose newborns to delays in the autonomic influence on the heart.

Salivary Therapeutic Monitoring of Buprenorphine in Neonates After Maternal Sublingual Dosing Guided by Physiologically Based Pharmacokinetic Modeling.

Opioid use disorder (OUD) during pregnancy is associated with high mortality rates and neonatal opioid withdrawal syndrome (NOWS). Buprenorphine, an opioid, is used to treat OUD and NOWS. Buprenorphine active metabolite (norbuprenorphine) can cross the placenta and cause neonatal respiratory depression (EC 50 = 35 ng/mL) at high brain extracellular fluid (bECF) levels. Neonatal therapeutic drug monitoring using saliva decreases the likelihood of distress and infections associated with frequent blood sampling. An adult physiologically based pharmacokinetic model for buprenorphine and norbuprenorphine after intravenous and sublingual administration was constructed, vetted, and scaled to newborn and pregnant populations. The pregnancy model predicted that buprenorphine and norbuprenorphine doses would be transplacentally transferred to the newborns. The newborn physiologically based pharmacokinetic model was used to estimate the buprenorphine and norbuprenorphine levels in newborn plasma, bECF, and saliva after these doses. After maternal sublingual administration of buprenorphine (4 mg/d), the estimated plasma concentrations of buprenorphine and norbuprenorphine in newborns exceeded the toxicity thresholds for 8 and 24 hours, respectively. However, the norbuprenorphine bECF levels were lower than the respiratory depression threshold. Furthermore, the salivary buprenorphine threshold levels in newborns for buprenorphine analgesia, norbuprenorphine analgesia, and norbuprenorphine hypoventilation were observed to be 22, 2, and 162 ng/mL. Using neonatal saliva for buprenorphine therapeutic drug monitoring can facilitate newborn safety during the maternal treatment of OUD using sublingual buprenorphine. Nevertheless, the suitability of using adult values of respiratory depression EC 50 for newborns must be confirmed.

Klebsiella pneumoniae Metallobetalactamase in the neonatology service of the Abel Santamaría Hospital: case report

Introduction: Klebsiella pneumoniae is considered a superbacteria due to its extreme resistance to most antimicrobials and because it produces carbapenemases, enzymes that hydrolyze carbapenem antibiotics. This threat is exacerbated by the reduction in the discovery of new antibiotics. Case presentation: Preterm newborn of 32,3 weeks of gestation and birth weight of 1790 grams, born on January 3, 2023 with mild neonatal depression and early sepsis due to coagulase-negative staphylococcus. It worsens, presenting jaundice, anemia and thrombocytopenia, with blood cultures positive for Enterobacter Gergoviae and later for Enterobacter agglomerans. Antibiotic therapy was based on different antibiograms depending on the germ isolated without presenting clinical improvement. The isolation obtained from Enterobacter aglomerans showed KPC resistance phenotype, so the sample was referred to the “Pedro Kouri” Institute of Tropical Medicine, where the growth of Klebsiella pneumoniae with NDM metallobetalactamase resistance phenotype was obtained, only Sensitive to colistin and Intermediate to phosphokine. Contact precautions and treatment with colistin and phosphokine are applied. As a result, the patient resolves the infection and it is not transmitted to other neonates in the service. Conclusions: Klebsiella pneumoniae NDM infections constitute a danger due to the few therapeutic options, leaving colistin as the only alternative, due to resistance to carbapenems and due to the limitations in its identification in microbiology laboratories at the provincial level. The rational use of antimicrobials and microbiological surveillance are important for its control.

Effects of Meperidine as a Pain Relief Method during Labor

Alterations in coagulation and decreased platelets are a frequent finding during pregnancy. This case presents an alteration of the PY2 pump of the platelets that contraindicates epidural analgesia and therefore the use of opioids such as meperidine is an option for the treatment of pain during childbirth. Objective: To show a clinical case of a pregnant woman in whom meperidine was administered as a pain relief method during labor. Presentation of the case: A full-term pregnant woman in the process of induction of labor who is administered meperidine to relieve pain during labor. A normal delivery occurs after which it is necessary to perform advanced neonatal resuscitation maneuvers due to respiratory depression in the newborn. Conclusions: The efficacy of meperidine has been proven in various studies, but if the expulsive process is expected to occur within one hour or after four hours from its administration, the use of other drugs such as fentanyl or paracetamol should be considered given the results. similar, to avoid complications such as neonatal respiratory depression at birth.

Role of Minimal Dose of Norepinephrine in Prevention of Hypotension Induced by Subarachnoid Anesthesia in Elective Cesarean Section

Abstract Background Maternal hypotension is a common complication after spinal anesthesia for cesarean delivery. Spinal anesthesia techniques produce hypotension through blockade of sympathetic nerve fibers which control vascular smooth muscle tone. For elective cesarean section, regional anesthesia is preferred as a technique to general anesthesia because of maternal and fetal show a risk to morbidity and mortality. Spinal anesthesia for cesarean section allows the mother to be awake, minimizes or completely avoids the problem of maternal aspiration, and avoids neonatal drug depression from general anesthetics. Aim of the Work The aim of this study to assess the effectiveness of minimal dose of norepinephrine in preventing the episodes of hypotension that follow subarachnoid anesthesia in elective cesarean section. Patients and Methods The study was conducted on 60 randomly chosen patients full filling the inclusion criteria at Ain-Shams university hospitals after approval of medical committee. They were allocated in two groups of 30 patients each: Group (A) received the minimal dose of norepinephrine (25 nanogram/kg/h). Group (B) didn’t receive an infusion with vasopressor. Results The patients in the study group (A) had less events of hypotension 10% compared to 76% in group (B) and less Tachycardia in group (A) with only 3.3% compared to group (B) which were 70%. Although no statistical difference in all other parameters measured in this study. Conclusion Our study suggests that the use of norepinephrine as a vasopressor in the treatment of subarachnoid induced hypotension is safe and effective.

Neonatal Depression Is Associated With 1-Year Mortality in Critical Congenital Heart Disease.

Background Low 5-minute Apgar scores (AS) are predictive of term and preterm neonatal mortality but have not been well studied in the critical congenital heart disease (CCHD) population. We analyzed US national vital statistics data to evaluate the association between neonatal depression (AS 0-3) and 1-year mortality in CCHD. Methods and Results We performed a retrospective cohort study using 2014 to 2018 Centers for Disease Control and Prevention cohort-linked birth certificate and infant death records. Five-minute AS were categorized as ≤3, 4 to 6, or ≥7. We calculated birth rates and associated mortality rates by AS group in infants with and without CCHD. Multivariable logistic regression analyzed neonatal, maternal, and pregnancy-related risk factors for neonatal depression and 1-year mortality. Of 11 642 neonates with CCHD (0.06% of all births), the 5.8% with AS 0 to 3 accounted for 23.3% of all 1-year CCHD mortality, with 69.9% of deaths occurring within 1 month of life. Gestational age at birth, growth restriction, extracardiac defects, race, and low maternal education were associated with an increased odds of AS 0 to 3 in neonates with CCHD relative to those with AS 7 to 10 on multivariable analysis. AS 0 to 3 was associated with 1-year CCHD mortality after adjusting for these factors, prenatal care, and delivery location (adjusted odds ratio, 14.57 [95% CI, 11.73-18.10]). Conclusions The AS is a routine clinical measure providing important prognostic information in CCHD. These findings suggest that prenatal and perinatal factors, beyond those included in current risk stratification tools, are important for CCHD outcomes. Multidisciplinary collaboration to understand the pathophysiology underlying neonatal depression may help identify interventions to improve CCHD mortality rates.

Opioids for Cesarean Delivery Under General Anesthesia and Neonatal Outcome: A Historical Cohort Study

(Can J Anesth/J Can Anesth. 2022;69:1017–1024)) While general anesthesia (GA) is not the preferred technique for cesarean delivery (CD), due to the risk of gastric aspiration, it is sometimes used for emergent delivery or in the setting of contraindications to neuraxial anesthesia. Opioids are often used in nonobstetric populations during anesthesia to attenuate the hemodynamic response to laryngoscopy. In pregnant patients with hypertensive disorders of pregnancy, opioids are used to avoid exaggerated sympathetic responses to intubation. However, beta-blockers, vasodilators, or magnesium are considered just as effective in stabilizing blood pressure as opioids in this population. Since opioids are associated with an increased risk of neonatal respiratory depression, their use in GA for cesarean is not common. This study aimed to describe the current use of opioids during GA for CD, find potential predictors of opioid use in pregnant patients, and investigate the association between opioid use and neonatal outcomes.

Effect of General Anesthesia On Apgar Score In Relation To Induction-Delivery and Uterine-Delivery Interval

The anaesthetic drugs technique used in caesarean section should prevent fetal depressant resulting from passing of drugs through the maternal-placental barrier which can lead to adverse effects such as decreasing in Apgar score and respiratory depression in new born neonates. Apgar score is the first test given to newborn after delivery by caesarian section or normal vaginal delivery to evaluate a newborn physical condition after delivery and to determine any immediate need for extra medical or emergency care. To determine the effect of general anaesthetic drugs on the Apgar score of new-borns in relation to the induction-delivery interval and uterine delivery interval. One hundred healthy full term pregnant women underwent elective C/S, on left lateral position the pre induction with 100% oxygen by face mask, then start induction with minimum dose of Thiopentone (3mg/kg ) with ketamine (1mg/kg), followed by non-depolarization muscle relaxant atracurium(0. 5 mg/kg ). Endotracheal intubation was done and maintenance of anaesthesia with oxygen, 0.5% Halothane and atracurium (0. 1 mg/kg) till the end of surgery. Neostigmine (2.5 mg) and atropine (1.2mg) was given as antidote. During operation the heart rates, blood pressures and oxygen saturation (pulse oxymeter) were monitored. Oxytocin (20 units) or ergometrine (0.8 mg) is injected intravenously after clamping the cord, then (tramadol 75 mg + midazolam 5mg) was given. Induction- delivery interval and uterine-delivery interval was noted using a stopwatch. After delivery the baby’s Apgar score was noted at 1, 5 and 10 min. and proper resuscitation was done. Low Apgar score and low to moderate score at one minute was found when induction –delivery interval up to five minutes and more than 10 minutes also low and low to moderate score of infants when uterine – delivery interval more than 120 seconds. One minute Apgar score of infants were affected by induction-delivery time (≤ 5 min and > 10 min) and uterine –delivery interval (>120 sec).

Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery

Epidural anesthesia is a primary choice for cesarean delivery, but supplemental analgesics are often required to relieve pain during uterine traction. To investigate the sedative and analgesic effects of intravenous esketamine administered before childbirth via cesarean delivery with the patient under epidural anesthesia. This multicenter, double-blind randomized clinical trial assessed 903 women 18 years or older who had full-term single pregnancy and were scheduled for elective cesarean delivery with epidural anesthesia in 5 medical centers in China from September 18, 2021, to September 20, 2022. Patients were randomized to receive intravenous injection of 0.25 mg/kg of esketamine or placebo before incision. The coprimary outcomes included scores on the numeric rating scale of pain (an 11-point scale, with 0 indicating no pain and 10 indicating the worst pain; a difference of ≥1.65 points was clinically meaningful) and Ramsay Sedation Scale (a 6-point scale, with 1 indicating restlessness and 6 indicating deep sleep without response; a difference of ≥2 points was clinically meaningful) immediately after fetal delivery. Secondary outcomes included neonatal Apgar score assessed at 1 and 5 minutes after birth. A total of 600 women (mean [SD] age, 30.7 [4.3] years) were enrolled and randomized; all were included in the intention-to-treat analysis. Immediately after fetal delivery, the score on the numeric rating scale of pain was lower with esketamine (median [IQR], 0 [0-1]) than with placebo (median [IQR], 0 [0-2]; median difference, 0; 95% CI, 0-0; P = .001), but the difference was not clinically important. The Ramsay Sedation Scale scores were higher (sedation deeper) with esketamine (median [IQR], 4 [3-4]) than with placebo (median [IQR], 2 [2-2]; median difference, 2; 95% CI, 2-2; P < .001). The neonatal Apgar scores did not differ between the 2 groups at 1 minute (median difference, 0; 95% CI, 0-0; P = .98) and at 5 minutes (median difference, 0; 95% CI, 0-0; P = .27). Transient neurologic or mental symptoms were more common in patients given esketamine (97.7% [293 of 300]) than in those given placebo (4.7% [14 of 300]; P < .001). For women undergoing cesarean delivery under epidural anesthesia, a subanesthetic dose of esketamine administered before incision produced transient analgesia and sedation but did not induce significant neonatal depression. Mental symptoms and nystagmus were common but transient. Indications and the optimal dose of esketamine in this patient population need further clarification, but study should be limited to those who require supplemental analgesia. ClinicalTrials.gov Identifier: NCT04548973.

No Code-The Role of Sodium Bicarbonate and Naloxone in Neonatal Resuscitation.

Resuscitations in neonates and infants present caregivers with challenging decisions in a highly stressful environment. Consideration of the pathophysiology of cardiac arrest and respiratory failure prior to an emergency allows for thoughtful utilization of pharmacotherapy. It is vital to remember that establishment of an airway and delivery of breaths and chest compressions should be prioritized. Epinephrine is first-line pharmacotherapy for severe bradycardia or cardiac arrest unresponsive to the provision of respiratory support and chest compressions. Sodium bicarbonate may be considered based on the intrinsic links between cardiac arrest, respiratory failure, and mixed acidosis. However, experimental and clinical data suggest that sodium bicarbonate worsens myocardial performance by several mechanisms (decreased intramyocardial pH, reduced oxygen delivery to tissues, reduced coronary perfusion pressure). Additionally, rapid administration of this hyperosmolar therapy may contribute to intracranial hemorrhage. With no clear benefit and multiple risks, sodium bicarbonate has been excluded from neonatal resuscitation algorithms. Opioids may produce respiratory depression in neonates, whether given to the mother prior to delivery or in neonatal intensive care; therefore, naloxone may be considered to restore respiratory drive. However, 50 years of neonatal utilization has not produced clinical studies documenting efficacy and safety. On the contrary, clinical studies fail to detect clear benefit and numerous concerning adverse reactions have been reported, including acute withdrawal, cardiorespiratory decompensation, and death. For these reasons, naloxone has also been removed from neonatal resuscitation algorithms. Clear understanding of pathophysiology, pharmacology, and clinical data support the use of multiple pharmacotherapies in neonatal resuscitation, including epinephrine, normal saline, intravenous glucose, adenosine, and calcium gluconate as reviewed in a previous column. The same pathways inform confident exclusion of sodium bicarbonate and naloxone.

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Comparision of ropivacaine 0.2% with or without clonidine in epidural labor analgesia: A randomised controlled study

Epidural labour analgesia is considered as the gold standard of pain relief for paturients inspite of the hesitancy that is prevalent in our country in providing pain-free labour. There are several other pharmacological and non pharmacological methods available for providing labour analgesia. Local anaesthetic is an indispensable drug for administering epidural labour analgesia Ropivacaine is the most widely used local anaesthetic for labour analgesia because of its safety profile proven by various studies.It is less potent and onset of action is slightly prolonged when compared to bupivacaine or levobupivacaine. Use of adjuvants along with local anaesthetic reduces the total dose of local anaesthetic that is required for providing effective labour analgesia. Clonidine is a centrally acting partial alpha 2 adrenergic agonist that reduces the anaesthetic and analgesic requirement of local anaesthetic. This study is aimed to study the effect of ropivacaine with clonidine as an adjuvant for labour analgesia.To compare the time of onset of analgesia, total dose of local anaesthetic required, total duration of analgesia and neonatal outcome between the two groups, Group I with ropivacaine and Group II ropivacaine with clonidine.: A prospective randomised controlled study was conducted in a government peripheral medical College after getting ethical committee clearance 100 patrurients randomised into two groups, Group I received 2% ropivacaine and Group II received 2% ropivacaine with 40 micrograms of clonidine.: The results were analysed with SPSSVersion 13 using student t - test and chi square test The mean age was 23.4 ±1.7 years. The mean onset time of Group A and Group B were 12.9±1.3 minutes and 17.7±1.3 minutes with p&amp;#60;0.001 which was significant. Total mean dose of Ropivacaine for both groups were 44.0±8.8 and 54.0±8.9 respectively with P &amp;#60;0.05. Neonatal outcome as measured using APGAR score were 8.5±0.5 and 8.4±0.5 being statistically insignificant.Addition of 40 micrograms of clonidine with Ropivacaine epidurally resulted in rapid onset of analgesia with required dose of Ropivacaine. Use of Clonidine as adjuvant didn't produce any undesirable motor blockade or neonatal depression.

The Relationship Between Neonatal Surgery, Postpartum Depression, and Infant Clinical Course.

Postpartum depression (PPD) affects 10-15% of mothers in the general population, and studies show increased incidence for mothers of infants with serious health conditions. This study investigates incidence of PPD in mothers of surgical patients in the neonatal intensive care unit (NICU) and characterizes these patients' clinical and neurodevelopmental outcomes. This retrospective cohort study analyzed Nebraska's Tracking Infant Progress Statewide (TIPS) database and referring hospital medical records from February 2013 to June 2018. Upon NICU discharge, children were referred to the TIPS program, with scheduled follow-up appointments at approximately 6months corrected age. All patients seen in NICU follow-up clinic with recorded scores for maternal Edinburgh postnatal depression screen (EPDS) were eligible except infants with congenital heart disease as this cohort was previously studied. Patients were stratified into groups based on presence or absence of a general surgical procedure within the first 6 months of life and positive (≥ 10) or negative (< 10) EPDS score. Statistical analyses assessed for significant differences between groups regarding gestational age, birth weight, maternal age, length of NICU stay (LOS), number of days on a ventilator, payment method, ethnicity, developmental testing, and rate of referral for early intervention services. Of 436 patients, 83 were surgical patients (16 with positive EPDS; 19.3% incidence), and 353 were non-surgical patients (44 with positive EPDS; 12.5% incidence). Statistical analysis showed no significant relationship between neonatal surgery and positive EPDS (χ2 = 2.6, p = 0.1). While the surgical cohort had longer LOS and days on ventilator, maternal EPDS did not predict these factors. In the surgical cohort, mothers of children not independent on oral feeding at discharge were more likely to screen positive for depression (7/14, 50% vs. 7/61, 11%; p < 0.05). Mothers of surgical patients are not significantly more likely to screen positive for post-partum depression compared to other NICU mothers. This underscores the importance of routine screening for PPD in mothers of both surgical and non-surgical NICU patients in order to identify parents and children at risk.

Needs assessment of general practitioners in Pakistan: A descriptive cross-sectional survey.

With the growing and complex nature of medicine, it is imperative for physicians to update their knowledge and skills to reflect current standards of care. In Pakistan, 71% of primary care needs are met by general practitioners (GPs). GPs are not required to complete structured training and no regulatory mandates exist for continuing medical education. We conducted a needs assessment to evaluate the readiness for competency-based updating of knowledge and skills, and the use of technology by practicing GPs in Pakistan. A cross-sectional survey inviting registered GPs across Pakistan was administered online and in-person. Questions pertained to physician demographics, practice characteristics, confidence in knowledge and skills, and preferred modes of updating knowledge and barriers. Descriptive analyses were performed for GPs and patient-related characteristics and bivariate analyses to evaluate the relationship between parameters of interest. Of the 459 GPs who responded, 35% were practicing for <5 years and 34% reported practicing for >10 years. Only 7% had a post-graduate qualification in family medicine. GPs reported needing practice in neonatal examination (52%), neurological exam (53%), depression screening (53%), growth charts (53%) and peak flow meter use (53%), interpretation of electrocardiograms (ECGs, 58%) and insulin dosing for diabetes (50%). High workload (44%) was the most common barrier to updating clinical knowledge. Sixty-two percent used the Internet on a regular basis. Most GPs have no structured training and encounter gaps in knowledge and skills in clinical practice. Flexible, hybrid, and competency-based continuing medical education programs can be used to update knowledge and skills.

Improving Newborn Resuscitation by Making Every Birth a Learning Event.

One third of all neonatal deaths are caused by intrapartum-related events, resulting in neonatal respiratory depression (i.e., failure to breathe at birth). Evidence-based resuscitation with stimulation, airway clearance, and positive pressure ventilation reduces mortality from respiratory depression. Improving adherence to evidence-based resuscitation is vital to preventing neonatal deaths caused by respiratory depression. Standard resuscitation training programs, combined with frequent simulation practice, have not reached their life-saving potential due to ongoing gaps in bedside performance. Complex neonatal resuscitations, such as those involving positive pressure ventilation, are relatively uncommon for any given resuscitation provider, making consistent clinical practice an unrealistic solution for improving performance. This review discusses strategies to allow every birth to act as a learning event within the context of both high- and low-resource settings. We review strategies that involve clinical-decision support during newborn resuscitation, including the visual display of a resuscitation algorithm, peer-to-peer support, expert coaching, and automated guidance. We also review strategies that involve post-event reflection after newborn resuscitation, including delivery room checklists, audits, and debriefing. Strategies that make every birth a learning event have the potential to close performance gaps in newborn resuscitation that remain after training and frequent simulation practice, and they should be prioritized for further development and evaluation.

Effectiveness of Intrathecal Administration of Bupivacaine with Fentanyl versus Nalbuphine for Elective Cesarean Section

Abstract Background Spinal anesthesia is the most popular procedure in the field of anesthesiology. Subarachnoid block is the preferred anesthetic technique for cesarean section, being simple to perform and economical with rapid onset. Lower incidence of failed block, less drug doses, minimal neonatal depression and decreased incidence of aspiration pneumonitis are added advantages of spinal anesthesia. Objectives The study aims to compare the postoperative analgesic efficacy of Fentanyl versus Nalbuphine when used with intrathecal injection of 0.5% hyperbaric bupivacaine in spinal anesthesia in patients undergoing cesarean section as the primary objective and compare intraoperative hemodynamic changes and postoperative pruritus and shivering as the secondary objectives. Methods and material After Approval was obtained from the research ethics committee of faculty of medicine, Ain Shams University and after obtaining a written informed consent. Fifty adult females underwent elective cesarean section with spinal anesthesia, their ages ranged between 18-45 years old and classified as ASA I and II were enrolled in the study at obstetrics and gynecology Ain Shams university hospital over 4 months. The patients were randomly divided using computer generated randomization into two groups 25patients in each (n = 25), Group A received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml fentanyl (25 μg); Group B received intrathecal injection of 2 ml of 0.5% hyperbaric bupivacaine plus 0.5 ml nalbuphine (0.8 mg) Results The main significant findings in this study was that fentanyl has a more rapid onset of motor block (5.63±0.25 minute in fentanyl group versus 5.88±0.19 minute in nalbuphine group), while nalbuphine produces less perioperative side effects as: shivering (7 patients in fentanyl group versus 1 patient in nalbuphine group), pruritis (6 patients in fentanyl group versus 1 patient in nalbuphine group), nausea and vomiting (5 patients in fentanyl group versus 1 patient in nalbuphine group). Regarding perioperative hemodynamic parameters and postoperative analgesia, they were comparable between the 2 groups. Conclusions We concluded that either intrathecal nalbuphine (0.8 mg) combined with (10 mg) Bupivacaine or intrathecal fentanyl (25 µg) combined with (10 mg) Bupivacaine improves intraoperative analgesia and prolongs early postoperative analgesia in cesarean section with significantly lower incidence of side effects as shivering, pruritis, nausea and vomiting in Nalbuphine.

Comparison of alfaxalone versus propofol as anaesthetic induction agents in increasing the rate of survival and vigour of neonates

PICO question&#x0D; In routine canine caesareans, is alfaxalone a superior anaesthetic induction agent than propofol in increasing the rate of survival and vigour of neonates?&#x0D; &#x0D; Clinical bottom line&#x0D; Category of research question&#x0D; Treatment&#x0D; The number and type of study designs reviewed&#x0D; Three randomised positive clinical trials have compared the efficacy between alfaxalone and propofol in routine canine caesarean sections for increased neonatal survival and vigour&#x0D; Strength of evidence&#x0D; Weak&#x0D; Outcomes reported&#x0D; Although two studies found alfaxalone to be associated with higher Apgar scores for neonates than propofol, each study nonetheless revealed positive vigour and high survival rates from the use of either alfaxalone or propofol. The evidence is too weak to suggest that one induction agent is superior to another. The selection between the two induction agents may not be the main concern in regard to neonatal depression and 24 hour survival post-delivery, provided that the entire canine caesarean protocol is thoroughly and carefully studied&#x0D; Conclusion&#x0D; Text here&#x0D; &#x0D; How to apply this evidence in practice&#x0D; The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.&#x0D; Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.&#x0D; &#x0D;