Neonatal Resuscitation In Delivery Room Research Articles

Improving Delivery of Positive Pressure Ventilation During Neonatal Resuscitation: A Quality Improvement Study

Background Positive pressure ventilation (PPV) is one of the most crucial steps of the Neonatal Resuscitation Program (NRP) algorithm. We observed multiple deviations from NRP algorithm during PPV delivery in our unit for which we planned a quality improvement (QI) initiative. The aim of this study was to improve PPV score (total score 14) from existing 20% (~3) to at least 60% (~8) during neonatal resuscitation in delivery room and maternity OT over a period of 48 weeks. Methods The study was conducted in 3 phases over a period of 48 weeks. The baseline and the sustenance phase were of 12 weeks and the intervention phase consisting of 4 PDSA cycles was of 24 weeks duration. Several change ideas were tested and implemented during these PDSA cycles including training sessions for effective PPV delivery, ensuring adequate number of personnel attending delivery and equipment check, specification of delivery team at the start of a shift, and involvement of obstetrics colleagues for better communication. The objective scoring of PPV (a total composite score of 14 over 7 domains) was taken as the process measure, while the proportion of deliveries with PPV score >60% (~8) and need for alternate airway were the outcome measures. We used statistical process control (SPC) Xbar mean chart and P charts for analyzing the data. Results The median score during the baseline phase was 20% (3/14) which improved to 71% (10/14) during the sustenance phase. The percentage of deliveries having a score of at least 60% (8/14) also improved significantly from the baseline to the sustenance phase; there was, however, no change in the need for alternate airway. Conclusion This QI study successfully improved the PPV delivery practices. Similar studies involving multiple centers and including other steps of NRP algorithm should be undertaken for the overall betterment of neonatal care and outcomes. What Is Known NRP is an evidence-based approach for neonatal resuscitation; however, evidence suggests that the quality and sequence of events during neonatal resuscitation significantly deviate from the standard guidelines. What This Study Adds QI is an excellent tool to improve the adherence to PPV delivery during newborn resuscitation. Along with training and teaching of the care giving staff, the study identified important gaps in PPV delivery which were solved using simple and comprehensive measures.

Neonatal Resuscitation in Delivery Room: Current Trends and Guidelines in 2022

Neonatal Resuscitation in Delivery Room: Current Trends and Guidelines in 2022

Teaching Approach for Neonatal Resuscitation in Delivery Room.

Background: - The successful transition from intrauterine to extrauterine life depends very much on Physiological changes that occur at birth,10% of all newborns in the United States require some intervention, and 1% will require extensive resuscitation measures at delivery. Therefore, we aim to look into neonatal resuscitation for both medical students and new physicians face in the recognition, diagnosis and management of these problems. Targeted Population:Neonatal resuscitation are requiring urgent management in the operative room, with Emergency Physicians for teaching approach protocol. Aim of the study: Appropriate approach of neonatal resuscitation and management by training protocol to Emergency Physicians. Based to prevent neonatal death and adverse long-term neurodevelopmental sequelae associated with perinatal asphyxia Conclusion: Resuscitation efforts may be discontinued after 10 minutes of resuscitation if the neonate has demonstrated no signs of life (no heartbeat or no respiratory effort for greater than 10minutes). And infants who required resuscitation are at risk of developing post resuscitative complications. After successful resuscitation, they require placement in a setting in which close monitoring and ongoing appropriate care can be provided.

Clinical characteristics and risk factors of very low birth weight and extremely low birth weight infants with bronchopulmonary dysplasia: multicenter retrospective analysis

Objective: To analyze clinical characteristics and risk factors of very low birth weight and extremely low birth weight infants with bronchopulmonary dysplasia (BPD). Methods: A retrospective epidemiological study was performed in 768 neonates (376 males) with birth weights<1 500 g and gestational age ≤ 34 weeks who survived ≥28 days. Clinical data were obtained from the multi-center clinical database of neonatal intensive care units (NICU) in 19 hospitals of Jiangsu Province between January 1, 2017 and December 31, 2017. These infants were divided into non-BPD group and BPD group according to BPD diagnositic criteria. Clinical features and potential risk factors were compared between groups with Chi-square test or nonparametric test. Risk factors for BPD were analyzed with Logistic regression analysis. Results: Among the total of 768 eligible neonates, 577 without BPD, 191 with BPD (24.9%). Mild, moderate and severe BPD accounted for 73.3% (140/191), 23.6% (45/191) and 3.1% (6/191) of all BPD cases respectively. There were significant differences in the average gestational age (29 (28, 30) vs. 30 (29, 31) weeks) or the average birth weight (1 170 (990, 1 300) vs. 1 300 (1 160, 1 400) g) between BPD group and non-BPD group (Z=-9.959,-7.202, both P=0.000). The incidences of BPD in the infants with gestational age of<28 weeks, 28-31 weeks and 32-34 weeks were 51.7% (46/89), 24.8% (139/561), 5.1% (6/118) respectively. The incidences of BPD in infants with birth weight<1 000 g, 1 000- 1 249 g and 1 250-1 500 g were 62.3% (48/77), 25.9% (70/270) and 17.3% (73/421) respectively. Proportion of male (55.5% (106/191) vs. 46.8% (270/577)), rate and length of conventional mechanical ventilation (48.7% (93/191) vs. 14.9% (86/577), 120 (72, 259) vs. 80 (29, 144)h), initial inhaled oxygen concentration and maximum inhaled oxygen concentration (0.35 (0.30, 0.40) vs. 0.30(0.25, 0.40), 0.40 (0.30, 0.50) vs. 0.30 (0.30, 0.40)) and volume of red blood cell transfusion (53(30, 90) vs.38(28, 55) ml) were higher in BPD group than in non-BPD group (χ(2)=4.350, 91.640, Z=-3.557, -2.848, -3.776, -4.677, all P<0.05). Rate of continuous positive airway pressure (12.6%(24/191) vs. 19.4%(112/577)) during neonatal resuscitation in delivery room was lower in BPD group than that in non-BPD group (χ(2)=4.614, P=0.032). The incidences of complications in BPD group including severe asphyxia, neonatal respiratory distress syndrome (NRDS), persistent pulmonary hypertension in newborns (PPHN), patent ductus arteriosus, anemia of prematurity, early onset sepsis, clinical sepsis and ventilator associated pneumonia were higher than that in non-BPD group (15.2%(29/191) vs. 4.5% (26/577), 91.1% (174/191) vs. 56.7% (327/577), 2.6% (5/191) vs. 0.2% (1/577), 43.5% (83/191) vs. 34.2% (197/577), 88.0% (168/191) vs. 58.8% (339/577), 15.7% (30/191) vs. 9.9% (57/577), 42.9% (82/191) vs. 18.6% (107/577), 14.1% (27/191) vs. 2.3% (13/577); χ(2)=24.605, 74.993, 9.167, 5.373, 61.866, 4.557, 43.149, 34.315, all P<0.05). Multivariate logistic regression analysis showed that NRDS (OR=4.651, 95%CI: 1.860-11.625), clinical sepsis (OR=1.989, 95%CI: 1.067-3.708), ventilator associated pneumonia (OR=3.155, 95%CI: 1.060-9.388), conventional mechanical ventilation (OR=2.298, 95%CI: 1.152-4.586), and volume of red blood cell transfusion (OR=1.013, 95%CI: 1.002-1.024) were risk factors of BPD. Conclusions: BPD is more common in very low birth weight infants of male with gestational age less than 32 weeks. Using CPAP in the delivery room, active treatment of NRDS, preventing nosocomial infection, and reducing invasive ventilation and red blood cell transfusion may decrease the incidence of BPD.

Prise en charge pédiatrique du nouveau-né post-terme

To estimate the modalities of management of post-term neonates. This study is based on PubMed search, Cochrane library and HAS recommendations. Medical team should be able to provide neonatal resuscitation in delivery room in case of meconium-stained fluid or perinatal asphyxia according to the international guidelines ILCOR 2010. The glycaemia of the post-term newborn with macrosomia should be evaluated. The initial clinical examination should search complications such as shoulder dystocia or clavicular fracture. Full blood count should be performed in symptomatic newborn post-term. Developmental assessment should be performed in post-term newborn in case of associated pathology. The risk of perinatal complications is increased in newborn post-term in delivery room and during hospitalization. Medical team should be able to manage these complications.