Singapore Neonatal Resuscitation Guidelines 2016

We present the revised Neonatal Resuscitation Guidelines for Singapore. The 2015 International Liaison Committee on Resuscitation Neonatal Task Force's consensus on science and treatment recommendations (2015), and guidelines from the American Heart Association and European Resuscitation Council were debated and discussed. The final recommendations of the National Resuscitation Council, Singapore, were derived after the task force had carefully reviewed the current available evidence in the literature and addressed their relevance to local clinical practice.

Recém-nascidos banhados em líquido amniótico meconial: atendimento em sala de parto e ocorrência de Síndrome da Aspiração Meconial / Meconium stained neonate: delivery room management and Meconium Aspiration Syndrome occurrence

As práticas para reanimação neonatal são fundamentadas em recomendações internacionais e no Brasil mantém-se a indicação de aspirar boca e nariz dos recém-nascidos banhados em mecônio, ainda que vigorosos. O objetivo deste estudo foi verificar o atendimento neonatal realizado na sala de parto em uma maternidade de atual conduta conservadora frente aos recém-nascidos a termo e vigorosos e a sua associação à ocorrência da Síndrome de Aspiração Meconial. Trata-se de um estudo observacional e transversal, com amostra de recém-nascidos a termo, cujas informações sobre os cuidados dispensados na sala de parto e as condições após o nascimento foram obtidas em registros de prontuários. Foram analisados 376 recém-nascidos, dos quais 70 (18,6%) nasceram banhados em mecônio. Destes, apenas 20 (28,6%) foram reanimados e 14 (70%) obtiveram Apgar no 1º minuto menor ou igual a 7. Às demais 50 crianças, o contato materno imediato foi estimulado e o cordão foi clampeado tardiamente. Dos 20 recém-nascidos banhados em mecônio e que foram reanimados ao nascer, 7 (35%) tiveram sua traqueia aspirada sob visualização direta, sendo que o escore médio de Apgar no 1º minuto destes indivíduos foi 4, enquanto o escore médio de Apgar no 1º minuto dos recém-nascidos que não foram submetidos à aspiração traqueal foi 8. Apenas um recém-nascido estudado desenvolveu Síndrome de Aspiração do Líquido Amniótico Meconial. A conduta expectando diante dos recém-nascidos vigorosos banhados em líquido amniótico meconial favorece o contato precoce com a mãe e a transferência sanguínea placentária e pode não aumentar a incidência de Síndrome da Aspiração Meconial.

The practices for neonatal reanimation are based on international recommendations and in Brazil the advised procedure is to aspirate the mouth and the nose of newborns that are born in meconiumstained amniotic fluid, even if they are vigorous. Thus, these children are separated from their mothers and their umbilical cord is immediately clamped. The objective of this study was to verify the neonatal assistance done in the labor room in conservative practice maternity towards vigorous and on-term newborns and its association with the occurrence of Meconium Aspiration Syndrome. This study is observational and transversal, with on-term newborns as samples, whose labor room care information and post-labor conditions were obtained through medical records. 376 newborns were analyzed, 70 of which (18,6%) were born through meconium-stained amniotic fluid. From these 70, only 20 (28,6%) were reanimated and 14 (70%) obtained first minute Apgar equal to or less than 7. Immediate maternal contact and late cord clamping was stimulated for the other 50 children. From the 20 newborns born in meconium that were reanimated at birth, 7 (35%) had their trachea aspirated under direct sight, being that the average first minute Apgar score of these individuals was 4, while the average first minute Apgar score of newborns not submitted to tracheal aspiration was 8. Only 1 newborn studied developed the Meconium Aspiration Syndrome. The expectant practice towards vigorous newborns through meconium-stained amniotic fluid favors the early contact with the mother and the placental blood transfusion and may not raise the incidence of Meconium aspiration Syndrome.

Reduction of intubation rate during newborn resuscitationafter transition from self-inflating bag to T-piece resuscitator: A quality improvement project

Introduction: T-piece resuscitator (TPR) has many advantages compared to self-inflating bag (SIB). Early Continuous Positive Airway Pressure (CPAP) during newborn resuscitation (NR) with TPR at delivery can reduce intubation rate. Methods: We speculated that the intubation rate at delivery room was high because SIB had always been used during NR and this can be improved with TPR. Intubation rate of newborn 50%. An audit was carried out in June 2010 to verify this problem using a check sheet. Results: 25 neonates without major congenital anomalies who required NR with SIB at delivery were included. Intubation rate of babies <24 hours of life when SIB was used was 68%. Post-intervention audit (August to November 2010) on 25 newborns showed that the intubation rate within 24 hours dropped to 8% when TPR was used. Proportion of intubated babies reduced from 48.3% (2008-2009) to 35.1% (2011-2012), odds ratio 0.58 (95% CI 0.49-0.68). Proportion of neonates on CPAP increased from 63.5% (2008-2009) to 81.0% (2011-2012), odds ratio 2.44 (95% CI 2.03-2.93). Mean ventilation days fell to below 4 days after 2010. Since then, all delivery standbys were accompanied by TPR and it was used for all NR regardless of settings. There was decline in intubation rate secondary to early provision of CPAP with TPR during NR. Mean ventilation days, mortality and length of NICU stay were reduced. Conclusion: This practice should be adopted by all hospitals in the country to achieve Millennium Development Goal 4 (2/3 decline of under 5 mortality rate) by 2015.

Práticas assistenciais no atendimento imediato ao recém-nascido em Centro de Parto Normal / Care practices management of the newborn immediately after birth in the context of birth centre

Trata-se de um estudo quantitativo, descritivo-exploratório, prospectivo e transversal que teve como objetivos: identificar as práticas no atendimento imediato ao recém-nascido de parto normal e as atribuições dos profissionais que atuam nessa assistência. Os dados foram coletados em um Centro de Parto Normal de um hospital público da cidade de São Paulo, e registrados em um instrumento tipo check-list, foram armazenados em banco de dados, processados pelo programa SPSS, versão 10.0. Observaram-se cem atendimentos, durante o período de fevereiro a julho de 2003. Identificou-se que o preparo prévio para o atendimento imediato ao RN foi realizado em 97,0% pela técnica ou pela auxiliar de enfermagem. No momento do parto, o neonatologista esteve presente em 64,0% dos atendimentos, nos outros 36,0% a enfermeira obstetra foi responsável pelo atendimento imediato ao RN. O índice de APGAR foi atribuído pelo neonatologista em 99,0% dos nascimentos, sendo o RN colocado sobre o abdome materno em 81,0% dos atendimentos e os demais 19,0%, em um berço aquecido. A secção do cordão umbilical ocorreu, em média, após 49 segundos do nascimento. A aspiração das vias aéreas superiores verificou-se em 47,0% dos RNs e foi realizada pelo neonatologista em 95,7% dos atendimentos. Observou-se a presença de líquido meconial em 24,0% dos atendimentos, sendo aspirada a traqueia em 3,0% dos RNs e 2,0% por intubação. A oxigenação dos RNs verificou-se em 26,0% dos atendimentos, massagem cardíaca foi uma prática realizada em 1,0% dos atendimentos, não sendo necessário uso de drogas de reanimação. O estímulo à amamentação foi uma prática verificada em 91,0%, em média com 29,35 minutos, após o nascimento. A média do tempo de amamentação foi 22,33 minutos. Após a reanimação inicial, desenvolveram desconforto respiratório 6,0% dos RNs que foram transferidos para a UTI neonatal, os demais, 94,0% permaneceram em alojamento conjunto

This is a descriptive, prospective, cross-sectional research whose objectives were: to identify the care practices management during the immediate care of the newborn in the context of a public hospital birth centre; to identify the professional team attributions during this situation. The study was carried out in a public hospital located in the east zone of São Paulo city. Data were obtainned by observation of professional team perfomance during the immediate care management of the newborn. It was collected from 100 childbirth care management from February to July, 2003. Data were recorded in a check-list instrument and they were entered and processed by SPSS 10.0 program. Descriptive and inferencial statistics were used to data analysis. It was verified that in 97.0% of chidbirth, the nursing thecnicians or nursing auxiliaries had prepared previously the delivery room to take care the newborn. The neonatologist phisician was present in 64.0% of the childbirths, other 36.0%, the obstetric nurses were responsible for assist the newborn in the early immediate care. The APGAR score was attributed by phisician in 99.0% of the newborns. Immediately after birth, 81.0% of the neonates were placed on their mother's abdomen, in skin-to-skin contact, other 19.0% were placed under a radiant warm in a heated cot. The mean of the time for umbilical cord section after birth was 49 seconds. Meconium-stainned-amniotic-fluid was verified in 24.0% of births. Upper airways succioning occured in 47.0% of the newborns and trachea succioning in 3.0%. Endotracheal intubation for succioning trachea was used in 66.6% of the newborns. Succioning was carried out by phisician in 95.7% of neonates that submmitted to this procedure.Oxigen administration was used for 26.0% of the neonates and 1.0% was submmited to cheast compression. Use of the drugs during the neonatal resuscitation was not verified. Early initiation of breastfeeding was stimulated in 91.0% of the neonates; the means of the time in minutes to begin breastfeeding after birth and the time duration of breastfeeding were, respectively, 29.35 and 22.33. After submmited to neonatal resuscitation, 6.0% of the newborns evaluated with respiratoy distress and they were referred to neonatal intensive care unit. It was remained with their mothers in rooming-in ward, 94.5% of the newborn.