A retrospective comparison of VLBW outcomes before and after implementing new delivery room guidelines at a regional tertiary care center.

OBJECTIVE: To evaluate the impact of implemented protocol changes on delivery room interventions and very low birth weight (VLBW) health outcomes. STUDY DESIGN: Retrospective study comparing birth characteristics, interventions and health outcomes of VLBW infants born in a tertiary care center before (calendar years 2008 to 2009) and after (calendar years 2012 to 2013) implementing new protocols using Chi-square analyses. RESULT: Four hundred and nine were born before and 303 after changes were implemented. Postimplementation infants had more use of antenatal steroids (P=0.02), gestational age ⩽24 weeks (P=0.03) and birth weights between 501 and 750 g (P=0.04) and less oxygen administration (P=0.002), face mask ventilation (P=0.0001), surfactant use (P=0.0001), chest compressions (P=0.0001), intubation (P=0.002), epinephrine use (P=0.011), hypothermia (P=0.0001) and discharges home on supplemental oxygen (P=0.05). CONCLUSION: Changes creating a new delivery team, adopting new delivery practice guidelines and updating delivery room equipment resulted in positive outcomes for delivery room practices and patient outcomes.

Simulation-based neonatal and infant resuscitation teaching: a systematic review of randomized controlled trials.

BACKGROUND: Current resuscitation guidelines recommend the use of simulation-based medical education (SBME) as an instructional methodology to improve patient safety and health. We sought to investigate the evidence-base for the effectiveness of SBME for neonatal and pediatric resuscitation training. METHOD: Therefore, we conducted a systematic literature research of electronic databases (PubMed, EMBASE, Clinical Trials). RESULTS: 13 randomized controlled trials with a total of 832 participants were identified. However, due to distinct differences in research objectives and varying outcome assessment a meta-analysis of studies could not be conducted. Eligible trials showed that SBME can enhance trainees' cognitive, technical, and behavioral skills as well as self-confidence. DISCUSSION/CONCLUSION: Skills acquired in the simulated environment can be integrated in clinical practice, and SBME might also lead to improved patient safety and health. Further research on SBME--especially investigating patient outcomes--is urgently required in order to strengthen these results and to establish a sound evidence-base for the effectiveness of SMBE for neonatal and infant resuscitation training.

Adaptación de las recomendaciones internacionales sobre reanimación neonatal 2010: comentarios / Changes in the international recommendations on neonatal resuscitation, 2010: comments

Desde la publicación de las últimas recomendaciones ILCOR del 2005, los cambios más significativos que se han implementado en las del 2010 son los siguientes: valoración del recién nacido mediante 2 características vitales (frecuencia cardiaca y respiración) para decidir inicialmente el siguiente paso en la reanimación; evaluación de la oxigenación mediante monitorización por pulsioximetría (el color no es fiable); inicio de la reanimación con aire en el recién nacido a término en lugar de oxígeno al 100%; uso de mezcladores de oxígeno y aire para administrar oxígeno suplementario en caso de necesidad; controversia en la aspiración endotraqueal en recién nacidos deprimidos con aguas meconiales; la proporción de ventilación compresión sigue siendo de 3/1, excepto en la parada cardiorrespiratoria de origen cardiaco, en que se debería considerar una proporción más alta; indicación de hipotermia terapéutica en recién nacidos a término o casi término diagnosticados de encefalopatía hipóxico-isquémica moderada o grave con protocolos y seguimiento coordinados por el sistema regional perinatal (cuidados posreanimación); retraso de al menos 1 min en la ligadura del cordón umbilical de recién nacidos que no requieren reanimación (no existe suficiente evidencia para recomendar un tiempo de ligadura de cordón en aquellos que requieren reanimación), y si no se detecta latido cardiaco después de 10 min de una correcta reanimación, se acepta desde un punto de vista ético, la posibilidad de interrumpir la reanimación, aunque muchos factores contribuyen a la decisión de seguir más allá de 10 min. En determinadas situaciones, no iniciar la reanimación se puede plantear teniendo en cuenta las recomendaciones generales, los resultados propios y la opinión de los padres (AU)

Since previous publication in 2005, the most significant changes that have been addressed in the 2010 International Liaison Committee on Resuscitation (ILCOR) recommendations are as follows: (I) use of 2 vital characteristics (heart rate and breathing) to initially evaluate progression to the following step in resuscitation; (II) oximetry monitoring for the evaluation of oxygenation (assessment of color is unreliable); (III) for babies born at term it is better to start resuscitation with air rather than 100% oxygen; (IV) administration of supplementary oxygen should be regulated by blending oxygen and air; (V) controversy about endotraqueal suctioning of depressed infants born through meconium-stained amniotic fluid; (VI) chest compression-ventilation ratio should remain at 3/1 for neonates unless the arrest is known to be of cardiac etiology, in which case a higher ratio should be considered; (VII)use of therapeutic hypothermia for infants born at term or near term evolving to moderate or severe hypoxic-ischemic encephalopathy, with protocol and follow-up coordinated through a regional perinatal system (post-resuscitation management); (VIII) cord clamping delay for at least 1 minute in babies who do not require resuscitation (there is insufficient evidence to recommend a time for clamping in those who require resuscitation) and, (IX) it is appropriate to consider discontinuing resuscitation if there has been no detectable heart rate for 10 minutes, although many factors contribute to the decision to continue beyond 10 minutes. Under certain circumstances, non-initiation of resuscitation could be proposed taking into consideration general recommendations, own results and parents’ opinion (AU)

[Changes in the international recommendations on neonatal resuscitation, 2010: comments]. / Adaptación de las recomendaciones internacionales sobre reanimación neonatal 2010: comentarios.

Since previous publication in 2005, the most significant changes that have been addressed in the 2010 International Liaison Committee on Resuscitation (ILCOR) recommendations are as follows: (i) use of 2 vital characteristics (heart rate and breathing) to initially evaluate progression to the following step in resuscitation; (ii) oximetry monitoring for the evaluation of oxygenation (assessment of color is unreliable); (iii) for babies born at term it is better to start resuscitation with air rather than 100% oxygen; (iv) administration of supplementary oxygen should be regulated by blending oxygen and air; (v) controversy about endotraqueal suctioning of depressed infants born through meconium-stained amniotic fluid; (vi) chest compression-ventilation ratio should remain at 3/1 for neonates unless the arrest is known to be of cardiac etiology, in which case a higher ratio should be considered; (vii) use of therapeutic hypothermia for infants born at term or near term evolving to moderate or severe hypoxic-ischemic encephalopathy, with protocol and follow-up coordinated through a regional perinatal system (post-resuscitation management); (viii) cord clamping delay for at least 1 minute in babies who do not require resuscitation (there is insufficient evidence to recommend a time for clamping in those who require resuscitation) and, (ix) it is appropriate to consider discontinuing resuscitation if there has been no detectable heart rate for 10 minutes, although many factors contribute to the decision to continue beyond 10 minutes. Under certain circumstances, non-initiation of resuscitation could be proposed taking into consideration general recommendations, own results and parents' opinion.

Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial.

OBJECTIVE: Disagreement exists concerning the appropriate delivery room management of the airway of vigorous meconium-stained infants. Some suggest a universal approach to intubation and suctioning of the airway in all such neonates, whereas others advocate a selective approach. We performed this investigation: 1) to assess whether intubation and suctioning of apparently vigorous, meconium-stained neonates would reduce the incidence of meconium aspiration syndrome (MAS); and 2) to determine the frequency of complications from delivery room intubation and suctioning of such infants. METHODS: Inclusion criteria included: 1) gestational age >/=37 weeks; 2) birth through meconium-stained amniotic fluid of any consistency; and 3) apparent vigor immediately after birth. Subjects were randomized to be intubated and suctioned (INT) or to expectant management (EXP). Primary outcome measures included: 1) the incidence of respiratory distress, including MAS, and 2) the incidence of complications from intubation. RESULTS: A total of 2094 neonates were enrolled from 12 participating centers (1051 INT and 1043 EXP). Meconium-stained amniotic fluid consistency was similar in both groups. Of the 149 (7.1%) infants that subsequently demonstrated respiratory distress, 62 (3.0%) had MAS and 87 (4.2%) had findings attributed to other disorders. There were no significant differences between groups in the occurrence of MAS (INT = 3.2%; EXP = 2.7%) or in the development of other respiratory disorders (INT = 3.8%; EXP = 4.5%). Of 1098 successfully intubated infants, 42 (3.8%) had a total of 51 complications of the procedure. In all cases, the complications were mild and transient in nature. CONCLUSIONS: Compared with expectant management, intubation and suctioning of the apparently vigorous meconium-stained infant does not result in a decreased incidence of MAS or other respiratory disorders. Complications of intubation are infrequent and short-lived.