Dana E Niles1, Courtney Cines2, Elena Insley2, Elizabeth E Foglia3, Okan U Elci4, Christiane Skåre5, Theresa Olasveengen5, Anne Ades2, Michael Posencheg3, Vinay M Nadkarni2, Jo Kramer-Johansen5. 1. The Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: niles@email.chop.edu. 2. The Children's Hospital of Philadelphia, Philadelphia, PA, USA. 3. The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 4. Westat-Biostatistics and Data Management Core, The Children's Hospital of Philadelphia, USA. 5. Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) and Department of Anaesthesiology, Oslo University Hospital and University of Oslo, Norway.
Abstract
INTRODUCTION: The Neonatal Resuscitation Program (NRP) guidelines recommend positive pressure ventilation (PPV) in the first 60s of life to support perinatal transition in non-breathing newborns. Our aim was to describe the incidence and characteristics of newborn PPV using real-time observation in the delivery unit. METHODS: Prospective, observational, quality improvement study conducted at a tertiary academic hospital. Deliveries during randomized weekday/evening 8-h shifts were attended by a trained observer. Intervention data were recorded for all newborns with gestational age (GA) ≥34wks that received PPV. Descriptive summaries and Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables were used to compare characteristics. RESULTS: Of 1135 live deliveries directly observed over 18mos, 64 (6%) newborns with a mean GA 39±2wks received PPV: Median time from birth to warmer was 20s (IQR 15-22s); PPV was initiated within 60s of life in 29 (45%) and between 60 and 90s of life in 17 (27%). PPV duration was <120s in 38 (60%). Seven/21 (33%) newborns that received PPV after vaginal delivery were not pre-identified and resuscitation team was alerted after delivery. We found no association between PPV start time and duration of PPV (p=0.86). CONCLUSION: We observed that most (94%) term newborns spontaneously initiate respirations. In over half observed deliveries receiving PPV, time to initiation of PPV was greater than 60s (longer than recommended). Compliance with current NRP guidelines is difficult, and it's not clear whether it is the recommendations or the training to achieve PPV recommendations that should be modified.
INTRODUCTION: The Neonatal Resuscitation Program (NRP) guidelines recommend positive pressure ventilation (PPV) in the first 60s of life to support perinatal transition in non-breathing newborns. Our aim was to describe the incidence and characteristics of newborn PPV using real-time observation in the delivery unit. METHODS: Prospective, observational, quality improvement study conducted at a tertiary academic hospital. Deliveries during randomized weekday/evening 8-h shifts were attended by a trained observer. Intervention data were recorded for all newborns with gestational age (GA) ≥34wks that received PPV. Descriptive summaries and Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables were used to compare characteristics. RESULTS: Of 1135 live deliveries directly observed over 18mos, 64 (6%) newborns with a mean GA 39±2wks received PPV: Median time from birth to warmer was 20s (IQR 15-22s); PPV was initiated within 60s of life in 29 (45%) and between 60 and 90s of life in 17 (27%). PPV duration was <120s in 38 (60%). Seven/21 (33%) newborns that received PPV after vaginal delivery were not pre-identified and resuscitation team was alerted after delivery. We found no association between PPV start time and duration of PPV (p=0.86). CONCLUSION: We observed that most (94%) term newborns spontaneously initiate respirations. In over half observed deliveries receiving PPV, time to initiation of PPV was greater than 60s (longer than recommended). Compliance with current NRP guidelines is difficult, and it's not clear whether it is the recommendations or the training to achieve PPV recommendations that should be modified.
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Authors: Tina Dempsey; Huong Lien Nguyen; Huong Thu Nguyen; Xuan Anh Bui; Phuong Thi Thu Pham; Toan K Nguyen; Francesco Cavallin; Daniele Trevisanuto; Susanna Myrnerts Höök; Nicolas Pejovic; Mats Blennow; Linus Olson; Hien Vu; Anh Duy Nguyen; Tobias Alfvén Journal: Children (Basel) Date: 2022-02-28
Authors: Dana E Niles; Christiane Skåre; Elizabeth E Foglia; Elena Insley; Courtney Cines; Theresa Olasveengen; Lance S Ballester; Anne Ades; Michael Posencheg; Vinay M Nadkarni; Jo Kramer-Johansen Journal: Resusc Plus Date: 2021-02-16