Research

13 pages, 2497 KiB

Open AccessArticle

Randomized Trial of 21% versus 100% Oxygen during Chest Compressions Followed by Gradual versus Abrupt Oxygen Titration after Return of Spontaneous Circulation in Neonatal Lambs

by Deepika Sankaran, Evan M. Giusto, Amy L. Lesneski, Morgan E. Hardie, Houssam M. Joudi, Emily C. A. Lane, Victoria L. Hammitt, Kirstie C. Tully, Payam Vali and Satyan Lakshminrusimha

Children 2023, 10(3), 575; https://doi.org/10.3390/children10030575 - 17 Mar 2023

Viewed by 1399

Abstract

The combination of perinatal acidemia with postnatal hyperoxia is associated with a higher incidence of hypoxic-ischemic encephalopathy (HIE) in newborn infants. In neonatal cardiac arrest, current International Liaison Committee on Resuscitation (ILCOR) and Neonatal Resuscitation Program (NRP) guidelines recommend increasing inspired O₂ [...] Read more.

The combination of perinatal acidemia with postnatal hyperoxia is associated with a higher incidence of hypoxic-ischemic encephalopathy (HIE) in newborn infants. In neonatal cardiac arrest, current International Liaison Committee on Resuscitation (ILCOR) and Neonatal Resuscitation Program (NRP) guidelines recommend increasing inspired O₂ to 100% during chest compressions (CC). Following the return of spontaneous circulation (ROSC), gradual weaning from 100% O₂ based on pulse oximetry (SpO₂) can be associated with hyperoxia and risk for cerebral tissue injury owing to oxidative stress. We hypothesize that compared to gradual weaning from 100% O₂ with titration based on preductal SpO₂, abrupt or rapid weaning of inspired O₂ to 21% after ROSC or use of 21% O₂ during CC followed by upward titration of inspired O₂ to achieve target SpO₂ after ROSC will limit hyperoxia after ROSC. Nineteen lambs were randomized before delivery and asphyxial arrest was induced by umbilical cord occlusion. There was no difference in oxygenation during chest compressions between the three groups. Gradual weaning of inspired O₂ from 100% O₂ after ROSC resulted in supraphysiological PaO₂ and higher cerebral oxygen delivery compared to 21% O₂ during CC or 100% O₂ during CC followed by abrupt weaning to 21% O₂ after ROSC. The use of 21% O₂ during CC was associated with very low PaO₂ after ROSC and higher brain tissue lactic acid compared to other groups. Our findings support the current recommendations to use 100% O₂ during CC and additionally suggest the benefit of abrupt decrease in inspired oxygen to 21% O₂ after ROSC. Clinical studies are warranted to investigate optimal oxygen titration after chest compressions and ROSC during neonatal resuscitation. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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8 pages, 1952 KiB

Open AccessArticle

Time to Effective Ventilation in Neonatal Manikins with a Supraglottic Airway vs. a Facemask: A Randomized Controlled Trial

by Nithya Sivakumar, Shoshana Newman-Lindsay, Deepika Sankaran, Satyan Lakshminrusimha and Lee Donohue

Children 2023, 10(3), 498; https://doi.org/10.3390/children10030498 - 02 Mar 2023

Cited by 2 | Viewed by 1047

Abstract

(1) Background: Timely and effective positive pressure ventilation (PPV) is the most important component of neonatal resuscitation. Emerging data supports the use of supraglottic airways such as the laryngeal mask airway (LMA) as a first-line interface for PPV during neonatal resuscitation. LMA use [...] Read more.

(1) Background: Timely and effective positive pressure ventilation (PPV) is the most important component of neonatal resuscitation. Emerging data supports the use of supraglottic airways such as the laryngeal mask airway (LMA) as a first-line interface for PPV during neonatal resuscitation. LMA use reduces the need for intubation compared to facemask use in systematic reviews, but there is no difference in the incidence of death or moderate-to-severe hypoxic ischemic encephalopathy (HIE). Time to effective ventilation during simulation with manikin models by providers with limited neonatal airway experience may add to the current evidence that compares the LMA to the neonatal facemask as the first-line ventilation interface during neonatal resuscitation.; (2) Methods: Thirty-two pre-clinical medical students were recruited and randomized to learning and performing ventilation with either the LMA or neonatal facemask on a neonatal manikin. Tidal volume was measured by breath-by-breath analysis to assess adequacy and consistency of PPV in 10 consecutive breaths. Perceived confidence was measured by pre- and post-intervention surveys that utilized a Likert scale from 1 to 5.; (3) Results: Median time to achieve effective ventilation was shorter with a neonatal facemask compared to the LMA (43 (30, 112) seconds vs. 82 (61, 264) seconds, p < 0.01). Participants reported higher perceived confidence post-intervention with use of a facemask when compared to use of the LMA (5 (4, 5) vs. 4 (4, 4), p = 0.03).; (4) Conclusions: Pre-clinical medical students demonstrated a shorter time to effective ventilation and reported higher confidence scores after learning and demonstrating PPV using the facemask when compared to LMA in a neonatal manikin. Further studies are warranted to evaluate the use of supraglottic airways in providers with limited experience with airway management of neonates, as well as in ways to better promote proficiency and confidence in the use of the LMA. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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10 pages, 242 KiB

Open AccessArticle

Retrospectively Assessed Muscle Tone and Skin Colour following Airway Suctioning in Video-Recorded Infants Receiving Delivery Room Positive Pressure Ventilation

by Gazmend Berisha, Anne Marthe Boldingh, Britt Nakstad, Elin Wahl Blakstad, Arild Erland Rønnestad and Anne Lee Solevåg

Children 2023, 10(1), 166; https://doi.org/10.3390/children10010166 - 14 Jan 2023

Cited by 1 | Viewed by 1537

Abstract

Background: Recently, the International Liaison Committee on Resuscitation published a systematic review that concluded that routine suctioning of clear amniotic fluid in the delivery room might be associated with lower oxygen saturation (SpO₂) and 10 min Apgar score. The aim of [...] Read more.

Background: Recently, the International Liaison Committee on Resuscitation published a systematic review that concluded that routine suctioning of clear amniotic fluid in the delivery room might be associated with lower oxygen saturation (SpO₂) and 10 min Apgar score. The aim of this study was to examine the effect of delivery room airway suctioning on the clinical appearance, including muscle tone and skin colour, of video-recorded term and preterm infants born through mainly clear amniotic fluid. Methods: This was a single-centre observational study using transcribed video recordings of neonatal stabilizations. All infants who received delivery room positive pressure ventilation (PPV) from August 2014 to November 2016 were included. The primary outcome was the effect of airway suctioning on muscle tone and skin colour (rated 0–2 according to the Apgar score), while the secondary outcome was the fraction of infants for whom airway suction preceded the initiation of PPV as a surrogate for “routine” airway suctioning. Results: Airway suctioning was performed in 159 out of 302 video recordings and stimulated a vigorous cry in 47 (29.6%) infants, resulting in improvements in muscle tone (p = 0.09) and skin colour (p < 0.001). In 43 (27.0%) infants, airway suctioning preceded the initiation of PPV. Conclusions: In this single-centre observational study, airway suctioning stimulated a vigorous cry with resulting improvements in muscle tone and skin colour. Airway suctioning was often performed prior to the initiation of PPV, indicating a practice of routine suctioning and guideline non-compliance. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

11 pages, 1138 KiB

Open AccessArticle

Chest Compression Rates of 90/min versus 180/min during Neonatal Cardiopulmonary Resuscitation: A Randomized Controlled Animal Trial

by Marlies Bruckner, Mattias Neset, Catalina Garcia-Hidalgo, Tze-Fun Lee, Megan O’Reilly, Po-Yin Cheung and Georg M. Schmölzer

Children 2022, 9(12), 1838; https://doi.org/10.3390/children9121838 - 28 Nov 2022

Cited by 6 | Viewed by 1605

Abstract

Background: To compare chest compression (CC) rates of 90/min with 180/min and their effect on the time to return of spontaneous circulation (ROSC), survival, hemodynamic, and respiratory parameters. We hypothesized that asphyxiated newborn piglets that received CC at 180/min vs. 90/min during cardiopulmonary [...] Read more.

Background: To compare chest compression (CC) rates of 90/min with 180/min and their effect on the time to return of spontaneous circulation (ROSC), survival, hemodynamic, and respiratory parameters. We hypothesized that asphyxiated newborn piglets that received CC at 180/min vs. 90/min during cardiopulmonary resuscitation would have a shorter time to ROSC. Methods: Newborn piglets (n = 7/group) were anesthetized, intubated, instrumented and exposed to 45 min normocapnic hypoxia followed by asphyxia and cardiac arrest. Piglets were randomly allocated to a CC rate of 180/min or 90/min. CC was performed using an automated chest compression machine using CC superimposed with sustained inflation. Hemodynamic and respiratory parameters and applied compression force were continuously measured. Results: The mean (SD) time to ROSC was 91 (34) and 256 (97) s for CC rates of 180/min and 90/min, respectively (p = 0.08). The number of piglets that achieved ROSC was 7 (100%) and 5 (71%) with 180/min and 90/min CC rates, respectively (p = 0.46). Hemodynamic parameters (i.e., diastolic and mean blood pressure, carotid blood flow, stroke volume, end-diastolic volume, left ventricular contractile function) and respiratory parameters (i.e., minute ventilation, peak inflation and peak expiration flow) were all improved with a CC rate of 180/min. Conclusion: Time to ROSC and hemodynamic and respiratory parameters were not statistical significant different between CC rates of 90/min and 180/min. Higher CC rates during neonatal resuscitation warrant further investigation. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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7 pages, 395 KiB

Open AccessArticle

pFOE or pFTOE as an Early Marker for Impaired Peripheral Microcirculation in Neonates

by Nina Hoeller, Christina H. Wolfsberger, Daniel Pfurtscheller, Corinna Binder-Heschl, Bernhard Schwaberger, Berndt Urlesberger and Gerhard Pichler

Children 2022, 9(6), 898; https://doi.org/10.3390/children9060898 - 16 Jun 2022

Cited by 1 | Viewed by 2220

Abstract

Background: Peripheral-muscle-fractional-oxygen-extraction (pFOE) and peripheral-muscle-fractional-tissue-oxygen-extraction (pFTOE) are often equated, since both parameters are measured with near-infrared-spectroscopy (NIRS) and estimate oxygen extraction in the tissue. The aim was to investigate the comparability of both parameters and their potential regarding detection of impaired microcirculation. Methods: [...] Read more.

Background: Peripheral-muscle-fractional-oxygen-extraction (pFOE) and peripheral-muscle-fractional-tissue-oxygen-extraction (pFTOE) are often equated, since both parameters are measured with near-infrared-spectroscopy (NIRS) and estimate oxygen extraction in the tissue. The aim was to investigate the comparability of both parameters and their potential regarding detection of impaired microcirculation. Methods: Term and preterm neonates with NIRS measurements of upper (UE) and lower extremities (LE) were included. pFOE was calculated out of peripheral-muscle-mixed-venous-saturation (pSvO₂), measured with NIRS and venous occlusion, and arterial oxygen saturation (SpO₂). pFTOE was calculated out of peripheral-muscle-tissue-oxygen-saturation and SpO₂. Both parameters were compared using Wilcoxon-Signed-Rank-test and Bland–Altman plots. Results: 341 NIRS measurements were included. pFOE was significantly higher than pFTOE in both locations. Bland–Altman plots revealed limited comparability, especially with increasing oxygen extraction with higher values of pFOE compared to pFTOE. Conclusion: The higher pFOE compared to pFTOE suggests a higher potential of pFOE to detect impaired microcirculation, especially when oxygen extraction is elevated. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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10 pages, 865 KiB

Open AccessArticle

Incidence, Predictors and Outcomes of Noninvasive Ventilation Failure in Very Preterm Infants

by Sara M. Fernandez-Gonzalez, Andrea Sucasas Alonso, Alicia Ogando Martinez and Alejandro Avila-Alvarez

Children 2022, 9(3), 426; https://doi.org/10.3390/children9030426 - 17 Mar 2022

Cited by 3 | Viewed by 2138

Abstract

Non-invasive ventilation (NIV) is now considered the first-line treatment for respiratory distress syndrome in preterm infants. We aimed to evaluate the rates of non-invasive ventilation failure rate in very preterm infants, as well as to identify its predictors and associated outcomes. We designed [...] Read more.

Non-invasive ventilation (NIV) is now considered the first-line treatment for respiratory distress syndrome in preterm infants. We aimed to evaluate the rates of non-invasive ventilation failure rate in very preterm infants, as well as to identify its predictors and associated outcomes. We designed a single-center retrospective cohort study including infants ≤32 weeks gestational age and ≤1500 g. The NIV failure was defined as the need for intubation at <72 h of life. After applying inclusion and exclusion criteria, 154 patients were included in the study, with a mean GA of 29.7 ± two weeks. The NIV failure rate was 16.2% (n = 25) and it was associated with lower bronchopulmonary dysplasia (BPD)-free survival (OR 0.08; 95% CI 0.02–0.32) and higher incidence of intraventricular hemorrhage > II (OR 6.22; 95% CI 1.36–28.3). These infants were significantly smaller in GA and weight. Higher FiO₂ during resuscitation (OR 1.14; 95% CI 1.06–1.22) and after surfactant administration (OR 1.17; 95% CI 1.05–1.31) represented independent risk factors for NIV failure. In conclusion, NIV failure is frequent and it could be predicted by a higher oxygen requirement during resuscitation and a modest response to surfactant therapy. Importantly, this NIV failure is associated with worse clinical outcomes. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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13 pages, 564 KiB

Open AccessArticle

Incidence of Intrapartum-Related Events at the Largest Obstetric Hospital in Hanoi, Vietnam: A Retrospective Study

by 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 and Tobias Alfvén

Children 2022, 9(3), 321; https://doi.org/10.3390/children9030321 - 28 Feb 2022

Cited by 2 | Viewed by 2363

Abstract

Every year, 2.4 million neonates die during their first month of life and even more suffer permanent injury. The main causes are intrapartum-related events, prematurity, and infection, with sub-Saharan Africa and southern Asia being the worst affected regions. With a focus on intrapartum-related [...] Read more.

Every year, 2.4 million neonates die during their first month of life and even more suffer permanent injury. The main causes are intrapartum-related events, prematurity, and infection, with sub-Saharan Africa and southern Asia being the worst affected regions. With a focus on intrapartum-related events, we aimed to assess the neonatal demographic characteristics, clinical management, and outcomes among neonates born at the largest obstetric hospital in Hanoi, Vietnam. This was a retrospective cross-sectional study that included all the inborn neonates in November 2019, which was selected as a representative month. A total of 4554 neonates were born during the study period. Of these, 1.0% (n = 44) were stillbirths, 0.15% (n = 7) died in hospital, 0.61% (n = 28) received positive pressure ventilation at birth, and 0.15% (n = 7) were diagnosed with hypoxic ischemic encephalopathy. A total of 581 (13%) neonates were admitted to the neonatal unit, among which the most common diagnoses were prematurity (37%, n = 217) and infection (15%, n = 89). Except for the intrapartum-related events, our findings are consistent with the previously documented data on neonatal morbidity. The intrapartum-related events, however, were surprisingly low in number even in comparison to high-income countries. Research on the current clinical practice at Phu San Hanoi Hospital may bring further clarity to identify the success factors. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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Review

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15 pages, 4072 KiB

Open AccessReview

Congenital Syphilis—An Illustrative Review

by Deepika Sankaran, Elizabeth Partridge and Satyan Lakshminrusimha

Children 2023, 10(8), 1310; https://doi.org/10.3390/children10081310 - 29 Jul 2023

Cited by 4 | Viewed by 5532

Abstract

Congenital syphilis is caused by the spirochete, Treponema pallidum, which can be transmitted from an infected mother to her fetus during pregnancy or by contact with a maternal lesion at the time of delivery. The incidence of congenital syphilis is rapidly increasing [...] Read more.

Congenital syphilis is caused by the spirochete, Treponema pallidum, which can be transmitted from an infected mother to her fetus during pregnancy or by contact with a maternal lesion at the time of delivery. The incidence of congenital syphilis is rapidly increasing all over world with 700,000 to 1.5 million cases reported annually between 2016 and 2023. Despite the widespread availability of Penicillin, 2677 cases were reported in 2021 in the US. Clinical manifestations at birth can vary widely ranging from asymptomatic infection to stillbirth or neonatal death. Low birth weight, rash, hepatosplenomegaly, osteolytic bone lesions, pseudoparalysis, central nervous system infection, and long-term disabilities have been reported in newborns with congenital syphilis. Prevention of congenital syphilis is multifaceted and involves routine antenatal screening, timely treatment of perinatal syphilis with penicillin, partner tracing and treatment, and health education programs emphasizing safe sex practices and strategies to curb illicit drug use. Neonatal management includes risk stratification based on maternal syphilis history, evaluation (nontreponemal testing, complete blood counts, cerebrospinal fluid, and long-bone analysis), treatment with penicillin, and followup treponemal testing. Public health measures that enhance early detection during pregnancy and treatment with penicillin, especially in high-risk mothers, are urgently needed to prevent future cases of congenital syphilis. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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15 pages, 1740 KiB

Open AccessReview

Cardiac Arrhythmias Requiring Electric Countershock during the Neonatal Period—A Systematic Review

by Nathalie Oeffl, Marlies Krainer, Stefan Kurath-Koller, Martin Koestenberger, Bernhard Schwaberger, Berndt Urlesberger and Lukas P. Mileder

Children 2023, 10(5), 838; https://doi.org/10.3390/children10050838 - 05 May 2023

Cited by 1 | Viewed by 1692

Abstract

Background: In neonates, cardiac arrhythmias are rare. Electric countershock therapy is an effective alternative to drug therapy for neonatal arrhythmias. There are no randomized controlled studies investigating electric countershock therapy in neonates. Objective: To identify all studies and publications describing electric countershock therapy [...] Read more.

Background: In neonates, cardiac arrhythmias are rare. Electric countershock therapy is an effective alternative to drug therapy for neonatal arrhythmias. There are no randomized controlled studies investigating electric countershock therapy in neonates. Objective: To identify all studies and publications describing electric countershock therapy (including defibrillation, cardioversion, and pacing) in newborn infants within 28 days after birth, and to provide a comprehensive review of this treatment modality and associated outcomes. Methods: For this systematic review we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). All articles reporting electric countershock therapy in newborn infants within 28 days after birth were included. Results: In terms of figures, 113 neonates who received electric countershock due to arrhythmias were reported. Atrial flutter (76.1%) was the most common arrhythmia, followed by supraventricular tachycardia (13.3%). Others were ventricular tachycardia (9.7%) and torsade de pointes (0.9%). The main type of electric countershock therapy was synchronized cardioversion (79.6%). Transesophageal pacing was used in twenty neonates (17.7%), and defibrillation was used in five neonates (4.4%). Conclusion: Electric countershock therapy is an effective treatment option in the neonatal period. In atrial flutter especially, excellent outcomes are reported with direct synchronized electric cardioversion. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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21 pages, 1394 KiB

Open AccessReview

The Respiratory Management of the Extreme Preterm in the Delivery Room

by Raquel Escrig-Fernández, Gonzalo Zeballos-Sarrato, María Gormaz-Moreno, Alejandro Avila-Alvarez, Juan Diego Toledo-Parreño and Máximo Vento

Children 2023, 10(2), 351; https://doi.org/10.3390/children10020351 - 10 Feb 2023

Cited by 1 | Viewed by 3137

Abstract

The fetal-to-neonatal transition poses an extraordinary challenge for extremely low birth weight (ELBW) infants, and postnatal stabilization in the delivery room (DR) remains challenging. The initiation of air respiration and the establishment of a functional residual capacity are essential and often require ventilatory [...] Read more.

The fetal-to-neonatal transition poses an extraordinary challenge for extremely low birth weight (ELBW) infants, and postnatal stabilization in the delivery room (DR) remains challenging. The initiation of air respiration and the establishment of a functional residual capacity are essential and often require ventilatory support and oxygen supplementation. In recent years, there has been a tendency towards the soft-landing strategy and, subsequently, non-invasive positive pressure ventilation has been generally recommended by international guidelines as the first option for stabilizing ELBW in the delivery room. On the other hand, supplementation with oxygen is another cornerstone of the postnatal stabilization of ELBW infants. To date, the conundrum concerning the optimal initial inspired fraction of oxygen, target saturations in the first golden minutes, and oxygen titration to achieve desired stability saturation and heart rate values has not yet been solved. Moreover, the retardation of cord clamping together with the initiation of ventilation with the patent cord (physiologic-based cord clamping) have added additional complexity to this puzzle. In the present review, we critically address these relevant topics related to fetal-to-neonatal transitional respiratory physiology, ventilatory stabilization, and oxygenation of ELBW infants in the delivery room based on current evidence and the most recent guidelines for newborn stabilization. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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13 pages, 2074 KiB

Open AccessReview

Role of Volume Replacement during Neonatal Resuscitation in the Delivery Room

by Deepika Sankaran, Emily C. A. Lane, Rebecca Valdez, Amy L. Lesneski and Satyan Lakshminrusimha

Children 2022, 9(10), 1484; https://doi.org/10.3390/children9101484 - 28 Sep 2022

Cited by 1 | Viewed by 5978

Abstract

Volume expanders are indicated in the delivery room when an asphyxiated neonate is not responding to the steps of neonatal resuscitation and has signs of shock or a history of acute blood loss. Fetal blood loss (e.g., feto-maternal hemorrhage) may contribute to perinatal [...] Read more.

Volume expanders are indicated in the delivery room when an asphyxiated neonate is not responding to the steps of neonatal resuscitation and has signs of shock or a history of acute blood loss. Fetal blood loss (e.g., feto-maternal hemorrhage) may contribute to perinatal asphyxia. Cord compression or a tight nuchal cord can selectively occlude a thin-walled umbilical vein, resulting in feto-placental transfusion and neonatal hypovolemia. For severe bradycardia or cardiac arrest secondary to fetal blood loss, Neonatal Resuscitation Program (NRP) recommends intravenous volume expanders (crystalloids such as normal saline or packed red blood cells) infused over 5 to 10 min. Failure to recognize hypovolemia and subsequent delay in volume replacement may result in unsuccessful resuscitation due to lack of adequate cardiac preload. However, excess volume load in the presence of myocardial dysfunction from hypoxic–ischemic injury may precipitate pulmonary edema and intraventricular hemorrhage (especially in preterm infants). Emergent circumstances and ethical concerns preclude the performance of prospective clinical studies evaluating volume replacement during neonatal resuscitation. Translational studies, observational data from registries and clinical trials are needed to investigate and understand the role of volume replacement in the delivery room in term and preterm neonates. This article is a narrative review of the causes and consequences of acute fetal blood loss and available evidence on volume replacement during neonatal resuscitation of asphyxiated neonates. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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Other

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8 pages, 785 KiB

Open AccessBrief Report

Telesimulation for the Training of Medical Students in Neonatal Resuscitation

by Lukas P. Mileder, Michael Bereiter, Bernhard Schwaberger and Thomas Wegscheider

Children 2023, 10(9), 1502; https://doi.org/10.3390/children10091502 - 04 Sep 2023

Viewed by 733

Abstract

Background: Telesimulation may be an alternative to face-to-face simulation-based training. Therefore, we investigated the effect of a single telesimulation training in inexperienced providers. Methods: First-year medical students were recruited for this prospective observational study. Participants received a low-fidelity mannequin and medical equipment for [...] Read more.

Background: Telesimulation may be an alternative to face-to-face simulation-based training. Therefore, we investigated the effect of a single telesimulation training in inexperienced providers. Methods: First-year medical students were recruited for this prospective observational study. Participants received a low-fidelity mannequin and medical equipment for training purposes. The one-hour telesimulation session was delivered by an experienced trainer and broadcast via a video conference tool, covering all elements of the neonatal resuscitation algorithm. After the telesimulation training, each student underwent a standardized simulated scenario at our Clinical Skills Center. Performance was video-recorded and evaluated by a single neonatologist, using a composite score (maximum: 10 points). Pre- and post-training knowledge was assessed using a 20-question questionnaire. Results: Seven telesimulation sessions were held, with a total of 25 students participating. The median performance score was 6 (5–8). The median time until the first effective ventilation breath was 30.0 s (24.5–41.0) and the median number of effective ventilation breaths out of the first five ventilation attempts was 5 (4–5). Neonatal resuscitation knowledge scores increased significantly. Conclusions: Following a one-hour telesimulation session, students were able to perform most of the initial steps of the neonatal resuscitation algorithm effectively while demonstrating notable mask ventilation skills. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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8 pages, 1080 KiB

Open AccessSystematic Review

The Efficacy of CPAP in Neonates with Meconium Aspiration Syndrome: A Systematic Review and Meta-Analysis

by Carlos J. Toro-Huamanchumo, Maryori M. Hilario-Gomez, Nelson Diaz-Reyes, José A. Caballero-Alvarado and Joshuan J. Barboza

Children 2022, 9(5), 589; https://doi.org/10.3390/children9050589 - 21 Apr 2022

Cited by 5 | Viewed by 3253

Abstract

Background: In neonates with meconium aspiration syndrome (MAS), continuous positive airway pressure (CPAP) may be more beneficial compared to endotracheal intubation (ETI). We evaluated the efficacy of CPAP in neonates with MAS. Methods: Four engines were used to search randomized clinical trials (RCTs). [...] Read more.

Background: In neonates with meconium aspiration syndrome (MAS), continuous positive airway pressure (CPAP) may be more beneficial compared to endotracheal intubation (ETI). We evaluated the efficacy of CPAP in neonates with MAS. Methods: Four engines were used to search randomized clinical trials (RCTs). We used relative risk (RR) and mean difference (MD) with 95% confidence intervals (95%CI) to assess the effect on dichotomous and continuous outcomes, respectively. In addition, we used the Paule–Mandel (PM) random effects model due to the anticipated lack of events. Results: Three RCTs were included (n = 432). No significant difference was found in mortality (RR = 0.82; 95%CI = 0.54–1.25; I² = 71%; p = 0.36), need for ventilation (RR = 0.49; 95%CI = 0.15–1.56; I² = 71%; p = 0.57), and incidence of pneumothorax (RR = 1.24; 95%CI = 0.30–5.12; I² = 0%; p = 0.77) in the CPAP group compared to the ETI group. Regarding secondary outcomes, compared to the ETI group, no significant differences were found in APGAR at one minute (MD = −1.01; 95%CI −2.97 to 0.94; I² = 98%; p = 0.31), APGAR at 5 min (MD = −1.00; 95%CI = −2.96 to 0.95; I² = 99%; p = 0.32), days of hospitalization (MD = −0.52; 95%CI = −1.46 to 0.42; I² = 94%; p = 0.28), and cord pH (MD = 0.003; 95%CI = −0.01 to 0.02; I² = 0%; p = 0.79). Conclusions: In patients with MAS, there is no significant effect of CPAP use compared to ETI on primary, specifically on mortality, need for ventilation, the incidence of pneumothorax, and secondary outcomes. Full article

(This article belongs to the Special Issue Stabilization and Resuscitation of Newborns: 2nd Edition)

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