Background

Objectives

Methods

Conclusion

Early warning scores are used to predict clinical deterioration, in order to optimize prevention strategies to reduce potentially occurring adverse events. They are widely used, because of national recommendations, governance and accreditation agencies requirements. Pediatric frameworks explicitly recognize the role of early warning scores in support of healthcare provider’s process of observing and recognizing the severity of deteriorating patients.

In pediatrics there are more than 33 Pediatric Track and Trigger Tools (PTTT) published which have undergone formal validation. Tool composition and characteristics are variable as well as their performance. Also PTTT impact on health outcomes, such as unplanned PICU admissions or cardiac arrests, or resource utilization is still uncertain, while there is some moderate evidence of impact on mortality when associated to a team of PICU experts available to respond.

Beyond looking at PTTT screening power and impact on clinical outcomes, attention is been lately given to how those systems are used and at the exploration of contextual, social or organizational factors that may contribute to their uptake. Human factors need to be carefully analyzed as ward cultures, hierarchies and the availability of competency based education have been found to negatively affect the implementation of complex multi-faced interventions such as Pediatric Early Warning Systems, designed to improve the recognition and response to deteriorating patients. Additional weighing of scores and response algorithms, particularly for patient populations with complex conditions and comorbidities and different clinical settings also deserves future investigation.

Background

Foot operated newborn resuscitator (FOR) has been developed with intention of improving the ease with which newborn resuscitation can be carried out in neonates requiring positive pressure ventilation (PPV).

Objectives

The primary outcome was to determine the non-inferiority of foot operated resuscitator versus routine bag and mask ventilation (BMV) in increasing heart rate above 100/min after 30 seconds of PPV.

Methods

Study conducted in a teaching hospital providing tertiary level care for neonates. Neonates around 35 weeks gestation requiring newborn resuscitation and meeting pre-existing criteria for requirement of Bag and Mask ventilation were included in the study. Sample size was 60 neonates was needed to detect a mean difference of 1.78 with 80% power. Analysis was by intention to treat.

Results

60 cases were enrolled (31 in FOR; 29 in BMV). Foetal distress, HR>100 at 30/60 sec, neonate intubation, NICU admission and survival were similar in both groups (Chi square test). Mean (SD) time to establish spontaneous breathing in FOR [61.2(36.5)] was lower as compared to to BMV [114(126)]. (p value = 0.054). Median(IQR) time to establish spontaneous breathing FOR [60(30)] vs BMV [60(75)] was not different. The median(IQR) duration of noninvasive ventilation in seconds for FOR (60(30)) and Bag and Mask group (60(105))was comparable(p = 0.465). Variation in time taken is high in BMV suggesting that the FOR device is easier to operate by health personnel.

Conclusion

Foot operated resuscitator is as good as, if not better in providing positive pressure ventilation in neonates.

Background

In healthy newborn infants, cerebral blood volume (CBV) physiologically decreases immediately after birth. In neonates receiving respiratory support (RS) the change of cerebral blood volume (ΔCBV) is significantly smaller, most probably due to less oxygen delivery to the brain.

Objectives

The aim of this study was to investigate whether preterm neonates receiving RS and having SpO₂ values below 80% 5 minutes after birth show differences in ΔCBV, compared to neonates reaching the SpO₂ target of 80% or above.

Methods

We retrospectively analysed data from five prospective observational studies, including preterm neonates receiving RS during delivery room stabilization. ΔCBV was measured with near-infrared spectroscopy during the first 15 minutes after birth using the NIRO 200-NX device (Hamamatsu, Japan). Depending on the SpO₂, neonates were divided into two groups: those with a 5-minute SpO₂ ≥80% (≥80% group) and those with a 5-minute SpO₂ <80% (<80% group).

Results

Fifty-two preterm neonates were included, 25 of whom (48.1%) were allocated to the “≥80% group” and 27 (51.9%) to the “<80% group”. There was a decrease in CBV in the “≥80% group”, whereas CBV remained unchanged in the “<80% group”. We found significant group differences for ΔCBV at minutes 3 and 4, compared to the reference values at minute 15 after birth.

Conclusion

Preterm neonates who received RS during delivery room stabilization reaching the SpO₂ target of 80% at 5 minutes after birth showed a decrease in CBV. In contrast, CBV remained unchanged in the “<80% group”, which seems to be a pathological finding.

Background

Heart rate (HR) measurement is critical in guiding early interventions in neonatal resuscitation. Conventional methods for HR assessment rely on auscultation and use of pulse oximeter (POX) for pulse rate (PR). Recent guidelines recommend the use of the electrocardiogram (ECG) in HR assessment during resuscitation, however there have been barriers to implementation including clinical feasibility and potential risk to the newborn.

Objectives

The aim of the study was to assess the feasibility of ECG with POX by comparing time to application of ECG electrodes vs POX sensors; time to first reliable HR/PR; and agreement of POX against ECG.

Methods

A cross sectional study. All pre-term and term deliveries from October 2018 to March 2019 were included. At delivery, neonates had both ECG/POX sensors applied from the time the neonate was put under the radiant warmer with continuous monitoring of HR/PR for 10 minutes or until transfer. Reporting of adverse side effects was monitored. Data was compared using a Mann-Whitney U test and agreement analysed using a Bland-Altman plot.

Results

Based on data collected so far (n=28), time to apply ECG [median= 25s(21,34)] vs POX [median = 37s(27.5, 42.25)] was significantly different (p=0.004). Time to display a reliable HR [median= 6.5s(5,15.25)] was also significantly different from POX [median= 65s(32,100.5)] (p=0.000). Bland-Altmann Plot showed reasonable agreement [mean= 7.57bpm(-33.92,49.06)].

Conclusion

ECG provided faster and more accurate display of HR during resuscitation, providing clinicians with a more reliable assessment of HR.