Abstract
Objective:
To explore physicians’ experiences and views related to resuscitation practice of preterm infants at birth, and determine whether the Canadian modifications of 2006 Neonatal Resuscitation Program (NRP) guidelines have been accepted by neonatologists.
Study Design:
Neonatologists (n=146) at 25 tertiary neonatal intensive care units (NICUs) across Canada were contacted via email to participate in a web-based survey about their practice regarding resuscitation of preterm infants in the delivery room (DR).
Result:
In all, 78 respondents (53%) from 23 centres completed the survey. Participants reported significant variability in temperature control measures. Hypothermia, <36.5 °C on NICU admission, was reported by 49% of respondents. Room air is used by 59% of respondents to initiate resuscitation. The majority (91%) of participants use pulse oximetry to titrate oxygen administration. Although more than two thirds (69%) of respondents target an oxygen saturation range of 85 to 92%, 51% of respondents would allow 5 to 10 min for the oxygen saturation to reach the target level. Carbon dioxide detectors are commonly used to confirm endotracheal tube placement (90%). Although respondents (96%) agree on the use of positive end- expiratory pressure (PEEP), when providing positive pressure ventilation (PPV), only 60% would initiate PPV with a pre-set peak inspiratory pressure, mostly 20 cm H2O.
Conclusion:
DR resuscitation practices are highly variable in Canadian NICU's and the currently recommended NRP guidelines are not uniformly followed. Factors leading to variability and discordance in practice should be investigated to facilitate better compliance.
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References
Kattwinkel J (ed). Textbook of Neonatal Resuscitation. 5th edn. American Academy of Pediatrics and American Heart Association: Elk Grove Village, IL, 2006.
Vento M, Aguar M, Leone T, Finer N, Gimeno M, Rich W et al. Using intensive care technology in the delivery room: a new concept for the resuscitation of extremely preterm neonates. Pediatrics 2008; 122: 1113–1116.
Laptook AR, Salhab W, Bhaskar B . Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics 2007; 119 (3): e643–e649.
Laptook A, Watkinson M . Temperature management in the delivery room. Seminars in Fetal & Neonatal Medicine 2008; 13: 383–391.
The STOP-ROP Multicenter Study Group. Supplemental therapeutic oxygen for prethreshold retinopathy of prematurity (STOP-ROP), a randomized, controlled trial I: primary outcomes. Pediatrics 2000; 105: 295–310.
Wagenaar GT, ter Horst SA, van Gastelen MA, Leijser LM, Mauad T, van der Velden PA et al. Gene expression profile and histopathology of experimental bronchopulmonary dysplasia induced by prolonged oxidative stress. Free Radic Biol Med 2004; 36: 782–801.
Scientific subcommittee of the Canadian NRP Steering Committee. Recommendations for specific treatment modifications in the Canadian context. Addendum to the 2006 NRP Provider Textbook, March 2007.
Mitchell A, Niday P, Boulton J, Chance G, Dulberq C . A prospective clinical audit of neonatal resuscitation practices in Canada. Adv Neonatal Care 2002; 2 (6): 316–326.
Leone TA, Rich W, Finer NN . A survey of delivery room resuscitation practices in the United States. Pediatrics 2006; 117 (2): e164–e175.
Trevisanuto D, Doglioni N, Ferrarese P, Bortolus R, Zanardo V . Neonatal Resuscitation Study Group, Italian Society of Neonatology. Neonatal resuscitation of extremely low birth weight infants: a survey of practice in Italy. Arch Dis Child Fetal Neonatal Ed 2006; 91 (2): F123–F124.
Braima O, Ryan CA . Neonatal resuscitation program guidelines 2006: ready, steady, can’t go!. Ir Med J 2008; 101 (5): 142–144.
O’Donnell CP, Davis PG, Morley CJ . Neonatal resuscitation: review of ventilation equipment and survey of practice in Australia and New Zealand. J Paediatr Child Health 2004; 40 (4): 208–212.
McCall EM, Alderdice FA, Halliday HL, Jenkins JG, Vohra S . Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev 2010; 3: CD004210.
Carroll PD, Nankervis CA, Giannone PJ, Cordero L . Use of polyethylene bags in extremely low birth weight infant resuscitation for the prevention of hypothermia. J Reprod Med 2010; 55 (1-2): 9–13.
Lenclen R, Mazraani M, Jugie M . Use of a polyethylene bag: a way to improve the thermal environment of the premature newborn at the delivery room. Arch Pediatr 2002; 9: 238–244.
Saugstad OD, Ramji S, Vento M . Resuscitation of depressed newborn infants with ambient air or pure oxygen: a meta-analysis. Biol Neonate. 2005; 87 (1): 27–34.
Tan A, Schulze A, O’Donnell CPF, Davis PG . Air versus oxygen for resuscitation of infants at birth. Cochrane Database Syst Rev 2005; (2): CD002273.
Finer N, Saugstad O, Vento M, Barrington K, Davis P, Duara S et al. Use of oxygen for resuscitation of the extremely low birth weight infant. Pediatrics 2010; 125 (2): 389–391.
Escrig R, Arruza L, Izquierdo I, Villar G, Sáenz P, Gimeno A et al. Achievement of targeted saturation values in extremely low gestational age neonates resuscitated with low or high oxygen concentrations: a prospective, randomized trial. Pediatrics 2008; 121 (5): 875–881.
Vento M, Moro M, Escrig R, Arruza L, Villar G, Lzquierdo I et al. Preterm resuscitation with low oxygen causes less oxidative stress, inflammation, and chronic lung disease. Pediatrics 2009; 124 (3): e439–e449.
Harling AE, Beresford MW, Vince GS, Bates M, Yoxall CW . Does use of 50% oxygen at birth in preterm infants reduce lung injury? Arch Dis Child Fetal Neonatal Ed 2005; 90 (5): F401–F405.
Ezaki S, Suzuki K, Kurishima C, Miura M, Weilin W, Hoshi R et al. Resuscitation of preterm infants with reduced oxygen results in less oxidative stress than resuscitation with 100% oxygen. J Clin Biochem Nutr 2009; 44 (1): 111–118.
Dawson JA, Kamlin CO, Wong C, te Pas AB, O’Donnell CP, Donath SM et al. Oxygen saturation and heart rate during delivery room resuscitation of infants <30 weeks’ gestation with air or 100% oxygen. Arch Dis Child Fetal Neonatal Ed 2009; 94: F87–F91.
Carlo WA, Finer N, Walsh M, Rich W, Gantz M, Laptook A et al., for SUPPORT Study Group of the Eunice Kennedy Shriver NlCHD Neonatal Research Network. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med 2010; 362 (21): 1959–1969.
Mariani G, Dik PB, Ezquer A, Aguirre A, Esteban ML, Perez C et al. Pre-ductal and post-ductal O2 saturation in healthy term neonates after birth. J Pediatr 2007; 150: 418–421.
Repetto JE, Donohue P-CP, Baker SF, Kelly L, Nogee LM . Use of capnography in the delivery room for assessment of endotracheal tube placement. J Perinatol 2001; 21: 284–287.
Garey DM, Ward R, Rich W, Heldt G, Leone T, Finer NN . Tidal volume threshold for colorimetric carbon dioxide detectors available for use in neonates. Pediatrics 2008; 121: e1524–e1527.
Finer N, Rich W . Neonatal resuscitation for the preterm infant: evidence versus practice. J Perinatol 2010; 30 (Suppl): S57–S66.
Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB . Nasal CPAP or intubation at birth of very preterm infants. N Engl J Med 2008; 358: 700–708.
Finer N, Carlo W, Walsh M, Rich W, Gantz M, Laptook A et al., for SUPPORT Study Group of the Eunice Kennedy Shriver NlCHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010; 362 (21): 1970–1979.
Acknowledgements
We would like to thank Dr Douglas McMillan for reviewing the survey and for his general support.
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El-Naggar, W., McNamara, P. Delivery room resuscitation of preterm infants in Canada: current practice and views of neonatologists at level III centers. J Perinatol 32, 491–497 (2012). https://doi.org/10.1038/jp.2011.128
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DOI: https://doi.org/10.1038/jp.2011.128
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