Ethical dilemmas of recording and reviewing neonatal resuscitation

Boer, Maria C den; Houtlosser, Mirjam; Zanten, Henriëtte A. van; Foglia, Elizabeth E.; Engberts, D. P.; Pas, Arjan B. te

doi:10.1136/archdischild-2017-314191

Cited by 25 publications

(20 citation statements)

References 39 publications

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“…Parental consent was obtained after a resuscitation was videotaped, but prior to video analysis (deferred consent). Video recording is a method increasingly used in clinical research, and its legal and ethical concerns have been debated 22 23. The safety of data storage was prioritised, and only the project team members had access to the video recordings.…”

Section: Methodsmentioning

confidence: 99%

Incidence of newborn resuscitative interventions at birth and short-term outcomes: a regional population-based study

Bjorland

Øymar

Ersdal

et al. 2019

bmjpo

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ObjectivesTo determine the incidence and characteristics of resuscitative interventions at different gestational ages and short-term outcomes after resuscitation.Design, setting and patientsA prospective observational study in an unselected population at Stavanger University Hospital, Norway, from October 2016 until September 2017.InterventionsUsing a data collection form and video recordings, we registered and analysed resuscitative interventions.Main outcome measuresIncidence of continuous positive airway pressure (CPAP), positive pressure ventilation (PPV), intubation, chest compressions and intravenous fluid or epinephrine boluses. Short-term outcomes of resuscitated newborns.ResultsAll 4693 newborns in the study period were included in the study. Two hundred and ninety-one (6.2%) newborns received interventions in the first minutes of life beyond drying and stimulation. PPV was provided in 170 (3.6%) while CPAP (without PPV) was provided in 121 (2.6%) newborns. Duration of PPV was median (IQR) 106 s (54–221). Intubations were performed in 19 (0.4%) newborns, with a mean (SD) intubation time of 47 (21) s. Ten (0.2%) newborns received chest compressions and epinephrine was administrated in three (0.1%) newborns. Sixty-three per cent of the treated newborns from 34 weeks’ gestational age were returned to parental care without further follow-up.ConclusionsThe need for resuscitative interventions after birth was frequent in this unselected population in a high-resource setting, but full cardiopulmonary resuscitation was rare. Short-term outcomes were good, suggesting that most newborns treated with resuscitative interventions were not severely affected.

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Section: Methodsmentioning

confidence: 99%

Incidence of newborn resuscitative interventions at birth and short-term outcomes: a regional population-based study

Bjorland

Øymar

Ersdal

et al. 2019

bmjpo

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“…Various neonatal intensive care units (NICUs) around the world implemented the technique of recording and reviewing neonatal resuscitation in order to improve the quality of provided support during transition at birth. Although NICU staff members agree that recording and reviewing neonatal resuscitation can improve the quality of the procedure, concerns about implementation of the technique and the impact of the technique on providers are raised as well 4. These concerns create a barrier to further implementation of the technique at other NICUs.…”

Section: Introductionmentioning

confidence: 99%

Benefits of recording and reviewing neonatal resuscitation: the providers’ perspective

Boer

Houtlosser

Foglia

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo assess benefits of recording and reviewing neonatal resuscitation as experienced by neonatal care providers.DesignA qualitative study using semistructured interviews questioning neonatal care providers about their experiences with recording and reviewing neonatal resuscitation. Data were analysed using the qualitative data analysis software Atlas.ti V.7.0.SettingNeonatal care providers working at neonatal intensive care units (NICUs) of the Leiden University Medical Center, the Netherlands, and the University of Pennsylvania School of Medicine, USA, participated in this study.ResultsIn total, 48 NICU staff members were interviewed. Reported experiences and attitudes are broadly similar for both NICUs. All interviewed providers reported positive experiences and benefits, with special emphasis on educational benefits. Recording and reviewing neonatal resuscitation is used for various learning activities, such as plenary review meetings and as tool for objective feedback. Providers reported to learn from reviewing their own performance during resuscitation, as well as from reviewing performances of others. Improved time perception, reflection on guideline compliance and acting less invasively during resuscitations were often mentioned as learning outcomes. All providers would recommend other NICUs to implement recording and reviewing neonatal resuscitation, as it is a powerful tool for learning and improving. However, they emphasised preconditions for successful implementation, such as providing information, not being punitive and focusing on the benefits for learning and improving.ConclusionRecording and reviewing neonatal resuscitation is considered highly beneficial for learning and improving resuscitation skills and is recommended by providers participating in it.

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“…However, there is evidence that the sequence and quality of interventions during NR often deviate from guidelines [ 3 , 7 – 11 ]. Video recording has been widely used for educational and clinical quality assessment purposes, with good acceptance by caregivers [ 12 , 13 ]. It is inexpensive, it does not interfere with resuscitation, and it offers data to assess performance accurately.…”

Section: Introductionmentioning

confidence: 99%

Adherence to the neonatal resuscitation algorithm for preterm infants in a tertiary hospital in Spain

Maya-Enero¹,

Botet-Mussons²,

J³

et al. 2018

BMC Pediatr

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BackgroundThere is evidence that delivery room resuscitation of very preterm infants often deviates from internationally recommended guidelines. There were no published data in Spain regarding the quality of neonatal resuscitation. Therefore, we decided to evaluate resuscitation team adherence to neonatal resuscitation guidelines after birth in very preterm infants.MethodsWe conducted an observational study. We video recorded resuscitations of preterm infants < 32 weeks’ gestational age and evaluated every step during resuscitation according to a score-sheet specifically designed for this purpose, following Carbine’s method, where higher scores indicated that more intense resuscitation maneuvers were required. We divided the score achieved by the total possible points per patient to obtain the percentage of adherence to the algorithm. We also compared resuscitations performed by staff neonatologists to those performed by pediatricians on-call. We compared percentages of adherence to the algorithm with the Chi-square test for large groups and Fisher’s exact test for smaller groups. We compared assigned Apgar scores with those given after analyzing the recordings and described them by their median and interquartile range. We measured the interrater agreement between Apgar scores with Cohen’s kappa coefficient. Linear and logarithmic regressions were drawn to characterize the pattern of algorithm adherence. Statistical analysis was performed using SPSS V.20. A p-value < 0.05 was considered significant. Our Hospital Ethics Committee approved this project, and we obtained parental written consent beforehand.ResultsSixteen percent of our resuscitations followed the algorithm. The number of mistakes per resuscitation was low. Global adherence to the algorithm was 80.9%. Ventilation and surfactant administration were performed best, whereas preparation and initial steps were done with worse adherence to the algorithm. Intubation required, on average, 2.2 attempts; success on the first attempt happened in 33.3% of cases. Only 12.5% of intubations were achieved within the allotted 30 s. Many errors were attributable to timing. Resuscitations led by pediatricians on-call were performed as correctly as those by staff neonatologists.ConclusionsResuscitation often deviates from the internationally recognized algorithm. Perfectly performed resuscitations are infrequent, although global adherence to the algorithm is high. Neonatologists and pediatricians need intubation training.

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Ethical dilemmas of recording and reviewing neonatal resuscitation

Cited by 25 publications

References 39 publications

Incidence of newborn resuscitative interventions at birth and short-term outcomes: a regional population-based study

Incidence of newborn resuscitative interventions at birth and short-term outcomes: a regional population-based study

Benefits of recording and reviewing neonatal resuscitation: the providers’ perspective

Adherence to the neonatal resuscitation algorithm for preterm infants in a tertiary hospital in Spain

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