Fifteen-minute consultation: stabilisation of the high-risk newborn infant beside the mother

Batey, Natalie; Yoxall, C W; Fawke, Joe; Duley, Lelia; Dorling, Jon

doi:10.1136/archdischild-2016-312276

Cited by 12 publications

(8 citation statements)

References 13 publications

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“…When a neonate in need of resuscitation is born, immediate clamping and cutting of the umbilical cord is still recommended according to several guidelines (see an overview in Supplement 1). Pilot studies have shown that resuscitation with an intact cord is a feasible practice for term non-vigorous vaginally born neonates, and data have shown there are long-term benefits during infancy [ 9 – 11 ]. Yet, larger randomized control trials are needed to supply reliable evidence regarding the appropriate steps to be taken during intact cord resuscitation (ICR) [ 3 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

A hybrid type I, multi-center randomized controlled trial to study the implementation of a method for Sustained cord circulation And VEntilation (the SAVE-method) of late preterm and term neonates: a study protocol

Ekelöf

Sæther

Santesson

et al. 2022

BMC Pregnancy Childbirth

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Background An intact umbilical cord allows the physiological transfusion of blood from the placenta to the neonate, which reduces infant iron deficiency and is associated with improved development during early childhood. The implementation of delayed cord clamping practice varies depending on mode of delivery, as well as gestational age and neonatal compromise. Emerging evidence shows that infants requiring resuscitation would benefit if respiratory support were provided with the umbilical cord intact. Common barriers to providing intact cord resuscitation is the availability of neonatal resuscitation equipment close to the mother, organizational readiness for change as well as attitudes and beliefs about placental transfusion within the multidisciplinary team. Hence, clinical evaluations of cord clamping practice should include implementation outcomes in order to develop strategies for optimal cord management practice. Methods The Sustained cord circulation And Ventilation (SAVE) study is a hybrid type I randomized controlled study combining the evaluation of clinical outcomes with implementation and health service outcomes. In phase I of the study, a method for providing in-bed intact cord resuscitation was developed, in phase II of the study the intervention was adapted to be used in multiple settings. In phase III of the study, a full-scale multicenter study will be initiated with concurrent evaluation of clinical, implementation and health service outcomes. Clinical data on neonatal outcomes will be recorded at the labor and neonatal units. Implementation outcomes will be collected from electronic surveys sent to parents as well as staff and managers within the birth and neonatal units. Descriptive and comparative statistics and regression modelling will be used for analysis. Quantitative data will be supplemented by qualitative methods using a thematic analysis with an inductive approach. Discussion The SAVE study enables the safe development and evaluation of a method for intact cord resuscitation in a multicenter trial. The study identifies barriers and facilitators for intact cord resuscitation. The knowledge provided from the study will be of benefit for the development of cord clamping practice in different challenging clinical settings and provide evidence for development of clinical guidelines regarding optimal cord clamping. Trial registration Clinicaltrials.gov, NCT04070560. Registered 28 August 2019.

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Section: Introductionmentioning

confidence: 99%

A hybrid type I, multi-center randomized controlled trial to study the implementation of a method for Sustained cord circulation And VEntilation (the SAVE-method) of late preterm and term neonates: a study protocol

Ekelöf

Sæther

Santesson

et al. 2022

BMC Pregnancy Childbirth

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“…Other approaches to intact-cord stabilization have also been proven feasible. Batey and colleagues [42] describe how intact-cord stabilization of high-risk infants can be done either with a standard resuscitation table or the LifeStart™ trolley. The Baby-DUCC feasibility study [37] is another example of how this may be done.…”

Section: Discussionmentioning

confidence: 99%

“…However, the potential problem of overstretching or kinking the cord, represented by the one case of cord snapping when using mobile equipment, is a safety issue that needs to be addressed. Other researchers have also described this challenge, and how it can be overcome, for example by placing the trolley closest possible to the birth canal [37,42].…”

Section: Safety Issuesmentioning

confidence: 99%

Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: a quality-improvement cohort study

Sæther

Gülpen

Jensen

et al. 2020

BMC Pregnancy Childbirth

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Background: Deferring cord clamping has proven benefits for both term and preterm infants, and recent studies have demonstrated better cardio-respiratory stability if clamping is based on the infant's physiology, and whether the infant has breathed. Nevertheless, current guidelines for neonatal resuscitation still recommend early cord clamping (ECC) for compromised babies, unless equipment and competent personnel to resuscitate the baby are available at the mother's bedside. The objective of this quality improvement cohort study was to evaluate whether implementing a new delivery room protocol involving mobile resuscitation equipment (LifeStart™) reduced the prevalence of ECC in assisted vaginal deliveries. Methods: Data on cord clamping and transitional care were collected 8 months before and 8 months after implementing the new protocol. The Model for Improvement was applied to identify drivers and obstacles to practice change. Statistical Process Control analysis was used to demonstrate signals of improvement, and whether these changes were sustainable. Multivariate logistic regression was used to evaluate the impact of the new protocol on the primary outcome, adjusted for possible confounders. Results: Overall prevalence of ECC dropped from 13 to 1% (P < 0.01), with a 98% relative risk reduction for infants needing transitional support on a resuscitation table (adjusted OR 0.02, P < 0.001). Mean cord clamping time increased by 43% (p < 0.001). Although fewer infants were placed directly on mothers' chest (n = 43 [42%] vs n = 69 [75.0%], P < 0.001), there were no significant differences in needs for immediate transitional care or transfers to Neonatal Intensive Care Unit. A pattern of improvement was seen already before the intervention, especially after mandatory educational sessions and cross-professional simulation training. Conclusions: A new delivery-room protocol involving mobile resuscitation equipment successfully eliminated early cord clamping in assisted vaginal deliveries of term and near-term infants. A systematic approach, like the Model for Improvement, seemed crucial for both achieving and sustaining the desired results.

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“…Strengths of our trial were that clamping was deferred for longer than in other trials at very preterm birth and that immediate neonatal care (including stabilisation and resuscitation), if needed, was provided with the cord intact. 20 Providing neonatal care with the cord intact allowed high-risk babies needing immediate resuscitation at birth to be randomised, a group largely excluded from previous trials. 21 …”

Section: Discussionmentioning

confidence: 99%

Randomised trial of cord clamping at very preterm birth: outcomes at 2 years

Armstrong-Buisseret

Powers

Dorling

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo report outcomes at 2 years corrected age for children of women recruited to a trial comparing alternative policies for timing of cord clamping and immediate neonatal care at very preterm birth.DesignParallel group randomised (1:1) trial.SettingEight UK tertiary maternity units.ParticipantsTwo hundred and seventy-six babies born to 261 women expected to have a live birth before 32+0 weeks’ gestation.InterventionsDeferred cord clamping (≥2 min) and immediate neonatal care with cord intact or immediate (≤20 s) clamping and immediate neonatal care after clamping.Main outcome measureComposite of death or adverse neurodevelopmental outcome at 2 years corrected age.ResultsSix babies born after 35+6 weeks were excluded. At 2 years corrected age, outcome data were not available for a further 52 children, leaving 218 for analysis (115 deferred clamping, 103 immediate clamping). Overall, 24/115 (21%) children allocated deferred clamping died or had an adverse neurodevelopmental outcome compared with 35/103 (34%) allocated immediate clamping; risk ratio (RR) 0.61 (95% CI 0.39 to 0.96); risk difference (RD) −13% (95% CI −25% to −1%). Multiple imputation for missing data gave an RR 0.69 (95% CI 0.44 to 1.09) and RD −9% (95% CI −21% to 2%).ConclusionsDeferred clamping and immediate neonatal care with cord intact may reduce the risk of death or adverse neurodevelopmental outcome at 2 years of age for children born very premature. Confirmation in larger studies is needed to determine the real benefits and harms.Trial registration number ISRCTN21456601.

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Fifteen-minute consultation: stabilisation of the high-risk newborn infant beside the mother

Cited by 12 publications

References 13 publications

A hybrid type I, multi-center randomized controlled trial to study the implementation of a method for Sustained cord circulation And VEntilation (the SAVE-method) of late preterm and term neonates: a study protocol

A hybrid type I, multi-center randomized controlled trial to study the implementation of a method for Sustained cord circulation And VEntilation (the SAVE-method) of late preterm and term neonates: a study protocol

Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: a quality-improvement cohort study

Randomised trial of cord clamping at very preterm birth: outcomes at 2 years

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