How to Provide Motherside Neonatal Resuscitation with Intact Placental Circulation?

Hutchon, David J R; Pratesi, Simone; Katheria, Anup

doi:10.3390/children8040291

Cited by 9 publications

(22 citation statements)

References 27 publications

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“…Providing neonatal resuscitation at the mother’s bedside with an intact umbilical cord is potentially a high benefit practice with major global benefits; it enables physiological benefits for the baby, keeps the midwife with the mother in the vital few minutes after birth, and allows the mother to stay with her newborn, preventing any suspicion of malpractice [ 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…In the United Kingdom, Hutchon and colleagues explored ways of achieving resuscitation with an intact cord. This resulted in the development of a small mobile bedside resuscitation trolley, later commercialised as the LifeStart trolley (Inspiration Healthcare, Crawley, UK) [ 12 , 13 , 14 , 15 ]. This was followed in the Netherlands by Concord: a purpose-built resuscitation table for physiological-based cord clamping in preterms [ 16 , 17 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…The primary objective for developing the BabySaver device was to reduce intrapartum-related deaths in low-resource delivery environments. We aimed to develop a device that: provides a stable, flat but firm surface for the baby [ 10 ] and enables the skilled birth attendant to resuscitate during the first “golden minute” after birth [ 21 ] facilitates resuscitation of depressed neonates at birth whilst keeping the umbilical cord intact [ 9 , 10 , 11 ] allows resuscitation of the babies by the mother’s side [ 9 , 10 , 11 ] prevents separation of the skilled birth attendant and mother, so that the care of the mother is not interrupted allows the mother to remain with the baby during its initial support, instead of removing it from her sight during these vital moments facilitates newborn resuscitation when only one skilled birth attendant is present. …”

Section: Introductionmentioning

confidence: 99%

“…provides a stable, flat but firm surface for the baby [ 10 ] and enables the skilled birth attendant to resuscitate during the first “golden minute” after birth [ 21 ]…”

Section: Introductionmentioning

confidence: 99%

“…facilitates resuscitation of depressed neonates at birth whilst keeping the umbilical cord intact [ 9 , 10 , 11 ]…”

Section: Introductionmentioning

confidence: 99%

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The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation

et al. 2021

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The initial bedside care of premature babies with an intact cord has been shown to reduce mortality; there is evidence that resuscitation of term babies with an intact cord may also improve outcomes. This process has been facilitated by the development of bedside resuscitation surfaces. These new devices are unaffordable, however, in most of sub-Saharan Africa, where 42% of the world’s 2.4 million annual newborn deaths occur. This paper describes the rationale and design of BabySaver, an innovative low-cost mobile resuscitation unit, which was developed iteratively over five years in a collaboration between the Sanyu Africa Research Institute (SAfRI) in Uganda and the University of Liverpool in the UK. The final BabySaver design comprises two compartments; a tray to provide a firm resuscitation surface, and a base to store resuscitation equipment. The design was formed while considering contextual factors, using the views of individual women from the community served by the local hospitals, medical staff, and skilled birth attendants in both Uganda and the UK.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…provides a stable, flat but firm surface for the baby [ 10 ] and enables the skilled birth attendant to resuscitate during the first “golden minute” after birth [ 21 ]…”

Section: Introductionmentioning

confidence: 99%

“…facilitates resuscitation of depressed neonates at birth whilst keeping the umbilical cord intact [ 9 , 10 , 11 ]…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation

et al. 2021

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Considering an Update on Umbilical Cord Milking for the New Guidelines for Neonatal Resuscitation

Dani

Sandri²,

Pratesi

2021

JAMA Pediatr

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We have to thank Aziz et al 1 who, on behalf of the American Heart Association and American Academy of Pediatrics, published the 2020 neonatal resuscitation guidelines, which detail, on the basis of current evidence, procedures, and interventions, what must be performed during the newborn's first minutes of life, in particular during the first minute, to restore cardiorespiratory function. This timeframe is full of activities, including assessment of the newborn's muscular tone, breathing, and heart rate and if necessary oxygen saturation, electrocardiogram, and need of support with positive pressure ventilation. 1 Moreover, umbilical cord management must be decided at the same time. The 2020 guidelines report these recommendations: "For preterm and term infants who do not require resuscitation at birth, it is reasonable to delay cord clamping for longer than 30 s[econds]" 1(pS167) and "For term and preterm infants who require resuscitation at birth, there is insufficient evidence to recommend early cord clamping versus delayed cord clamping," 1(pS167) specifying that early cord clamping (ECC) means clamping within 30 seconds after birth. Thus, since most infants born very preterm need resuscitation, virtually none of them may have the potential beneficial effects of delayed cord clamping (DCC), although this strategy has been found to decrease mortality in infants born at 28 weeks' gestation or less. 2 Moreover, the guidelines report that umbilical cord milking (UCM) "is being studied as an alternative to delayed cord clamping but should be avoided in babies less than 28 weeks' gestational age, because it is associated with brain injury" 1(pS168) and concluded, therefore, that "for infants born at less than 28 w[ee]k[s] of gestation, cord milking is not recommended." 1(pS167) Thus, the strong message of these guidelines 1 is that UCM must be avoided in infants born very preterm, and most neonatologists will likely be prompted to stop milking cords and will continue to clamp them immediately in infants in more severe condition who require resuscitation.But what are the actual facts supporting this recommendation? Guidelines recommend avoiding UCM refer to a single randomized clinical trial by Katheria et al. 3 This study found that severe intraventricular hemorrhage (grade 3 or more) was significantly more frequent (22% vs 6%) in infants born at 23 weeks and 0 days' gestation to 27 weeks and 6 days' gestation who had UCM, in comparison with those who had DCC. 3 However, this study did not include a control group assisted with the current standard of care, 3 namely ECC, and therefore what it actually demonstrates is that DCC is more effective than UCM in preventing severe intraventricular hemorrhage but not that UCM is less effective or more dangerous than ECC in infants born preterm and full term who need resuscitation at birth. On the other hand, it is noteworthy that the severe intraventricular hemorrhage rate of 22% in in-fantsassistedwithUCM 3 isnothigherthanexpected,since the Vermont Oxford Network reports...

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What does the evidence tell us? Revisiting optimal cord management at the time of birth

Rabe

Mercer

2022

Eur J Pediatr

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A newborn who receives a placental transfusion at birth from delayed cord clamping (DCC) obtains about 30% more blood volume than those with immediate cord clamping (ICC). Benefits for term neonates include higher hemoglobin levels, less iron deficiency in infancy, improved myelination out to 12 months, and better motor and social development at 4 years of age especially in boys. For preterm infants, benefits include less intraventricular hemorrhage, fewer gastrointestinal issues, lower transfusion requirements, and less mortality in the neonatal intensive care unit by 30%. Ventilation before clamping the umbilical cord can reduce large swings in cardiovascular function and help to stabilize the neonate. Hypovolemia, often associated with nuchal cord or shoulder dystocia, may lead to an inflammatory cascade and subsequent ischemic injury. A sudden unexpected neonatal asystole at birth may occur from severe hypovolemia. The restoration of blood volume is an important action to protect the hearts and brains of neonates. Currently, protocols for resuscitation call for ICC. However, receiving an adequate blood volume via placental transfusion may be protective for distressed neonates as it prevents hypovolemia and supports optimal perfusion to all organs. Bringing the resuscitation to the mother’s bedside is a novel concept and supports an intact umbilical cord. When one cannot wait, cord milking several times can be done quickly within the resuscitation guidelines. Cord blood gases can be collected with optimal cord management. Conclusion: Adopting a policy for resuscitation with an intact cord in a hospital setting takes a coordinated effort and requires teamwork by obstetrics, pediatrics, midwifery, and nursing. What is Known:• Placental transfusion through optimal cord management benefits morbidity and mortality of newborn infants.• The World Health Organisation has recommended placental transfusion in their guidance. What is New:• Improved understanding of transitioning to extrauterine life has been described.• Resuscitation of newborn infants whilst the umbilical cord remains intact could improve the postpartum adaptation.

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How to Provide Motherside Neonatal Resuscitation with Intact Placental Circulation?

Cited by 9 publications

References 27 publications

The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation

The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation

Considering an Update on Umbilical Cord Milking for the New Guidelines for Neonatal Resuscitation

What does the evidence tell us? Revisiting optimal cord management at the time of birth

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