Limited agreement between clinical assessment of infant colour at birth and oxygen saturation in a hospital in Ethiopia

Cavallin, Francesco; Cori, Maria Sofia; Negash, Senait; Azzimonti, Gaetano; Manenti, Fabio; Putoto, Giovanni; Trevisanuto, Daniele

doi:10.1111/apa.15463

Cited by 3 publications

(4 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our data also suggested a large underestimation of hypoxia during transport, since most desaturated infants at admission to the referral hospital had not received supplemental oxygen before. Clinical evaluation of cyanosis can be difficult as there is limited agreement between infant color and oxygen saturation, hence a pulse oximeter should be included in the ambulance equipment [20]. These problems occurred despite the frequent presence of a nurse during the transport, which was higher compared to previous studies in low/ middle-income countries [9,21,22].…”

Section: Discussionmentioning

confidence: 98%

Prognostic role of TOPS in ambulance-transferred neonates in a low-resource setting: a retrospective observational study

Cavallin

Contin

Alfeu

et al. 2022

BMC Pregnancy Childbirth

Self Cite

View full text Add to dashboard Cite

Background Assessing the severity of transferred neonates at admission can improve resource allocation. This study evaluated the role of TOPS (illness severity score including temperature, oxygen saturation, skin perfusion and blood sugar) in predicting mortality in neonates transferred by ambulance in a low-resource setting. Methods The study was conducted at Beira Central Hospital (Mozambique). Infants who were transferred by ambulance to the Neonatal Intensive Care Unit between 16th June and 16th October 2021 were included. The association between TOPS and mortality was investigated with a logistic regression model. Receiver-operating characteristics (ROC) curve was derived for TOPS; area under the ROC curve, sensitivity and specificity were calculated. Results In-transport mortality was 2/198 (1.0%) and in-hospital mortality was 75/196 (38.3%). Median gestational age and birthweight were 38 weeks and 2600 g. Main causes of admission were asphyxia (29.3%), prematurity (25.3%) and sepsis (22.7%). Hypothermia and oxygen desaturation at admission were 75.8% and 32.3%. TOPS ≥ 1 was associated with increased mortality risk (odds ratio 7.06. 95% confidence interval 1.90 to 45.82), with 0.97 sensitivity and 0.26 specificity. Conclusions The high mortality rate calls for interventions and quality initiative studies to improve the transfer process and the conditions at admission. TOPS can be used to identify neonates at risk of mortality and concentrate efforts of health care providers. Interventions preventing hypothermia and oxygen desaturation should be implemented in pre-transport stabilization and care during transport.

show abstract

Section: Discussionmentioning

confidence: 98%

Prognostic role of TOPS in ambulance-transferred neonates in a low-resource setting: a retrospective observational study

Cavallin

Contin

Alfeu

et al. 2022

BMC Pregnancy Childbirth

Self Cite

View full text Add to dashboard Cite

show abstract

“…These findings suggest that SpO 2 measurement would be considered also in low-resource settings because the agreement between the assessment of infant colour and SpO 2 is limited. 32 The questions regarding supplemental oxygen still remain: oxygen or not, when and how much? Our results raise the question if these neonates would benefit from supplemental O 2 during PPV.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, preventing dangerous hyperoxia is also recommended3 4 7; of note, 33% of neonates receiving supplemental oxygen after PPV had SpO 2 levels above target range (>95%) at 10 min. These findings suggest that SpO 2 measurement would be considered also in low-resource settings because the agreement between the assessment of infant colour and SpO 2 is limited 32…”

Section: Discussionmentioning

confidence: 99%

Oxygen saturation after birth in resuscitated neonates in Uganda: a video-based observational study

Larsson

Höök

Mpamize

et al. 2022

bmjpo

Self Cite

View full text Add to dashboard Cite

BackgroundMonitoring of peripheral capillary oxygen saturation (SpO2) during neonatal resuscitation is standard of care in high-resource settings, but seldom performed in low-resource settings. We aimed to measure SpO2 and heart rate during the first 10 min of life in neonates receiving positive pressure ventilation (PPV) according to the Helping Babies Breathe (HBB) protocol and compare results with SpO2 and heart rate targets set by the American Heart Association (AHA).MethodsA cross-sectional study was conducted at Mulago National Referral Hospital, Kampala, Uganda, as a substudy of the NeoSupra Trial. SpO2 and heart rate were measured on apnoeic neonates (≥34 weeks) who received PPV according to HBB (room air). Those who remained distressed after PPV received supplemental oxygen (O2). All resuscitations were video recorded and data were extracted by video review at 1 min intervals until 10 min post partum. Data were analysed for all observations and separately for only observations before and during PPV.Results49 neonates were analysed. Median SpO2 at 5 min (n=39) was 67% (49–88) with 59% of the observations below AHA target of 80%. At 10 min median SpO2 (n=44) was 93% (80–97) and 32% were below AHA target of 85%. When only observations before and during PPV were analysed, median SpO2 at 5 min (n=18) was 52% (34–66) and 83% were below AHA target. At 10 min (n=15), median SpO2 was 72% (57–89) and 67% were below AHA target. Median heart rates were above AHA target of 100 beats/min at all time intervals.ConclusionsA high proportion of neonates resuscitated with PPV after birth failed to reach the AHA SpO2 target in this small sample, implying an increased risk of hypoxic-ischaemic encephalopathy. Further studies in low-resource settings are needed to evaluate baseline data and the need for supplemental O2 and optimal SpO2 during PPV.Trial registration numberThis is a substudy to the trial ‘Neonatal Resuscitation with Supraglottic Airway Trial (NeoSupra)’; ClinicalTrials.gov Registry (NCT03133572).

show abstract

“…6 Systematic reviews have shown that this programme changes newborn resuscitation practices at health facilities in low-resource settings. 7 In this issue of Acta Paediatrica, Cavallin et al 8 analyse one step in the initial management of newborn babies in a low-income setting: the clinical assessment of the neonate's colour at birth. They looked at how closely the cyanotic or pink colour that is observed in newborn infants corresponded to levels of pulse-oximeter data at 1.0, 1.5, 2.0 and 5.0 minutes after birth.…”

Section: Global Investment Is Needed So That Countries Can Reduce Neo...mentioning

confidence: 99%

Global investment is needed so that countries can reduce neonatal mortality to below 12 deaths per 1000 live births by 2030

Persson

2020

Acta Paediatrica

View full text Add to dashboard Cite

Limited agreement between clinical assessment of infant colour at birth and oxygen saturation in a hospital in Ethiopia

Cited by 3 publications

References 9 publications

Prognostic role of TOPS in ambulance-transferred neonates in a low-resource setting: a retrospective observational study

Prognostic role of TOPS in ambulance-transferred neonates in a low-resource setting: a retrospective observational study

Oxygen saturation after birth in resuscitated neonates in Uganda: a video-based observational study

Global investment is needed so that countries can reduce neonatal mortality to below 12 deaths per 1000 live births by 2030

Contact Info

Product

Resources

About