Neonatal resuscitation for the preterm infant: evidence versus practice

Abstract

In an effort to determine the actual conduct of neonatal resuscitation and the errors that may be occurring during this process, we developed a method of video recording neonatal resuscitations as an ongoing quality assurance project. We initiated video recordings of resuscitations using simple video recorders attached to an overhead warmer and reviewed the resultant tapes during biweekly quality improvement meetings. We also added the continuous recording of analog information such as heart rate, oximeter values, fraction of inspired oxygen and airway pressure. We subsequently developed a checklist that includes a preresuscitation briefing and a postresuscitation debriefing, all of which are reviewed at the same time as the video recording. We have examined the use of oxygen in the very preterm infant, the effectiveness of bag and mask ventilation, including the detection of airway obstruction during such ventilation, intubation in the delivery area and environment. In addition, we have trained our teams and leaders using Crew Resource Management and focused on improved communication. The availability of a dedicated room for resuscitation allows an increased ambient environment and the ability to provide a userfriendly setting similar to the neonatal intensive care unit to optimize performance. There are numerous opportunities for improving team and leader performance and outcomes following neonatal resuscitation. Further prospective studies are required to evaluate specific interventions.

Debriefing in the Emergency Department After Clinical Events: A Practical Guide

“…25,33,[40][41][42] Clinicians in ED, neonatology, and trauma care have implemented real-time video capture of resuscitation events in the clinical environment as part of local quality programs. [43][44][45][46][47][48][49][50][51] Nadler et al 25 demonstrated that including video recordings of neonatal resuscitations in debriefings improved teamwork in future neonatal resuscitations. The simulation literature is more mixed, with a meta-analysis demonstrating that video-assisted debriefing has negligible and nonsignificant effects on timerelated skills.…”

Delivery room resuscitation of preterm infants in Canada: current practice and views of neonatologists at level III centers

“…The reliance on chest rise to assess the optimal tidal volume is difficult and inaccurate. 28 About two thirds of the participants routinely try nasal continuous positive airway pressure in babies with less severe respiratory distress as a means to avoid intubation in the DR. This practice can be supported by two recent randomized controlled trials, at least in terms of the feasibility of using nasal continuous positive airway pressure as an alternative to combined intubation and surfactant for even extreme preterm infants.…”

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

“…o xygen supplementation is one of the most common therapeutic interventions in resuscitation and neonatal intensive care of term and preterm infants (1). However, both hypoxia and hyperoxia must be avoided because of their detrimental effects on morbidity and mortality in these children.…”