Category: Resuscitation

Multiple intubation attempts and IVH

A single-center retrospective study of over 300 infants less than 1500 grams birth weight found that infants with severe IVH had a higher number of intubation attempts in the first four days of life than infants with mild or no…

Delayed cord clamping improves motor function

A randomized trial of women delivering singleton fetuses before 32 weeks gestation compared the effects of delayed cord clamping (30-45 seconds) versus immediate (less than ten seconds) cord clamping. There were no differences in rates of intraventricular hemorrhage or late-onset…

Signs of CPAP failure after birth

An observational study from one center used the results of pulmonary function testing in 32 preterm infants stabilized on CPAP immediately after birth to compare patterns in infants who failed CPAP versus those who succeeded. Respiratory interventions were recorded starting…

The Apgar Score

A recent statement by the AAP and ACOG emphasizes the following about the Apgar score: It does not predict mortality or neurologic outcome in an individual infant. It alone should not be used to diagnose asphyxia – it is not…

Is resuscitation of preterm infants with room air risky?

In a retrospective cohort study of infants less than 27 weeks gestation from 17 Canadian NICUs, when compared to infants resuscitated with 100% oxygen, infants resuscitated with less than 100% (typically 21-40%) oxygen had a higher rate of severe neurologic injury or death (adjusted…

Measuring heart rate during resuscitation

A simulation study compared the accuracy and time to detection of various heart rates detected either by umbilical palpation, listening to tapping of heart rate, or auscultation. While these methods were fairly accurate and timely in detection of heart rates…

The effect of rudeness on team performance

A randomized trial in a simulated setting assessed the effects of rudeness on performance of a NICU team that had to respond to a case scenario of a preterm infant with acute deterioration due to necrotizing enterocolitis. A putative external…

CPAP for Preterm Infants

A review article summarizes the available evidence on nasal CPAP and discusses implications for developing countries. Key points of this review are: In preterm infants less than 28 weeks gestation whose mothers have received antenatal steroids, CPAP is the preferred…

Delay in increase of delivered oxygen during resuscitation

During neonatal resuscitation, when positive pressure ventilation is delivered through a T-piece resuscitator and the fraction of inspired oxygen is increased at the oxygen blender, it may take some time before the infant actually receives the increased FiO2.  In a…

Sustained lung inflation at birth

A randomized trial of babies 25 – 28 weeks gestation compared two methods of initial stabilization after birth – nasal CPAP alone versus sustained lung inflation followed by nasal CPAP. Infants receiving the sustained lung inflation had a lower incidence of mechanical…

Risk factors for morbidity in term neonates

A prospective two-year cohort study of term neonates without major congenital anomalies determined the antepartum and intrapartum factors associated with a composite measure of neonatal morbidity, defined as one or more of the following: hypoxic ischemic encephalopathy, meconium aspiration with pulmonary…

Heart rate at birth measured by pulse oximetry versus electrocardiography

Concurrent readings of heart rate immediately after birth as detected by pulse oximetry and EKG electrodes were compared in 53 neonates (both term and preterm infants were included). The leads or sensor were applied as soon as possible after birth…

Lung-protective respiratory support in preterm infants

Lung injury in preterm infants receiving respiratory support can be decreased by avoiding: (1) Atelectrauma by promoting alveolar stability, (2) Volutrauma by limiting tidal volume to prevent alveolar overdistension, and (3) Oxitrauma by minimizing oxygen toxicity by improving ventilation-perfusion matching.…

Umbilical cord milking versus immediate cord clamping

A randomized trial of infants born at less than 32 weeks gestation compared the effects of umbilical cord milking versus immediate cord clamping. Thirty infants were assigned to each arm. Infants who underwent umbilical cord milking had a higher serum hemoglobin,…

The stable microbubble test to predict CPAP success

The stable microbubble test (SMT) performed on gastric aspirate in the first hour of life was prospectively studied in 68 infants less than 30 weeks gestation placed on CPAP immediately after birth. The diagnostic test accuracy of the SMT was…

Music to improve neonatal CPR

In the world of adult CPR, listening to specific music pieces (Staying Alive, Nellie the Elephant, Disco Science) while performing CPR has been shown to improve the quality of CPR. A pilot study evaluated the effect of ‘Radetzkymarsch’ (110 beats…

Cord milking prior to umbilical cord clamping vs immediate clamping

A single-center randomized trial compared the effects of immediate umbilical cord clamping after birth with clamping after active cord milking in infants 24 – 28 weeks gestation. In the latter group, around 20 cms of the cord was actively milked…

Exothermic mattresses to prevent admission hypothermia

A randomized trial from Ireland compared preterm infants less than 31 weeks gestation who underwent temperature management at birth with or without an exothermic mattress. All infants received radiant heat and were placed in a polyethylene bag as well. The trial…

Sudden unexpected postnatal collapse of healthy newborns

A study from Sweden reviewed all cases from five delivery units of late preterm and term infants who appeared to be healthy but collapsed within 24 hours of birth. Data from two and a half years were analyzed. The incidence of…

Supraglottic airway devices in resuscitation

A systematic review of studies of laryngeal masks and oropharyngeal airways during neonatal resuscitation found no studies about oropharyngeal airways. There were four studies of the use of laryngeal masks. Compared to bag and mask ventilation, infants given positive pressure…