Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2016 | Research article

Analyzing video recorded support of postnatal transition in preterm infants following a c-section

Authors: Dimitrios Konstantelos, Jürgen Dinger, Sascha Ifflaender, Mario Rüdiger

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

Abstract

Background

Over the past years, research on neonatal resuscitation has focused on single interventions. The present study was performed to analyze the process quality of delivery room management of preterm infants born by c-section in our institution.

Methods

We performed a cross-sectional study of videos of preterm infants born by c-section. Videos were analyzed according to time point, duration and number of performed medical interventions. The study period occurred between January 2012 and December 2013. Infants were caterogized in 3 groups according to their gestational age.

Results

One hundred eleven videos were analyzed. 100 (90 %) of the infants were transferred to NICU and 91 (83 %) received respiratory support after a median of 0.5 min. All infants were auscultated after 8 (5–16) seconds median (IQR) and an oxygen saturation sensor was placed after 37 (28–52) seconds. 23 infants were intubated after 9 (6–17) minutes and 17 received exogenous surfactant; 29 % according to INSURE (intubation-surfactant-extubation) technique. The duration of intubation attempts was 47 (25–60) seconds. 51 % of the newborns received a sustained inflation for 8 (6–9) seconds. A successful IV-line placement occurred after 15 (12–20) minutes. 4 % of the infants were transported to the NICU without an IV-line after 3 (difference range: 2–5) unsuccessful attempts.

Conclusions

Using video analysis as a tool to study process quality, we conclude that interventions differ not only between but also within similar age groups. This data can be used for benchmarking with current guidelines and practice in other centers.

Available only for authorised users

O’Donnell CPF. Turn and face the strange - ch.ch.ch.changes to neonatal resuscitation guidelines in the past decade. J Paediatr Child Health. 2012;48:735–9.CrossRefPubMed

Raghuveer TS, Cox AJ. Neonatal resuscitation: an update. Am Fam Physician. 2011;83:911–8.PubMed

Davis PG, Dawson JA. New concepts in neonatal resuscitation. Curr Opin Pediatr. 2012;24:147–53.CrossRefPubMed

Gittermann MK, Fusch C, Gittermann AR, Regazzoni BM, Moessinger AC. Early nasal continuous positive airway pressure treatment reduces the need for intubation in very low birth weight infants. Eur J Pediatr. 1997;156:384–8.CrossRefPubMed

Finer NN, Carlo WA, Duara S, Fanaroff AA, Donovan EF, Wright LL, Kandefer S, Poole WK. Delivery room continuous positive airway pressure/positive end-expiratory pressure in extremely low birth weight infants: a feasibility trial. Pediatrics. 2004;114:651–7.CrossRefPubMed

Lindner W, Voßbeck S, Hummler H, Pohlandt F. Delivery room management of extremely Low birth weight infants : spontaneous breathing or intubation? Pediatrics. 1999;103:961–7.CrossRefPubMed

Dani C, Lista G, Pratesi S, Boni L, Agosti M, Biban P, Del Vecchio A, Gazzolo D, Gizzi C, Magaldi R, Messner H, Mosca F, Sandri F, Scopesi F, Trevisanuto D, Vento G. Sustained lung inflation in the delivery room in preterm infants at high risk of respiratory distress syndrome (SLI STUDY): study protocol for a randomized controlled trial. Trials. 2013;14:67.CrossRefPubMedPubMedCentral

van Vonderen JJ, Hooper SB, Hummler HD, Lopriore E, te Pas AB. Effects of a sustained inflation in preterm infants at birth. J Pediatr. 2014;165(5):903–8.CrossRefPubMed

te Pas AB, Walther FJ. A randomized, controlled trial of delivery-room respiratory management in very preterm infants. Pediatrics. 2007;120:322–9.CrossRef

10.

te Pas AB, Siew M, Wallace MJ, Kitchen MJ, Fouras A, Lewis RA, Yagi N, Uesugi K, Donath S, Davis PG, Morley CJ, Hooper SB. Establishing functional residual capacity at birth: the effect of sustained inflation and positive end-expiratory pressure in a preterm rabbit model. Pediatr Res. 2009;65:537–41.CrossRef

11.

Lindner W, Högel J, Pohlandt F. Sustained pressure-controlled inflation or intermittent mandatory ventilation in preterm infants in the delivery room? a randomized, controlled trial on initial respiratory support via nasopharyngeal tube. Acta Paediatr. 2005;94:303–9.PubMed

12.

Kendig J, Notter R, Cox C, Reubens L, Davis J, Maniscalco W, Sinkin R, Bartoletti A, Dweck H, Horgan M, Risemberg H, Phelps DS D. A comparison of surfactant as immediate prophylaxis and as rescue therapy in newborns of less than 30 weeks’ gestation. N Engl J Med. 1991;324:866–71.CrossRef

13.

Doron MW, Veness-Meehan KA, Margolis LH, Holoman EM, Stiles AD. Delivery room resuscitation decisions for extremely premature infants. Pediatrics. 1998;102:574–82.CrossRefPubMed

14.

Horbar JD, Carpenter JH, Buzas J, Soll RF, Suresh G, Bracken MB, Leviton LC, Plsek PE, Sinclair JC. Collaborative quality improvement to promote evidence based surfactant for preterm infants: a cluster randomised trial. BMJ. 2004;329(7473):1004.CrossRefPubMedPubMedCentral

15.

Laptook AR, Watkinson M. Temperature management in the delivery room. Semin Fetal Neonatal Med. 2008;13:383–91.CrossRefPubMed

16.

Dawson JA, Davis PG, O’Donnell CPF, Kamlin COF, Morley CJ. Pulse oximetry for monitoring infants in the delivery room: a review. Arch Dis Child Fetal Neonatal Ed. 2007;92:F4–7.CrossRefPubMedPubMedCentral

17.

Velaphi S, Vidyasagar D. The pros and cons of suctioning at the perineum (intrapartum) and post-delivery with and without meconium. Semin Fetal Neonatal Med. 2008;13:375–82.CrossRefPubMed

18.

Mehler K, Grimme J, Abele J, Huenseler C, Roth B, Kribs A. Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life. Acta Paediatr Int J Paediatr. 2012;101:1232–9.CrossRef

19.

Klebermass-Schrehof K, Wald M, Schwindt J, Grill A, Prusa A-R, Haiden N, Hayde M, Waldhoer T, Fuiko R, Berger A. Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology. 2013;103:252–8.CrossRefPubMed

20.

Jobe AH. Transition/adaptation in the delivery room and less RDS: “Don’t just do something, stand there!”. J Pediatr. 2005;147:284–6.CrossRefPubMed

21.

Rüdiger M, Braun N, Gurth H, Bergert R, Dinger J. Preterm resuscitation I: clinical approaches to improve management in delivery room. Early Hum Dev. 2011;87:749–53.CrossRefPubMed

22.

Konstantelos D, Ifflaender S, Dinger J, Burkhardt W, Rüdiger M. Analyzing support of postnatal transition in term infants after c-section. BMC Pregnancy Childbirth. 2014;14:225.CrossRefPubMedPubMedCentral

23.

Konstantelos D, Gurth H, Bergert R, Ifflaender S, Rüdiger M. Positioning of term infants during delivery room routine handling - analysis of videos. BMC Pediatr. 2014;14:33.CrossRefPubMedPubMedCentral

24.

Konstantelos D, Ifflaender S, Dinger J, Rüdiger M. Suctioning habits in the delivery room and the influence on postnatal adaptation - a video analysis. J Perinat Med. 2015;43(6):777–82.CrossRefPubMed

25.

Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Halliday HL. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants - 2010 update. Neonatology. 2010;97:402–17.CrossRefPubMed

26.

Sobotka KS, Hooper SB, Allison BJ, te Pas AB, Davis PG, Morley CJ, Moss TJM. An initial sustained inflation improves the respiratory and cardiovascular transition at birth in preterm lambs. Pediatr Res. 2011;70:56–60.CrossRefPubMed

27.

te Pas AB, Siew M, Wallace MJ, Kitchen MJ, Fouras A, Lewis RA, Yagi N, Uesugi K, Donath S, Davis PG, Morley CJ, Hooper SB. Effect of sustained inflation length on establishing functional residual capacity at birth in ventilated premature rabbits. Pediatr Res. 2009;66:295–300.CrossRef

28.

Kribs A, Roll C, Göpel W, Wieg C, Groneck P, Laux R, Teig N, Hoehn T, Böhm W, Welzing L, Vochem M, Hoppenz M, Bührer C, Mehler K, Stützer H, Franklin J, Stöhr A, Herting E, Roth B. Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr. 2015;169:723–30.CrossRefPubMed

29.

Schilleman K, Witlox RS, van Vonderen JJ, Roegholt E, Walther FJ, te Pas AB. Auditing documentation on delivery room management using video and physiological recordings. Arch Dis Child Fetal Neonatal Ed. 2014;99(6):F485–90.CrossRefPubMed

30.

Göpel W, Kribs A, Ziegler A, Laux R, Hoehn T, Wieg C, Siegel J, Avenarius S, von der Wense A, Vochem M, Groneck P, Weller U, Möller J, Härtel C, Haller S, Roth B, Herting E. Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet. 2011;378:1627–34.CrossRefPubMed

31.

Lane B, Finer N, Rich W. Duration of intubation attempts during neonatal resuscitation. J Pediatr. 2004;145(1):67–70.CrossRefPubMed

32.

O’Donnell CPF, Kamlin COF, Davis PG, Morley CJ. Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics. 2006;117:e16–21.CrossRefPubMed

33.

Haubner LY, Barry JS, Johnston LC, Soghier L, Tatum PM, Kessler D, Downes K, Auerbach M. Neonatal intubation performance: room for improvement in tertiary neonatal intensive care units. Resuscitation. 2013;84:1359–64.CrossRefPubMed

34.

Speidel B. Adverse effects of routine procedures on preterm infants. Lancet. 1978;1(8069):864–6.CrossRefPubMed

35.

Sheila N, Campbell Laura BS. Nursing procedures and alterations in transcutaneous oxygen tension in premature infants. Nurs Res. 1982;31:330–6.

Title: Analyzing video recorded support of postnatal transition in preterm infants following a c-section
Authors: Dimitrios Konstantelos
Jürgen Dinger
Sascha Ifflaender
Mario Rüdiger
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-016-1045-2

At a glance: The STEP trials

Springer Medicine

Analyzing video recorded support of postnatal transition in preterm infants following a c-section

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

Could the erythrocyte indices or serum ferritin predict the therapeutic response to a trial with oral iron during pregnancy? Results from the Accuracy study for Maternal Anaemia diagnosis (AMA)

Religious beliefs and practices in pregnancy and labour: an inductive qualitative study among post-partum women in Ghana

Long-term adherence and effects on grip strength and upper leg performance of prescribed supplemental vitamin D in pregnant and recently pregnant women of Somali and Swedish birth with 25-hydroxyvitamin D deficiency: a before-and-after treatment study

First trimester serum placental growth factor and hyperglycosylated human chorionic gonadotropin are associated with pre-eclampsia: a case control study

Bacterial vaginosis and adverse outcomes among full-term infants: a cohort study

“Why screen if we cannot follow-up and manage?” Challenges for gestational diabetes screening and management in low and lower-middle income countries: results of a cross-sectional survey