RESUMEN
INTRODUCTION: Heart rate is the most important indicator of infant well-being during neonatal resuscitation. The Nellcor Pedi-Cap turns gold when exposed to exhaled gas with CO2>15 mmHg. The aim of this study was to determine if Pedi-Cap gold color change during neonatal resuscitation precedes an increase in heart rate in babies with bradycardia receiving mask ventilation. METHODS: This was a single-center retrospective review of video recordings and physiologic data of newborns with bradycardia receiving mask positive pressure ventilation during neonatal resuscitation. Subjects were included if the baby's HR<100 BPM within the first 90 s of resuscitation. The primary outcome was the change in HR prior to Pedi-Cap gold color change compared to the HR after Pedi-Cap gold color change. RESULTS: Forty-one newborns during the study period had HR<100 BPM and received mask positive pressure ventilation with a Pedi-Cap. The median heart rate 10s prior to Pedi-Cap gold color change was 75 BPM (IQR 62-85) and increased to 136 BPM (IQR 113-158) 30 s after gold color change (p<0.001). SpO2 increased from 45 ± 17% prior to Pedi-Cap gold color change to 52 ± 17% 30s after gold color change (p=0.001). CONCLUSIONS: Colorimetric CO2 detection during mask positive pressure ventilation in neonatal resuscitation precedes a significant increase in heart rate and SpO2. The Pedi-Cap can be easily applied during resuscitation, requires no electricity, provides immediate feedback and may be a useful, simple tool early in resuscitation and may be especially useful in resource limited settings.
Asunto(s)
Bradicardia/diagnóstico , Capnografía/instrumentación , Dióxido de Carbono/análisis , Reanimación Cardiopulmonar/instrumentación , Paro Cardíaco/terapia , Monitoreo Fisiológico/instrumentación , Taquicardia/diagnóstico , Bradicardia/mortalidad , Bradicardia/terapia , Capnografía/métodos , Reanimación Cardiopulmonar/métodos , Estudios de Cohortes , Color , Comorbilidad , Electrocardiografía/métodos , Femenino , Paro Cardíaco/diagnóstico , Paro Cardíaco/mortalidad , Frecuencia Cardíaca/fisiología , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Monitoreo Fisiológico/métodos , Respiración con Presión Positiva/métodos , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Tasa de Supervivencia , Taquicardia/epidemiología , Resultado del TratamientoRESUMEN
BACKGROUND: Umbilical cord milking (UCM) improves blood pressure and urine output, and decreases the need for transfusions in comparison to immediate cord clamping (ICC). The immediate effect of UCM in the first few minutes of life and the impact on neonatal resuscitation has not been described. METHODS: Women admitted to a tertiary care center and delivering before 32 weeks gestation were randomized to receive UCM or ICC. A blinded analysis of physiologic data collected on the newborns in the delivery room was performed using a data acquisition system. Heart rate (HR), SpO2, mean airway pressure (MAP), and FiO2 in the delivery room were compared between infants receiving UCM and infants with ICC. RESULTS: 41 of 60 neonates who were enrolled and randomized had data from analog tracings at birth. 20 of these infants received UCM and 21 had ICC. Infants receiving UCM had higher heart rates and higher SpO2 over the first 5 minutes of life, were exposed to less FiO2 over the first 10 minutes of life than infants with ICC. CONCLUSIONS: UCM when compared to ICC had decreased need for support immediately following delivery, and in situations where resuscitation interventions were needed immediately, UCM has the advantage of being completed in a very short time to improve stability following delivery. TRIAL REGISTRATION: ClinicalTrials.gov NCT01434732.