What is the Opinion of the Health Care Personnel Regarding the Use of Different Assistive Tools to Improve the Quality of Neonatal Resuscitation?

OBJECTIVE: It is important to determine whether the use of different quality improvement tools in neonatal resuscitation is well-received by health care teams and improves coordination and perceived quality of the stabilization of the newborn at birth. This study aimed to explore the satisfaction of personnel involved in resuscitation for infants under 32 weeks of gestational age (<32 wGA) at birth with the use of an assistance toolkit: Random Real-time Safety Audits (RRSA) of neonatal stabilization stations, the use of pre-resuscitation checklists, and the implementation of briefings and debriefings. STUDY DESIGN: A quasi-experimental, prospective, multicenter intervention study was conducted in five level III-A neonatal intensive care units in Madrid (Spain). The intervention involved conducting weekly RRSA of neonatal resuscitation stations and the systematic use of checklists, briefings, and debriefings during stabilization at birth for infants <32 wGA. The satisfaction with their use was analyzed through surveys conducted with the personnel responsible for resuscitating these newborns. These surveys were conducted both before and after the intervention phase (each lasting 1 year) and used a Likert scale response model to assess various aspects of the utility of the introduced assistance tools, team coordination, and perceived quality of the resuscitation. RESULTS: Comparison of data from 200 preintervention surveys and 155 postintervention surveys revealed statistically significant differences (p < 0.001) between the two phases. The postintervention phase scored higher in all aspects related to the effective utilization of these tools. Improvements were observed in team coordination and the perceived quality of neonatal resuscitation. These improved scores were consistent across personnel roles and years of experience. CONCLUSION: Personnel attending to infants <32 wGA in the delivery room are satisfied with the application of RRSA, checklists, briefings, and debriefings in the neonatal resuscitation and perceive a higher level of quality in the stabilization of these newborns following the introduction of these tools. KEY POINTS: · RRSA, checklists, briefings, and debriefings improve the quality of neonatal resuscitation at birth.. · These tools, when used together, are well-received and enhance perceived resuscitation quality.. · Perception of utility and quality improvement is consistent across roles and experience..

Association of the presence of a COVID-19 infection at the time of birth and the rates of exclusive breastfeeding upon discharge in BFHI hospitals: a multicenter, prospective cohort study.

BACKGROUND: Very few studies have assessed the association between COVID-19 infection and the rates of exclusive breastfeeding (EBF) upon discharge following the first waves of the pandemic and after initiation of vaccination. The primary objective of this study is to compare the rates of EBF since birth upon discharge in mothers diagnosed with COVID-19 infection at the time of the delivery versus a group of non-infected mothers in maternity hospitals with Baby Friendly Hospital Initiative (BFHI) accreditation. The secondary objectives include determining the rates of any breastfeeding at three and six months of life in both groups, as well as determining the possible factors associated with EBF rates observed upon discharge. METHODS: An observational, Spanish multi-center hospital, prospective cohort study conducted from 1 to 2021 to 31 March 2022 and with follow-up during the first six months of life. Follow-up was performed via telephone contact with calls performed at three and six months. A multivariate logistic regression analysis model was used to identify the factors related to a lower probability of EBF upon discharge. RESULTS: 308 mother-infant pairs participated in the study, 111 in the cohort of women with COVID infection and 197 in the comparison group. EBF upon discharge was 62.7% in the COVID group vs. 81.2% in the comparison group (p = 0.002); at three months; 52.4% vs. 57.0% (p = 0.33) were performing EBF, with the rates of EBF at six months being 43.0% vs. 39.3% (p = 0.45), respectively. Exposure to COVID-19 at delivery (AOR 5.28; 95% CI 2.01, 13.86), not practicing BF previously (AOR 36.3; 95% CI 7.02, 187.74), birth via Cesarean section (AOR 5.06; 95% CI 1.62, 15.79) and low birth weight of the newborn (AOR 1.01; 95% CI 1.01, 1.01) were associated with a greater risk of not performing EBF upon discharge. CONCLUSIONS: Mothers with a mild or asymptomatic COVID-19 infection at the time of the delivery were less likely to have exclusively breastfed during their hospital stay than other mothers in these BFHI-accredited hospitals. However, there were no differences in breastfeeding rates between the groups at three and six months postpartum.

Aplicación conjunta de diversas herramientas de calidad en la reanimación neonatal / Combined application of various quality assessment tools in neonatal resuscitation

Introducción: Es importante conocer si en la reanimación neonatal el uso de diversas herramientas de calidad tiene impacto en la preparación del puesto de estabilización, correcto desarrollo del procedimiento y evolución clínica de aquellos neonatos más vulnerables. Material y métodos: Estudio de intervención cuasiexperimental, prospectivo y multicéntrico en 5 unidades neonatales iii-A. En las fases pre y postintervención, ambas de un año de duración, se realizaron auditorías aleatorias semanales de los puestos de estabilización en el paritorio para comprobar su preparación. En la fase postintervención se usaron checklists, briefings y debriefings en las reanimaciones de los neonatos menores de 32 semanas. Se compararon el desarrollo del procedimiento y la evolución inicial posreanimación entre ambos periodos. Resultados: Se realizaron 852 auditorías en el periodo preintervención y 877 en el postintervención. El porcentaje de auditorías sin defecto fue superior en la segunda fase (63% vs. 81% p<0,001). Se incluyeron 75 reanimaciones en la fase inicial y 48 en la segunda, de las cuales en 36 (75%) se habían utilizado todas las herramientas de calidad. No existieron diferencias en las principales variables clínicas durante la estabilización, aunque se objetivó una tendencia a menores problemas técnicos durante el procedimiento en el segundo periodo. Conclusiones: La utilización de auditorías aleatorias, checklists, briefings y debriefings en la reanimación de los menores de 32 semanas es factible, pero no tiene impacto en los resultados clínicos a corto plazo ni en la correcta ejecución del procedimiento. Las auditorías de los puestos de reanimación neonatal mejoran significativamente su preparación. (AU)

Introduction: In neonatal resuscitation, it is important to know whether the use of a combination of quality assessment tools has an impact on the preparation of the resuscitation bed and equipment, the correct performance of the procedure and the clinical outcomes of the most vulnerable neonates. Material and methods: Multicentre, prospective, quasi-experimental interventional study in five level III-A neonatal units. In the pre- and post-intervention phases, both of which lasted 1 year, there were weekly random audits of the stabilization beds in the delivery room to assess their preparation. In the post-intervention phase, checklists, briefings and debriefings were used in the resuscitation of neonates delivered before 32 weeks. We compared the performance of the procedure and early post-resuscitation outcomes in the 2 periods. Results: 852 audits were carried out in the pre-intervention period and 877 in the post-intervention period. There was a greater percentage of audits that did not identify defects in the second phase (63% vs 81%; P<.001). The first phase included 75 resuscitations and the second 48, out of which all the quality assessment tools had been used in 36 (75%). We did not find any differences in the main clinical variables during stabilization, although we observed a trend towards fewer technical problems during the procedure in the second period. Conclusions: The use of random audits, checklists, briefings and debriefings in the resuscitation of newborns delivered before 32 weeks is feasible but has no impact on short-term clinical outcomes or correct performance of the procedure. Audits of neonatal resuscitation beds significantly improved their preparation. (AU)

Combined application of various quality assessment tools in neonatal resuscitation.

INTRODUCTION: In neonatal resuscitation, it is important to know whether the use of a combination of quality assessment tools has an impact on the preparation of the resuscitation bed and equipment, the correct performance of the procedure and the clinical outcomes of the most vulnerable neonates. MATERIAL AND METHODS: Multicentre, prospective, quasi-experimental interventional study in five level III-A neonatal units. In the pre- and post-intervention phases, both of which lasted 1 year, there were weekly random audits of the stabilization beds in the delivery room to assess their preparation. In the post-intervention phase, checklists, briefings and debriefings were used in the resuscitation of neonates delivered before 32 weeks. We compared the performance of the procedure and early post-resuscitation outcomes in the 2 periods. RESULTS: Total of 852 audits were carried out in the pre-intervention period and 877 in the post-intervention period. There was a greater percentage of audits that did not identify defects in the second phase (63% vs 81%; P < .001). The first phase included 75 resuscitations and the second 48, out of which all the quality assessment tools had been used in 36 (75%). We did not find any differences in the main clinical variables during stabilization, although we observed a trend towards fewer technical problems during the procedure in the second period. CONCLUSIONS: The use of random audits, checklists, briefings and debriefings in the resuscitation of newborns delivered before 32 weeks is feasible but has no impact on short-term clinical outcomes or correct performance of the procedure. Audits of neonatal resuscitation beds significantly improved their preparation.

Infección por COVID-19 en el parto y tasas de lactancia materna exclusiva en una maternidad IHAN / COVID-19 infection in childbirth and exclusive breastfeeding rates in a BFHI maternity

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A prospective study among neonates born to mothers with active or past Graves disease.

OBJECTIVE: The aim of this prospective study was to describe demographic and clinical characteristics of neonates born to mothers with active or past Graves disease and to assess compliance since implementation of a new protocol in our center. METHODS: We prospectively followed up neonates born to mothers with active or past Graves disease in a tertiary hospital in Spain between August 2019 and September 2021 according to our protocol. We reviewed maternal and neonatal history of these neonates, and we followed up newborns at risk of neonatal hyperthyroidism. RESULTS: Among 5808 births, 33 neonates were born to mothers with active or past Graves disease (0.57%). Six mothers (18.2%) had positive levels of thyroid-stimulating hormone receptor antibodies during pregnancy and five mothers (15.1%) between weeks 20 and 24 of pregnancy. Two of them had received definitive therapy for Graves disease before pregnancy. Two neonates (7.1%) were at high risk of neonatal hyperthyroidism and were followed-up until two months, without hyperthyroidism signs or abnormal thyroid hormone levels. Compliance of protocol during pregnancy was 84.9% and 75.8% at birth. CONCLUSIONS: Prevalence of Graves disease among pregnant women was 0.57%, with no cases of neonatal hyperthyroidism. Compliance of protocol was adequate during pregnancy (84.9%) and acceptable at birth (75.8%).

Negative Transmission of SARS-CoV-2 to Hand-Expressed Colostrum from SARS-CoV-2-Positive Mothers.

Aim: The objective of our study was to determine whether the SARS-CoV-2-positive mothers transmit the virus to their hand-expressed colostrum. Methods: This is an observational prospective study that included pregnant women who tested positive for SARS-CoV-2 by PCR test on a nasopharyngeal swab at the moment of childbirth and who wanted to breastfeed their newborns. A colostrum sample was obtained from the mothers by manual self-extraction. To collect the samples, the mothers wore surgical masks, washed their hands with an 85% alcohol-based gel, and washed their breast with gauze that was saturated with soap and water. Results: We obtained seven colostrum samples from different mothers in the first hours postdelivery. SARS-CoV-2 was not detected in any of the colostrum samples obtained in our study. Conclusion: In our study, breast milk was not a source of SARS-CoV-2 transmission. Hand expression (assuring that a mask is used and that appropriate hygienic measures are used for the hands and the breast), when direct breastfeeding is not possible, appears to be a safe way of feeding newborns of mothers with COVID-19.

Differences in mother-to-infant bonding according to type of C-section: Elective versus unplanned.

Aim To compare the mother-to-infant bond of mothers who gave birth by elective C-section versus urgent C-section in the first 48-72h of life and 10-12weeks after delivery. METHODS: This is a cohort prospective study of women giving birth by C-section. 48-72h after delivery, sociodemographic variables were collected, Mother-to-Infant Bonding Scale and newborn's response to separation test were performed. 10-12weeks after delivery Mother-to-Infant Bonding Scale and questions about baby's feeding were completed. RESULTS: A total of 116 dyads were recruited, 58 in each group. No significant differences between the two C-sections in bonding, newborn response to separation or type of feeding were observed at any time points. However, those dyads presenting with an abnormal bond at time 1 had more frequently an abnormal bond at time 2 (50% versus 8.1%, p=0.000). CONCLUSIONS: No differences in mother-to-infant bond were found according to type of C-section.

Neuroendocrinology of childbirth and mother-child attachment: the basis of an etiopathogenic model of perinatal neurobiological disorders.

This review focuses on the neuroendocrine mechanisms in the mother and the newborn that are involved in the generation and consolidation of mother-child attachment. The role that different hormones and neurotransmitters play on the regulation of these mechanisms during parturition, the immediate postpartum period and lactation is discussed. Interferences in the initiation of mother-child attachment may have potential long-term effects for the behavior and affection of the newborn. Therefore, the possible consequences of alterations in the physiological neuroendocrine mechanisms of attachment, caused by elective Cesarean section, intrapartum hormonal manipulations, preterm delivery, mother-infant postpartum separation and bottle-feeding instead of breastfeeding are also discussed.

Analgesia with breastfeeding in addition to skin-to-skin contact during heel prick.

OBJECTIVE: To investigate the analgesic effect (measured with Neonatal Infant Pain Scale (NIPS)) of breastfeeding (BF) in addition to skin-to-skin contact (SSC) versus other methods of non-pharmacological analgesia during blood sampling through heel lance in healthy term neonates. DESIGN: Randomised controlled trial. SETTING: Tertiary level maternity ward. PATIENTS: One hundred thirty-six healthy term newborns. INCLUSION CRITERIA: healthy term neonates, wish to breastfeed and absence of feeding during the previous 60 min. INTERVENTION: Neonates were randomly assigned to four groups: Group breastfed with SSC (BF+SSC Group) (n=35); Group sucrose with SSC (Sucrose+SSC Group) (n=35); SSC Group (n=33); or Sucrose Group (n=33). Babies were recorded with a video camera. OUTCOME MEASURES: Three observers watched the videos and measured NIPS score at three time points (t0: 2 min before heel prick; t1: During heel prick; and t2: 2 min after the heel prick). The influences of non-pharmacological methods on crying time, percentage of crying while sampling, heart rate, number of attempts and duration of sampling were also studied. RESULTS: BF+SSC Group achieved a significant lower median NIPS score (value=1) compared with other groups (value=2, 4 and 4, respectively). The percentage of neonates with moderate-to-severe pain was also lower in the BF+SSC Group. Both groups BF+SSC and Sucrose+SSC achieved a significant lower percentage of crying compared with SSC Group. CONCLUSIONS: This study suggests that BF in addition to SSC provides superior analgesia to other kinds of non-pharmacological analgesia in healthy term neonates during heel prick.

Mode of delivery may influence neonatal responsiveness to maternal separation.

INTRODUCTION: Maternal-infant separation (MIS) is a highly stressful situation for the neonate. MATERIALS AND METHODS: A study was conducted to observe and describe the reactions of term neonates to brief maternal separation and restoration of skin contact within the first 48 h of life, and to assess whether the mode of delivery influences neonatal responsiveness. A brief maternal-infant separation situation was videotaped to observe the reactions of the newborns within the first 12-48 h of life. Characteristics observed in the newborns were: the Moro reflex, spreading out arms and feet, looking at the mother, presence/lack of crying, and some dichotomous variables (present or lacking); in mothers: adult speech, "motherese" speech, speaking to another adult present in the room, singing, clicking, tapping on the diaper, rocking, kissing the baby, touching toes, touching hands, changing position, making loving comments, calling the newborn by his/her name and touching his/her back. Crying on restoration of contact was measured. RESULTS: Ten neonates born by planned C-section and 21 neonates born by oxytocin-induced vaginal delivery were included. No behavioral differences were observed according to the mode of delivery. Neonates born by vaginal delivery took longer (64.8±8.6 s) to calm down than those born by C-section (0.9±1.4 s) (p=0.004). A correlation was observed between cortisol concentrations at birth and the time required to calm the baby down (r=0.41; p=0.02). CONCLUSION: Neonates born by a planned C-section cried much less on maternal separation, which might indicate an altered attachment behavior and altered response to stress. Further studies are needed to determine the potential long-term implications of variations in mother-infant attachment during the first days of life.

Contacto piel con piel: beneficios para el recién nacido y la madre / Skin-to-skin contact: beneficial effects on the mother and the newborn

Este estudio demuestra cómo la aplicación del contacto piel con piel implica una mayor estabilidad térmica en el recién nacido y una mayor proporción de lactancia materna en el momento del alta hospitalaria

Oxytocin and autism: a hypothesis to research. Can perinatal oxitocinergic manipulation facilitate autism?

The study of the neurohormonal and behavioral processes and neural mechanisms involved in the development of attachment between the infant and the mother has received increased attention over the last years. Oxytocin has been shown to play a central role in the regulation of affiliate social behavior, including sexual behavior, mother infant bonding and social memory and recognition. Following normal physiological vaginal birth highest levels plasmatic endogenous oxytocin are achieved, which has been related to the presence of a sensitive period which seems to facilitate bonding and initial mother and newborn attachment. Perinatal manipulation of peptidic hormones like oxytocin can have life long lasting effects on social and sexual behaviors in animal models. Disregulation of oxytocinergic system has been observed in individuals with autistic disorders. A review of the possible effects of oxytocinergic perinatal manipulation in human newborns is discussed in the present review article. The hypothesis of the possible effect of perinatal oxytocin manipulation on the ethiology of autism is discussed.

Cytomegalovirus infection in the first year of life in human immunodeficiency virus-infected children: impact on survival and progression of the HIV disease.

BACKGROUND: Cytomegalovirus (CMV) is one of the most common opportunistic infections in AIDS patients. The aim of this study was to assess the influence of CMV infection in the first year of life and its the impact on survival and progression of the disease. MATERIAL/METHODS: This prospective cohort study included all children with a diagnosis of HIV infection in the first year of life followed at the University Hospital 12 de Octubre, Madrid. Urine culture was performed at birth or as soon as the diagnosis of HIV was given. RESULTS: Among the 81 patients studied, 16 presented a positive culture for CMV in urine during the first year of life. At 2 and 5 years of age, 23.6% and 39.6% of the children, respectively, died among those children without CMV infection, whereas 20% and 40% of children with acquired CMV died at this time point. Neither a greater progression of the disease nor any differences in the degree of immunosupression were observed among the children infected with CMV compared with those not infected. CONCLUSIONS: In this study no relationships between CMV infection during the first year of life and faster progression of HIV infection or lower survival or a greater degree of immunosuppression in HIV-infected children was observed.