Maternal and Neonatal Prognostic Factors for Cardiorespiratory Events in Healthy Term Neonates During Early Skin-to-Skin Contact.

Background: During early skin-to-skin contact (ESSC), alterations in peripheral oxygen saturation (SpO2) and heart rate (HR) have been frequently observed. Objectives: This study aimed to determine the incidence of cardiorespiratory events (CREs) during ESSC in healthy term newborns (HTNs) and estimate the association of maternal and neonatal prognostic factors with the risk of CREs. Methods: A pooled analysis of the cohort from a clinical trial involving healthy mother-child dyads during ESSC was performed. Pulse oximetry was employed to continuously monitor SpO2 and HR within 2 h after birth. The individual and combined prognostic relevance of the demographic and clinical characteristics of dyads for the occurrence of a CRE (SpO2 <91% or HR <111 or >180 bpm) was analyzed through logistic regression models. Results: Of the 254 children assessed, 169 [66.5%; 95% confidence interval (95% CI), 60.5-72.5%] had at least one CRE. The characteristics that increased the risk of CRE were maternal age ≥35 years (odds ratio, 2.21; 95% CI, 1.19-4.09), primiparity (1.96; 1.03-3.72), gestational body mass index (BMI) >25 kg/m2 (1.92; 1.05-3.53), and birth time between 09:00 p.m. and 08:59 a.m. (2.47; 1.02-5.97). Conclusion: CREs were more frequent in HTNs born during nighttime and in HTNs born to first-time mothers, mothers ≥35 years, and mothers with a gestational BMI >25 kg/m2. These predictor variables can be determined during childbirth. Identification of neonates at higher risk of developing CREs would allow for closer surveillance during ESSC.

Mother's Bed Incline and Desaturation Episodes in Healthy Term Newborns during Early Skin-to-Skin Contact: A Multicenter Randomized Controlled Trial.

INTRODUCTION: Early skin-to-skin contact (ESSC) is associated with rare, sudden, unexpected postnatal collapse episodes. Placing the newborn in ESSC closer to an upright position may reduce the risk of airway obstruction and improve respiratory mechanics. This study assessed whether a greater inclination of the mother's bed during ESSC would reduce the proportion of healthy term newborns (HTNs) who experienced episodes of pulse oximeter saturation (SpO2) <91%. METHODS: We conducted a multicenter randomized controlled trial comparing the effect of the mother's bed incline, 45° versus 15°, on desaturation in HTNs during ESSC. Before delivery on 1,271 dyads, randomization was conducted, and stringent criteria to select healthy mothers and term newborns were monitored until after birth. Preductal SpO2 was continuously monitored between 10 min and 2 h after birth. The primary outcome was the occurrence of at least one episode of SpO2 <91%. RESULTS: 254 (20%) mother-infant dyads were eligible for analysis (45°, n = 126; 15°, n = 128). Overall, 57% (95% confidence interval [CI]: 51%-63%) of newborns showed episodes of SpO2 <91%. The proportion of infants with SpO2 <91% episodes was 52% in 45° and 62% in 15° (relative risk: 0.80; 95% CI: 0.6-1.07). CONCLUSIONS: We did not show that a high mother bed inclination during ESSC led to significantly fewer HTNs who experienced episodes of SpO2 <91%. Desaturation episodes from 10 min to 2 h after birth occurred in more than half of HTNs.

What is the impact of mother's bed incline on episodes of decreased oxygen saturation in healthy newborns in skin-to-skin contact after delivery: Study protocol for a randomized controlled trial.

BACKGROUND: Early mother-child skin-to-skin contact (SSC) in the first 2 h postpartum is highly beneficial for both mother and child. However, cases have been reported of newborns who have experienced apparently life-threatening events (ALTEs) or sudden death during this procedure. The causes of these events are unknown. Newborn's prone position could influence the onset of these events but there is very little evidence to support any recommendation. We hypothesize that newborns' breathing obstruction episodes increase as mothers lie more horizontally. The main objective of this study is to compare the occurrence of desaturation and bradycardia episodes as a function of mother's bed incline. The study is designed as a randomized, controlled, assessor blind, multicenter, superiority trial with two parallel groups and 1:1 allocation ratio. METHODS: The study participants will be full-term healthy mother-newborn dyads from ten hospitals in Spain. Participants will be randomly assigned to one of two study arms defined by mother's bed inclination (45° or 15°). The planned sample size is 5866. Centralized permuted blocks randomization and assessor blinding will be implemented. The newborns will be monitored remotely with pulse oximetry, from 10 min to 2 h after delivery. We established SO2 and heart rate (HR) limit alarms, as well as an action protocol in the event of alarm activation. The primary outcome is the number of healthy newborns who undergo episodes of SO2 ≤ 90%. Secondary outcomes are the mean SO2 level, the number of newborns who experience episodes of SO2 ≤ 85%, the time to SSC discontinuation due to abnormal SO2 or HR, and episodes of HR < 111 beats per minute (bpm) or > 180 bpm. Subgroups and pooled analysis will be performed to identify if breast-feeding and mother and child positions favor the occurrence of desaturation or bradycardia episodes. DISCUSSION: A simple intervention such as modifying mother's bed angle of inclination while in SSC with her child during the first 2 h postpartum could favor newborn's hemodynamic and respiratory stabilization and thus contribute to reducing the onset of ALTEs. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02585492 . Registered on 22nd October 2015. PROTOCOL VERSION: 2 (30th June 2015).

Episodios aparentemente letales en las primeras dos horas de vida durante el contacto piel con piel. Incidencia y factores de riesgo / Apparently life-threatening episodes in the first two hours of life during skin-to-skin mother-infant contact. Incidence and risk factors

Objetivo. Valorar un incremento inesperado de la incidencia en nuestro Hospital de episodios aparentemente letales en recién nacidos en las primeras 2 horas de vida. Esto ha sucedido en los 2 últimos años desde que el contacto piel con piel madre-hijo se estableció como práctica habitual. Métodos. Se ha realizado una valoración completa de los datos de todos los pacientes para detectar posibles factores de riesgo. También se ha analizado la diferente incidencia en cuatro periodos sucesivos a lo largo de los últimos 35 años con 208.220 nacidos vivos. Resultados. En el último periodo el aumento de incidencia de estos sucesos ha sido estadísticamente significativa. Se han detectado varios factores potenciales de riesgo: contacto piel con piel, primiparidad, incidencia aumentada durante la noche y suceder en el segundo periodo de adaptación neonatal (30 a 90 minutos de vida). Dos de nuestros 8 pacientes tienen secuelas neurológicas y otro de ellos murió. Conclusión. Los episodios aparentemente letales en las primeras 2 horas de vida son poco frecuentes, pero sus consecuencias pueden ser graves. El contacto piel con piel entre la madre y el neonato en la sala de partos durante el periodo de adaptación neonatal precoz puede constituir uno de los principales factores de riesgo. En tanto que el contacto piel con piel se ha mostrado beneficioso y sin riesgos aparentes, debemos estimular su práctica. Pero deberíamos garantizar la preparación del equipo y la atención durante su transcurso, especialmente si la madre está sola o concurren otros factores de riesgo(AU)

Objective. To evaluate an unexpected increase in the incidence of apparently life threatening events and sudden deaths in neonates during the first 2hours after birth in our hospital. This increase occurred in the first 2 years after generalized skin-to-skin contact between mother and infant became routine practice. Methods. Full information on all our patients was collected to evaluate possible risk factors. Differences in incidence in four successive periods comprising the previous 35 years, with 208220 live neonates, were also analyzed. Results. In the last period, there was a statistically significant increase in the rate of apparently life threatening events and sudden deaths in neonates. Several potential risk factors were detected: skin-to-skin contact, primiparity, an increased incidence in night hours and the invariable occurrence of these events in the second period of neonatal adaptation (30 to 90minutes of life). Of eight patients with apparently life-threatening events, two had neurological sequelae and another died. Conclusion. Apparently life threatening events in the first 2hours of life are uncommon but may have serious consequences. One of the main risk factors may be skin-to-skin contact between mother and infant in the delivery room during the early adaptation period. As such contact has been proven to be beneficial and without apparent risks, this practice should be promoted. However, maternity staff should be vigilant during skin-to-skin contact, especially if the mother is alone with her neonate or other risk factors are present(AU)