Maternal stress after preterm birth: Impact of length of antepartum hospital stay.

BACKGROUND: Preterm birth is associated with increased parental stress, worry, and anxiety, and affects parental-child interactional behaviour. AIM: To evaluate the influence of length of antepartum hospital stay on maternal stress after the birth of a preterm infant. METHODS: A prospective two-centre pilot case-control study was performed at two tertiary level Neonatal-Intensive-Care-Units (NICU). Mothers of preterm infants <36+0 weeks of gestation admitted to the NICUs were included. The stress of mothers with length of antepartum hospital stay <12h (n=20) were case-matched and compared to that of mothers with length of antepartum hospital stay ≥12h (n=20). Maternal stress was assessed within three days after birth with the Parental-Stress-Scale:NICU (PSS:NICU) questionnaire measuring three scales: "relationship and parental role", "sights and sounds", and "baby looks and behaves". Maternal socio-demographic data were collected by questionnaire administered at the same time. RESULTS: Both groups of mothers had similar socio-demographic data. Stress scale of "sights and sounds" was significantly increased in mothers with antepartum stay ≥12h (2.48±0.69) compared to mothers with antepartum stay <12h (1.95±0.73) (p=0.024). There was no significant difference between the two groups regarding the "looks and behaves" (2.73±0.80 vs. 2.72±0.91; p=0.962) and "relationship and parental role" scales (3.31±1.08 vs. 3.58±1.18; p=0.484). CONCLUSIONS: Our study demonstrated higher levels of maternal stress after preterm birth in mothers, who had been admitted to hospital for longer periods of time before delivery. Interventional programmes starting in the antepartum period should be established in order to reduce the burden of stress and to improve parental-child interaction.

Exhaled CO2 Parameters as a Tool to Assess Ventilation-Perfusion Mismatching during Neonatal Resuscitation in a Swine Model of Neonatal Asphyxia.

BACKGROUND: End-tidal CO2 (ETCO2), partial pressure of exhaled CO2 (PECO2), and volume of expired CO2 (VCO2) can be continuously monitored non-invasively to reflect pulmonary ventilation and perfusion status. Although ETCO2 ≥14 mmHg has been shown to be associated with return of an adequate heart rate in neonatal resuscitation and quantifying the PECO2 has the potential to serve as an indicator of resuscitation quality, there is little information regarding capnometric measurement of PECO2 and ETCO2 in detecting return of spontaneous circulation (ROSC) and survivability in asphyxiated neonates receiving cardiopulmonary resuscitation (CPR). METHODS: Seventeen newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-minute normocapnic hypoxia followed by apnea to induce asphyxia. Protocolized resuscitation was initiated when heart rate decreased to 25% of baseline. Respiratory and hemodynamic parameters including ETCO2, PECO2, VCO2, heart rate, cardiac output, and carotid artery flow were continuously measured and analyzed. RESULTS: There were no differences in respiratory and hemodynamic parameters between surviving and non-surviving piglets prior to CPR. Surviving piglets had significantly higher ETCO2, PECO2, VCO2, cardiac index, and carotid artery flow values during CPR compared to non-surviving piglets. CONCLUSION: Surviving piglets had significantly better respiratory and hemodynamic parameters during resuscitation compared to non-surviving piglets. In addition to optimizing resuscitation efforts, capnometry can assist by predicting outcomes of newborns requiring chest compressions.

Cerebral Oxygen Saturation to Guide Oxygen Delivery in Preterm Neonates for the Immediate Transition after Birth: A 2-Center Randomized Controlled Pilot Feasibility Trial.

OBJECTIVE: To assess if monitoring of cerebral regional tissue oxygen saturation (crSO2) using near-infrared spectroscopy (NIRS) to guide respiratory and supplemental oxygen support reduces burden of cerebral hypoxia and hyperoxia in preterm neonates during resuscitation after birth. STUDY DESIGN: Preterm neonates <34(+0) weeks of gestation were included in a prospective randomized controlled pilot feasibility study at 2 tertiary level neonatal intensive care units. In a NIRS-visible group, crSO2 monitoring in addition to pulse oximetry was used to guide respiratory and supplemental oxygen support during the first 15 minutes after birth. In a NIRS-not-visible group, only pulse oximetry was used. The primary outcomes were burden of cerebral hypoxia (<10th percentile) or hyperoxia (>90th percentile) measured in %minutes crSO2 during the first 15 minutes after birth. Secondary outcomes were all cause of mortality and/or cerebral injury and neurologic outcome at term age. Allocation sequence was 1:1 with block-randomization of 30 preterm neonates at each site. RESULTS: In the NIRS-visible group burden of cerebral hypoxia in %minutes, crSO2 was halved, and the relative reduction was 55.4% (95% CI 37.6-73.2%; P = .028). Cerebral hyperoxia was observed in NIRS-visible group in 3 neonates with supplemental oxygen and in NIRS-not-visible group in 2. Cerebral injury rate and neurologic outcome at term age was similar in both groups. Two neonates died in the NIRS-not-visible group and none in the NIRS-visible group. No severe adverse reactions were observed. CONCLUSIONS: Reduction of burden of cerebral hypoxia during immediate transition and resuscitation after birth is feasible by crSO2 monitoring to guide respiratory and supplemental oxygen support. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02017691.

Chest compressions in newborn animal models: A review.

OBJECTIVE: Much of the knowledge about the optimal way to perform chest compressions (CC) in newborn infants is derived from animal studies. The objective of this review was to identify studies of CC in newborn term animal models and review the evidence. We also provide an overview of the different models. DATA SOURCES: MEDLINE, EMBASE and CINAHL, until September 29th 2014. Study eligibility criteria and interventions: term newborn animal models where CC was performed. RESULTS: Based on 419 retrieved studies from MEDLINE and 502 from EMBASE, 28 studies were included. No additional studies were identified in CINAHL. Most of the studies were performed in pigs after perinatal transition without long-term follow-up. The models differed widely in methodological aspects, which limits the possibility to compare and synthesize findings. Studies uncommonly reported the method for randomization and allocation concealment, and a limited number were blinded. Only the evidence in favour of the two-thumb encircling hands technique for performing CC, a CC to ventilation ratio of 3:1; and that air can be used for ventilation during CC; was supported by more than one study. CONCLUSIONS: Animal studies should be performed and reported with the same rigor as in human randomized trials. Good transitional and survival models are needed to further increase the strength of the evidence derived from animal studies of newborn chest compressions.

aEEG and NIRS during transition and resuscitation after birth: promising additional tools; an observational study.

AIM OF THE STUDY: During resuscitation no routine cerebral monitoring is available. We aimed at monitoring cerebral activity and oxygenation continuously during neonatal transition and resuscitation. METHODS: Neonates ≥34 weeks of gestation born via cesarean section were included. Cerebral activity was continuously measured with amplitude-integrated-EEG (aEEG) and cerebral oxygenation (rSO2) with near-infrared-spectroscopy (NIRS) during the first 10 min after birth. For quantitative analysis of aEEG every minute the mean minimum amplitude (V(min)) and maximum amplitude (V(max)) was determined. Uncompromised neonates were compared to neonates in need of resuscitation. RESULTS: Out of 224 eligible neonates 31 uncompromised and 15 in need of respiratory support were included. Uncompromised neonates showed higher values for V(min) in the third minute and higher values for V(max) in the third and fourth minute compared to the tenth minute post-partum. In uncompromised neonates rSO2 values during the first 6 min after birth were lower compared to minute ten. Neonates in need of respiratory support had lower rSO2 values over the first 8 min after birth compared to minute ten. CONCLUSIONS: This is the first study demonstrating that monitoring of aEEG and NIRS to measure cerebral activity and oxygenation during immediate postpartum transition is feasible. During transition compromised neonates requiring resuscitation showed a different cerebral activity pattern compared to uncompromised neonates.