The Respiratory Management of the Extreme Preterm in the Delivery Room.

The fetal-to-neonatal transition poses an extraordinary challenge for extremely low birth weight (ELBW) infants, and postnatal stabilization in the delivery room (DR) remains challenging. The initiation of air respiration and the establishment of a functional residual capacity are essential and often require ventilatory support and oxygen supplementation. In recent years, there has been a tendency towards the soft-landing strategy and, subsequently, non-invasive positive pressure ventilation has been generally recommended by international guidelines as the first option for stabilizing ELBW in the delivery room. On the other hand, supplementation with oxygen is another cornerstone of the postnatal stabilization of ELBW infants. To date, the conundrum concerning the optimal initial inspired fraction of oxygen, target saturations in the first golden minutes, and oxygen titration to achieve desired stability saturation and heart rate values has not yet been solved. Moreover, the retardation of cord clamping together with the initiation of ventilation with the patent cord (physiologic-based cord clamping) have added additional complexity to this puzzle. In the present review, we critically address these relevant topics related to fetal-to-neonatal transitional respiratory physiology, ventilatory stabilization, and oxygenation of ELBW infants in the delivery room based on current evidence and the most recent guidelines for newborn stabilization.

Time to improve documentation of neonatal resuscitation: a narrative review.

A complete, objective and systematic documentation of delivery room resuscitation is important for research, for quality improvement, for teaching and as a reference for postresuscitation care. However, documentation during neonatal resuscitation is usually paper-based, retrospective, inaccurate and unreliable. In this narrative review, we discuss the strengths and pitfalls of current documentation methods in neonatal resuscitation, as well as the challenges of introducing new or emerging technologies in this field. In particular, we discuss innovations in electronic and automated medical records, video recording and Smartphones and Tablet Apps. Given the lack of a consensus standard, we finally propose a list of items that should be part of any neonatal resuscitation documentation method.

Training, experience and need of booster courses in neonatal cardiopulmonary resuscitation. Survey to pediatricians.

INTRODUCTION: The resuscitation of the newborn in the delivery room requires high capacities and occurs frequently in an unexpected way. Many professionals trained in pediatrics as pediatric residents will work posteriorly in pediatric units with delivery rooms and will perform neonatal resuscitation only occasionally. Skills acquired in practice or resuscitation courses deteriorate over time. MATERIAL AND METHODS: Descriptive observational study through a survey to pediatricians trained in neonatology at a tertiary hospital in Madrid, and who completed their residency period between 2009 and 2016. Questions about their training in resuscitation and their usual work in the delivery room. RESULTS: Out of 179 surveys sent, 140 pediatricians (78,2%) answered it. 73.6% took a training course in neonatal resuscitation during the residency. There was a progressive increase in the number of residents who did the course during the study period. 74.3% have worked after residency in assistance at birth. 40.7% have taken a refresher course in neonatal resuscitation. CONCLUSIONS: Training in neonatal resuscitation has increased and been consolidated during the training process for pediatric residents. A high percentage of pediatricians work after residency in pediatric units with delivery rooms, less than half of these professionals having been recycled in neonatal resuscitation. Recycling and periodic training seem interesting options to improve the performance of these professionals in the delivery room.

Spanish guide for neonatal stabilization and resuscitation 2021: Analysis, adaptation and consensus on international recommendations.

After the publication of the recommendations, agreed by all the scientific societies through the ILCOR, at the end of 2020, the GRN-SENeo began a process of analysis and review of the main changes since the last guidelines, to which a specific consensus positioning on controversial issues, trying to avoid ambiguities and trying to adapt the evidence to our environment. This text summarizes the main conclusions of this work and reflects the positioning of that group.

Formación, experiencia y necesidad de reciclaje en reanimación neonatal. Encuesta a pediatras / Training, experience and need of booster courses in neonatal cardiopulmonary resuscitation. Survey to pediatricians

Introducción: La reanimación del recién nacido en sala de partos requiere altas capacidades y se produce con frecuencia de manera inesperada. Muchos profesionales formados en pediatría mediante el método de residencia trabajarán a posteriori en unidades pediátricas con paritorio y realizarán reanimación neonatal solo de forma ocasional. Las competencias adquiridas en la práctica o los cursos de reanimación se deterioran con el tiempo. Material y métodos: Estudio descriptivo observacional a través de una encuesta a pediatras formados en Neonatología de un hospital terciario de Madrid y que finalizaron su residencia entre los años 2009 y 2016. Preguntas acerca de su formación en reanimación y su trabajo habitual en paritorio. Resultados: Ciento cuarenta pediatras contestaron la encuesta de 179 encuestas enviadas (78,2%). El 73,6% realizó un curso de formación en reanimación neonatal durante la residencia, objetivándose un incremento progresivo en el número de residentes que lo realizaron durante el período de estudio. El 74,3% ha trabajado tras la residencia en la asistencia al nacimiento. El 40,7% ha realizado algún curso de reciclaje en reanimación neonatal. Conclusiones: Ha aumentado y se ha consolidado la formación en reanimación neonatal durante el proceso de formación de residentes de Pediatría. Un alto porcentaje de pediatras trabajan tras la residencia en Unidades Pediátricas con paritorio, habiéndose reciclado menos de la mitad de esos profesionales en reanimación neonatal. El reciclaje y el entrenamiento periódico parecen opciones interesantes para mejorar la actuación de estos profesionales en sala de partos.(AU)

Introduction: the resuscitation of the newborn in the delivery room requires high capacities and occurs frequently in an unexpected way. Many professionals trained in pediatrics as pediatric residents will work posteriorly in pediatric units with delivery rooms and will perform neonatal resuscitation only occasionally. Skills acquired in practice or resuscitation courses deteriorate over time. Material and methods: descriptive observational study through a survey to pediatricians trained in neonatology at a tertiary hospital in Madrid, and who completed their residency period between 2009 and 2016. Questions about their training in resuscitation and their usual work in the delivery room. Results: Out of 179 surveys sent 140 pediatricians (78,2%) answered it. 73.6% took a training course in neonatal resuscitation during the residency. There was a progressive increase in the number of residents who did the course during the study period. 74.3% have worked after residency in assistance at birth. 40.7% have taken a refresher course in neonatal resuscitation. Conclusions: training in neonatal resuscitation has increased and been consolidated during the training process for pediatric residents. A high percentage of pediatricians work after the residency in pediatric units with delivery rooms, less than half of these professionals having been recycled in neonatal resuscitation. Recycling and periodic training seem interesting options to improve the performance of these professionals in the delivery room. (AU)

Guía española de estabilización y reanimación neonatal 2021. Análisis, adaptación y consenso sobre las recomendaciones internacionales / Spanish guide for neonatal stabilization and resuscitation 2021: Analysis, adaptation and consensus on international recommendations

Tras la publicación de las recomendaciones, consensuadas por todas las sociedades científicas a través del ILCOR, a finales del año 2020, el GRN-SENeo inició un proceso de análisis y revisión de los principales cambios desde las últimas guías, a los que se añadió un posicionamiento específico de consenso en temas controvertidos, tratando de evitar ambigüedades, y procurando adaptar la evidencia a nuestro medio. El presente texto, resume las principales conclusiones de este trabajo y refleja el posicionamiento de dicho grupo. (AU)

After the publication of the recommendations, agreed by all the scientific societies through the ILCOR, at the end of 2020, the GRN-SENeo began a process of analysis and review of the main changes since the last guidelines, to which a specific consensus positioning on controversial issues, trying to avoid ambiguities and trying to adapt the evidence to our environment. This text summarizes the main conclusions of this work and reflects the positioning of that group. (AU)

[Spanish guide for neonatal stabilization and resuscitation 2021: Analysis, adaptation and consensus on international recommendations]. / Guía española de estabilización y reanimación neonatal 2021. Análisis, adaptación y consenso sobre las recomendaciones internacionales.

After the publication of the recommendations, agreed by all the scientific societies through the ILCOR, at the end of 2020, the GRN-SENeo began a process of analysis and review of the main changes since the last guidelines, to which a specific consensus positioning on controversial issues, trying to avoid ambiguities and trying to adapt the evidence to our environment. This text summarizes the main conclusions of this work and reflects the positioning of that group.

[Training, experience and need of booster courses in neonatal cardiopulmonary resuscitation. Survey to pediatricians]. / Formación, experiencia y necesidad de reciclaje en reanimación neonatal. Encuesta a pediatras.

INTRODUCTION: the resuscitation of the newborn in the delivery room requires high capacities and occurs frequently in an unexpected way. Many professionals trained in pediatrics as pediatric residents will work posteriorly in pediatric units with delivery rooms and will perform neonatal resuscitation only occasionally. Skills acquired in practice or resuscitation courses deteriorate over time. MATERIAL AND METHODS: descriptive observational study through a survey to pediatricians trained in neonatology at a tertiary hospital in Madrid, and who completed their residency period between 2009 and 2016. Questions about their training in resuscitation and their usual work in the delivery room. RESULTS: Out of 179 surveys sent 140 pediatricians (78,2%) answered it. 73.6% took a training course in neonatal resuscitation during the residency. There was a progressive increase in the number of residents who did the course during the study period. 74.3% have worked after residency in assistance at birth. 40.7% have taken a refresher course in neonatal resuscitation. CONCLUSIONS: training in neonatal resuscitation has increased and been consolidated during the training process for pediatric residents. A high percentage of pediatricians work after the residency in pediatric units with delivery rooms, less than half of these professionals having been recycled in neonatal resuscitation. Recycling and periodic training seem interesting options to improve the performance of these professionals in the delivery room.

Propuesta de adaptación de las recomendaciones de reanimación cardiopulmonar pediátrica avanzada a la infección por coronavirus / No disponible

No disponible

New Strategies of Pulmonary Protection of Preterm Infants in the Delivery Room with the Respiratory Function Monitoring.

OBJECTIVE: To investigate if the use of a visible respiratory function monitor (RFM) to use lower tidal volumes (Vts) during positive pressure ventilation (PPV) in the delivery room (DR) reduces the need of surfactant administration and invasive mechanical ventilation during the first 72 hours after birth of preterm infants <32 weeks' gestational age (GA). STUDY DESIGN: Infants <32 weeks' GA (n = 106) requiring noninvasive PPV were monitored with a RFM at birth and randomized to visible (n = 54) or masked (n = 52) display on RFM. Pulmonary data were recorded during the first 10 minutes after birth. Secondary analysis stratified patients by GA (<28, 28-29+6, or ≥30 weeks). RESULTS: Median expiratory Vts during inflations were greater in the masked group (7 mL/kg) than in the visible group (5.8 mL/kg; p = 0.001) same as peak inflation pressure (PIP) administered (21.5 vs. 19.7 cmH2O; p < 0.001). Consequently, minute volumes were greater in the masked group (256 vs. 214 mL/kg/min; p < 0.001), with no differences in respiratory rate. These differences were higher in those <30 weeks' GA. There was no difference in the need of surfactant administration or intubation during the first 72 hours of age. CONCLUSION: Using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits.

Recomendaciones de expertos sobre el material del carro y mochila de reanimación cardiopulmonar pediátrica y neonatal / Materials for the paediatric resuscitation trolley or backpack: Expert recommendations

La parada cardiorrespiratoria (PCR) se puede presentar en cualquier lugar y en cualquier momento y por ello todos los centros sanitarios y los servicios de urgencias extrahospitalarias deben disponer de personal y material adecuado para realizar una reanimación cardiopulmonar (RCP). Estas recomendaciones son el consenso de expertos del Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal sobre el material y medicación de RCP pediátrica y neonatal y su distribución y utilización. Los carros y mochilas de RCP deben tener el material y la medicación para llevar a cabo de forma rápida y eficiente una RCP pediátrica. Debe existir al menos un carro de RCP accesible en cada centro de atención primaria, unidad de cuidados intensivos pediátricos, unidad de cuidados intensivos neonatales, servicio de urgencias, servicio de urgencias extrahospitalarias, planta de pediatría, área de consultas y zona de radiología. El carro de RCP debe contener solo el material y la medicación imprescindibles para realizar una RCP y atender a las urgencias vitales. El material debe ser conocido por el personal, incluir los repuestos necesarios y ser revisado y repuesto periódicamente. La estandarización y unificación del contenido (material y medicación) de los carros y mochilas de RCP pediátrica, así como el entrenamiento del personal en su utilización, son una parte esencial de la organización asistencial de la RCP pediátrica (AU)

Cardio-respiratory arrest (CPA) is infrequent in children, but it can occur in any place and at any time. This fact means that every health care facility must always have the staff and material ready to resuscitate a child. These recommendations are the consensus of experts of the Spanish Paediatric and Neonatal Resuscitation Group on the material and medication for paediatric and neonatal resuscitation and their distribution and use. CPR trolleys and backpacks must include the essential material to quickly and efficiently perform a paediatric CPR. At least one CPR trolley must be available in every Primary Care facility, Paediatric Intensive Care Unit, Emergency Department, and Pre-hospital Emergency Areas, as well as in paediatric wards, paediatric ambulatory areas, and radiology suites. This trolley must be easily accessible and exclusively include the essential items to perform a CPR and to assist children (from newborns to adolescents) who present with a life-threatening event. Such material must be familiar to all healthcare staff and also include the needed spare parts, as well as enough drug doses. It must also be re-checked periodically. The standardisation and unification of the material and medication of paediatric CPR carts, trolleys, and backpacks, as well as the training of the personnel in their use are an essential part of the paediatric CPR (AU)

[Materials for the paediatric resuscitation trolley or backpack: Expert recommendations]. / Recomendaciones de expertos sobre el material del carro y mochila de reanimación cardiopulmonar pediátrica y neonatal.

Cardio-respiratory arrest (CPA) is infrequent in children, but it can occur in any place and at any time. This fact means that every health care facility must always have the staff and material ready to resuscitate a child. These recommendations are the consensus of experts of the Spanish Paediatric and Neonatal Resuscitation Group on the material and medication for paediatric and neonatal resuscitation and their distribution and use. CPR trolleys and backpacks must include the essential material to quickly and efficiently perform a paediatric CPR. At least one CPR trolley must be available in every Primary Care facility, Paediatric Intensive Care Unit, Emergency Department, and Pre-hospital Emergency Areas, as well as in paediatric wards, paediatric ambulatory areas, and radiology suites. This trolley must be easily accessible and exclusively include the essential items to perform a CPR and to assist children (from newborns to adolescents) who present with a life-threatening event. Such material must be familiar to all healthcare staff and also include the needed spare parts, as well as enough drug doses. It must also be re-checked periodically. The standardisation and unification of the material and medication of paediatric CPR carts, trolleys, and backpacks, as well as the training of the personnel in their use are an essential part of the paediatric CPR.

Factores de riesgo asociados a mortalidad fetal intraparto en recién nacidos pretérmino / Risks factors associated with intra-partum foetal mortality in pre-term infants

INTRODUCCIÓN: El parto prematuro es una de las principales causas de mortalidad perinatal y fetal. Sin embargo, los factores de riesgo perinatales asociados a mortalidad fetal intraparto en partos pretérmino no han sido bien analizados. OBJETIVO: Analizar la mortalidad fetal y los factores de riesgo perinatales asociados a mortalidad fetal intraparto en gestaciones de menos de 32 semanas. MATERIAL Y MÉTODOS: Se incluyeron en el análisis todos los partos pretérmino entre las semanas 22 y 31 + 6 días, nacidos en un hospital terciario durante un periodo de 7 años (2008-2014). Se realizó análisis de regresión logística para identificar factores de riesgo perinatales asociados a mortalidad fetal intraparto (excluidos malformaciones y cromosomopatías severas). RESULTADOS: En este período el 63,1% (106/168) de la mortalidad fetal (≥ 22 semanas) se produjo en gestaciones menores de 32 semanas. Ochocientos ochenta y dos nacimientos entre las semanas 22 y 31+6 días fueron incluidos en el análisis. La mortalidad fetal fue del 11,3% (100/882). La mortalidad fetal intraparto fue del 2,6% (23/882), afectando en el 78,2% de los casos (18/23) a gestantes hospitalizadas. Encontramos que las técnicas de reproducción asistida, la ecografía fetal patológica, la no administración de corticoides antenatales, la menor edad gestacional y el bajo peso para la edad gestacional fueron factores de riesgo independientes asociados a mortalidad fetal intraparto. CONCLUSIÓN: La mortalidad fetal intraparto afectó a un porcentaje importante de nacimientos entre las semanas 22 y 31 + 6 días. El análisis de la mortalidad fetal intraparto y los factores de riesgo asociados a esta resulta de gran interés clínico y epidemiológico para optimizar el cuidado perinatal y aumentar la supervivencia del recién nacido pretérmino

INTRODUCTION: Pre-term delivery is one of the leading causes of foetal and perinatal mortality. However, perinatal risk factors associated with intra-partum foetal death in preterm deliveries have not been well studied. OBJECTIVE: To analyse foetal mortality and perinatal risk factors associated with intra-partum foetal mortality in pregnancies of less than 32 weeks gestational age. MATERIAL AND METHODS: The study included all preterm deliveries between 22 and 31 +1 weeks gestational age (WGA), born in a tertiary-referral hospital, over a period of 7 years (2008-2014). A logistic regression model was used to identify perinatal risk factors associated with intra-partum foetal mortality (foetal malformations and chromosomal abnormalities were excluded). RESULTS: During the study period, the overall foetal mortality was 63.1% (106/168) (≥ 22 weeks of gestation) occurred in pregnancies of less than 32 WGA. A total of 882 deliveries between 22 and 31 + 6 weeks of gestation were included for analysis. The rate of foetal mortality was 11.3% (100/882). The rate of intra-partum foetal death was 2.6% (23/882), with 78.2% (18/23) of these cases occurring in hospitalised pregnancies. It was found that Assisted Reproductive Techniques, abnormal foetal ultrasound, no administration of antenatal steroids, lower gestational age, and small for gestational age, were independent risk factors associated with intra-partum foetal mortality. CONCLUSION: This study showed that there is a significant percentage intra-partum foetal mortality in infants between 22 and 31+6 WGA. The analysis of intrapartum mortality and risk factors associated with this mortality is of clinical and epidemiological interest to optimise perinatal care and improve survival of preterm infants

Adaptación de las recomendaciones internacionales en estabilización y reanimación neonatal 2015 / Changes in the international recommendations on neonatal stabilisation and resuscitation (2015)

Las recomendaciones internacionales del International Liaison Committee on Resuscitation (ILCOR), mediante una revisión exhaustiva de la evidencia disponible en el desarrollo de las medidas de soporte a la transición y de reanimación del recién nacido tras su nacimiento, aportan una guía universal a partir de la cual cada grupo o comité local puede adaptarla a su realidad e idiosincrasia, y elaborar sus propias guías o recomendaciones. El objetivo de esta revisión es analizar los principales cambios, abordar las controversias generadas desde 2010, contrastarlas con las de otras organizaciones nacionales e internacionales como son la European Resuscitation Council (ERC), American Heart Association (AHA) o la Australian-New Zealand Committee on Resuscitation (ANZCOR). De esta forma, el Grupo de Reanimación Neonatal de la Sociedad Española de Neonatología (GRN-SENeo) consensúa respuestas claras sobre muchas de las preguntas que ofrecen diferentes opciones de actuación, y genera las próximas recomendaciones de nuestro país para el soporte a la transición o la reanimación del recién nacido tras su nacimiento, con seguridad y eficacia

The International Liaison Committee on Resuscitation (ILCOR) recommendations provide a universal guide of measures to support the transition and resuscitation of newborn after their birth. This guide is expected to be adapted by local groups or committees on resuscitation, according to their own circumstances. The objective of this review is to analyse the main changes, to discuss several of the controversies that have appeared since 2010, and contrasting with other national and international organisations, such as European Resuscitation Council (ERC), American Heart Association (AHA), or the Australian-New Zealand Committee on Resuscitation (ANZCOR). Thus, the Neonatal Resuscitation Group of the Spanish Society of Neonatology (GRN-SENeo) aims to give clear answers to many of the questions when different options are available, generating the forthcoming recommendations of our country to support the transition and/or resuscitation of a newborn after birth, safely and effectively

[Risks factors associated with intra-partum foetal mortality in pre-term infants]. / Factores de riesgo asociados a mortalidad fetal intraparto en recién nacidos pretérmino.

INTRODUCTION: Pre-term delivery is one of the leading causes of foetal and perinatal mortality. However, perinatal risk factors associated with intra-partum foetal death in preterm deliveries have not been well studied. OBJECTIVE: To analyse foetal mortality and perinatal risk factors associated with intra-partum foetal mortality in pregnancies of less than 32 weeks gestational age. MATERIAL AND METHODS: The study included all preterm deliveries between 22 and 31 +1 weeks gestational age (WGA), born in a tertiary-referral hospital, over a period of 7 years (2008-2014). A logistic regression model was used to identify perinatal risk factors associated with intra-partum foetal mortality (foetal malformations and chromosomal abnormalities were excluded). RESULTS: During the study period, the overall foetal mortality was 63.1% (106/168) (≥22 weeks of gestation) occurred in pregnancies of less than 32 WGA. A total of 882 deliveries between 22 and 31+6 weeks of gestation were included for analysis. The rate of foetal mortality was 11.3% (100/882). The rate of intra-partum foetal death was 2.6% (23/882), with 78.2% (18/23) of these cases occurring in hospitalised pregnancies. It was found that Assisted Reproductive Techniques, abnormal foetal ultrasound, no administration of antenatal steroids, lower gestational age, and small for gestational age, were independent risk factors associated with intra-partum foetal mortality. CONCLUSION: This study showed that there is a significant percentage intra-partum foetal mortality in infants between 22 and 31+6 WGA. The analysis of intrapartum mortality and risk factors associated with this mortality is of clinical and epidemiological interest to optimise perinatal care and improve survival of preterm infants.

[Changes in the international recommendations on neonatal stabilisation and resuscitation (2015)]. / Adaptación de las recomendaciones internacionales en estabilización y reanimación neonatal 2015.

The International Liaison Committee on Resuscitation (ILCOR) recommendations provide a universal guide of measures to support the transition and resuscitation of newborn after their birth. This guide is expected to be adapted by local groups or committees on resuscitation, according to their own circumstances. The objective of this review is to analyse the main changes, to discuss several of the controversies that have appeared since 2010, and contrasting with other national and international organisations, such as European Resuscitation Council (ERC), American Heart Association (AHA), or the Australian-New Zealand Committee on Resuscitation (ANZCOR). Thus, the Neonatal Resuscitation Group of the Spanish Society of Neonatology (GRN-SENeo) aims to give clear answers to many of the questions when different options are available, generating the forthcoming recommendations of our country to support the transition and/or resuscitation of a newborn after birth, safely and effectively.

Survival estimations at the limit of viability.

OBJECTIVE: The purpose of this study was to assess the variability in neonatal survival to discharge from the neonatal unit by using different inclusion criteria. METHODS: An observational and descriptive study was performed between January 2008 and December 2013 which included infants born between 22 weeks and 31 weeks and 6 d of gestation. The rate of survival was calculated using three different inclusion criteria: the total number of preterm births, the number of all preterm live births, and the number of preterm newborns admitted to the neonatal unit. RESULTS: A total of 783 patients met the inclusion criteria. The survival rate for births between 22 and 31 weeks and 6 d of gestation was 72.8% of total births, 82.3% of live births, and 84.0% of all admissions to the neonatal unit. Therefore, we found a significant difference in survival rates according to whether or not foetal mortality (11.6%) and mortality in the delivery room (2.0%) were included. This variation increased with decreasing gestational age: 17,2%, 25%, and 38,4% at 23 weeks gestation. CONCLUSIONS: Late foetal mortality and the mortality in the delivery room affect the survival rates of preterm infants significantly, especially the most immature newborns.