In Situ Simulation and Clinical Outcomes in Infants Born Preterm.

OBJECTIVE: To evaluate impact of a multihospital collaborative quality improvement project implementing in situ simulation training for neonatal resuscitation on clinical outcomes for infants born preterm. STUDY DESIGN: Twelve neonatal intensive care units were divided into 4 cohorts; each completed a 15-month long program in a stepped wedge manner. Data from California Perinatal Quality Care Collaborative were used to evaluate clinical outcomes. Infants with very low birth weight between 22 through 31 weeks gestation were included. Primary outcome was survival without chronic lung disease (CLD); secondary outcomes included intubation in the delivery room, delivery room continuous positive airway pressure, hypothermia (<36°C) upon neonatal intensive care unit admission, severe intraventricular hemorrhage, and mortality before hospital discharge. A mixed effects multivariable regression model was used to assess the intervention effect. RESULTS: Between March 2017 and December 2020, a total of 2626 eligible very low birth weight births occurred at 12 collaborative participating sites. Rate of survival without CLD at participating sites was 74.1% in March to August 2017 and 76.0% in July to December 2020 (risk ratio 1.03; [0.94-1.12]); no significant improvement occurred during the study period for both participating and nonparticipating sites. The effect of in situ simulation on all secondary outcomes was stable. CONCLUSIONS: Implementation of a multihospital collaborative providing in situ training for neonatal resuscitation did not result in significant improvement in survival without CLD. Ongoing in situ simulations may have an impact on unit practice and unmeasured outcomes.

Achieving targeted pulse oximetry values in preterm infants in the delivery room.

OBJECTIVE: To determine whether resuscitation teams can better maintain newborn transitional oxygen saturation (SpO2) values within a prespecified target range using a graphical display of the targets and real-time SpO2 data compared with using only numerical oximeter values. STUDY DESIGN: Preterm neonates were enrolled in this prospective cohort evaluation of a change in practice. The Transitional Oxygen Targeting System (TOTS) plots real-time SpO2 values in relation to 10th and 50th percentile SpO2 curves, which provides a visual target. After introduction of the TOTS, the resuscitation team adjusted the fraction of inspired oxygen to maintain the SpO2 within the target range, and before its use neonates were resuscitated in attempt to target normal transitional SpO2 values without using the TOTS monitor. Duration of time within 10th-50th percentile values was compared between 2 cohorts, children evaluated with the TOTS and those not evaluated with the TOTS (controls). RESULTS: A total of 40 infants were enrolled, including 20 prospectively evaluated with the TOTS and 20 controls. Mean gestational age, birth weight, total resuscitation time, duration of supplemental oxygen administration, changes in oxygen concentration, and respiratory support provided were similar in the 2 groups. The TOTS cohort spent 52% of time within the target range; the control cohort, 37% (P = .03). CONCLUSION: SpO2 values were maintained within a specified target range for significantly longer in preterm neonates resuscitated using the TOTS display compared with those resuscitated without TOTS.

Reanimación neonatal: ¿qué hay de nuevo? / Neonatal resuscitation: What is new?

A escala mundial, alrededor de 5 a 10% de recién nacidos requieren algún tipo de asistencia en el momento del nacimiento que puede ir desde maniobras de reanimación tan sencillas como la aspiración de secreciones y estimulación táctil, a otras más complejas como ventilación con presión positiva, compresiones torácicas externas y administración de epinefrina. Esto obliga a difundir un programa de reanimación que proporcione una oportunidad para aprender de manera organizada, apropiada y oportuna, la asistencia a recién nacidos para asegurar su adecuada transición a la vida extrauterina y disminuir los riesgos de daño neurológico. El Programa de Reanimación Neonatal (PRN) constituye un modelo preciso de educación médica de trascendental importancia, pues representa una prioridad dentro de los programas de salud reproductiva. Aquí se presentan las últimas recomendaciones de la Academia Americana de Pediatría y la Asociación Americana del Corazón para actualizar el PRN, basadas en diferentes niveles de evidencia. El conocimiento de las mismas y la destreza de quienes apliquen el programa seguramente ayudarán a disminuir uno de los grandes problemas de salud pública en México: la asfixia neonatal y sus complicaciones.

Worldwide, 5-10% of all newborns require some kind of intervention at birth. Thus, it is important to teach the Neonatal Resuscitation Program (NRP) to all personnel attending deliveries. This program provides a systematic approach to different situations encountered at birth to facilitate neonatal resuscitation. The NRP has been embraced by public health authorities among different countries. In this paper we summarize the most recent recommendations from the American Academy of Pediatrics (AAP) and American Heart Association (AHA) to update the NRP; these are based on different levels of evidence. The knowledge and practice of these recommendations will certainly help to improve neonatal outcomes and to decrease asphyxia and its complications.