Delayed vs Immediate Cord Clamping Changes Oxygen Saturation and Heart Rate Patterns in the First Minutes after Birth.

OBJECTIVE: To build arterial oxygen saturation (SpO2) and heart rate (HR) percentiles for the first 10 minutes after birth in term infants born after an uneventful gestation, vaginal delivery, and delayed cord clamping (DCC) for ≥60 seconds, and to compare our results with previous ones constructed after immediate cord clamping. STUDY DESIGN: Preductal SpO2, HR, and timing of DCC immediately after complete fetal body expulsion were recorded. The pulse-oximeter was adjusted in the right wrist/hand and set at maximal intensity and measurements performed every 2 seconds. RESULTS: A total of 282 term newborn infants were included. The definitive data set comprised of 70 257 SpO2 and 79 746 HR measurements. Median and IQR of SpO2 (%) at 1, 5, and 10 minutes after birth were 77 (68-85), 94 (90-96), and 96 (93-98), respectively. HR (beats per minute) median and IQR at 1, 5, and 10 minutes after birth were 148 (84-170), 155 (143-167), and 151 (142-161), respectively. We found significantly higher SpO2 for the 10th, 50th, and 90th percentiles compared with the previous reference ranges for the first 5 minutes and HR for the first 1-2 minutes after birth. CONCLUSIONS: Spontaneously breathing term newborn infants born by vaginal delivery who underwent DCC ≥60 seconds achieved higher SpO2 and HR in the first 5 minutes after birth compared with term neonates born under the same conditions but with immediate cord clamping. Further studies in neonates undergoing cesarean delivery are under way.

Expired Tidal Volume and Respiratory Rate During Postnatal Stabilization of Newborn Infants Born at Term via Cesarean Delivery.

Objective: To retrieve evolving respiratory measures in the first minutes after birth in normal neonates born at term using a respiratory function monitor. Study design: We evaluated newborn babies delivered at term via cesarean after uncomplicated pregnancies. Immediately after birth, a respiratory function monitor with an adapted flowmeter and a face mask were applied at 2, 5, and 10 minutes after birth for 90 seconds in each period. We analyzed expired and inspired tidal volume, respiratory rate (RR), percentage of leakage, and number of analyzed breaths in each individual infant's recording using a respiratory research software. Results: A total of 243 infants completed the study. The final data set included 59 058 (48.35%) valid observations for each of the variables representing the analysis of 32 801 breaths. With these data, we constructed a reference range with 10th, 25th, 50th, 75th, and 90th percentiles for expired tidal volume and RR. Tidal volumes plateaued earlier in female than in male infants. No correlation with delayed cord clamping, gestational age, maternal morbidity, or indication for cesarean delivery were established. Conclusions: We have constructed a reference range with percentiles for inspired and expired tidal volumes and RR in newborn babies born at term for the first 10 minutes after birth. Reference ranges can be employed for research and can be useful in the clinical setting to guide positive pressure ventilation in the delivery room.

Risk Factors for Mortality in Nursing Home Residents: An Observational Study.

Purpose: Identifying mortality risk factors in people living in nursing homes could help healthcare professionals to individualize or develop specific plans for predicting future care demands and plan end-of-life care in this population. This study aims to identify mortality risk factors in elderly nursing home (NH) residents, based on variables adapted to this environment, routinely collected and easily accessible to their healthcare professionals. Methods: A prospective, longitudinal, observational study of NH residents aged 65 years and older was carried out collecting sociodemographic, functional and cognitive status, nutritional variables, comorbidities, and other health variables. These variables were analyzed as mortality risk factors by Cox proportional hazard models. Results: A total of 531 residents (75.3% female; average age 86.7 years (SD: 6.6)) were included: 25.6% had total dependence, 53.4% had moderate to severe cognitive impairment, 84.5% were malnourished or at risk of malnutrition, and 79.9% were polymedicated. Risk of mortality (hazard ratio, HR) increased in totally dependent residents (HR = 1.52; p = 0.02) and in those with moderate or severe cognitive impairment ((HR = 1.59; p = 0.031) and (HR = 1.93; p = 0.002), respectively). Male gender (HR = 1.88; p < 0.001), age ≥80 years (HR = 1.73; p = 0.034), hypertension (HR = 1.53; p = 0.012), atrial fibrillation/arrhythmia (HR = 1.43; p = 0.048), and previous record of pneumonia (HR = 1.65; p = 0.029) were also found to be mortality drivers. Conclusion: Age and male gender (due to the higher prevalence of associated comorbidity in these two variables), certain comorbidities (hypertension, atrial fibrillation/arrhythmia, and pneumonia), higher functional and cognitive impairment, and frequency of medical emergency service care increased the risk of mortality in our study. Given their importance and their easy identification by healthcare professionals in nursing homes, these clinical variables should be used for planning care in institutionalized older adults.

Delirium Predisposing and Triggering Factors in Nursing Home Residents: A Cohort Trial-Nested Case-Control Study.

BACKGROUND: Delirium is a common geriatric syndrome, with a prevalence of between 15-70% among older long-term care residents. It is associated with adverse outcomes, and its onset may prove imperceptible to health professionals. Few studies in institutionalized older people have analyzed the predictors of delirium. OBJECTIVE: The aim of the present study was to identify delirium predisposing and triggering factors, and develop a predictive model. METHODS: A cohort trial-nested case-control study covering a period of 12 consecutive months (April 2015 - March 2016) was carried out. Predisposing and triggering episodes of delirium were recorded. RESULTS: A total of 443 older persons were recruited, with a mean age of 85.73 (6.72) years and female predominance (78.3%; n = 374). The incidence of older people with delirium was 18.7% (n = 83). Dementia was the predisposing factor with the highest predictive capacity (OR = 2.74 [1.49-5.04]). In the presence of dementia, falls (OR = 2.45 [1.49-3.69]), neuroleptics (OR = 2.39 [1.23-4.65]) and anticholinergic drug use (OR = 1.87 [0.95-3.69]) were identified as triggering factors. The area under the curve (AUC) was 0.72 (95% CI: 0.66-0.78). CONCLUSIONS: Our findings suggest that interventions targeted to potentially preventable triggering factors could avoid the onset of delirium in older people with dementia. Knowledge of the predictive factors of delirium facilitates the screening of older people at increased risk, thereby allowing mental health service providers to prevent and identify the onset of a delirium episode. The decrease in delirium predictive factors should lead to a direct reduction in the occurrence of delirium and its consequences.

A Predictive Model of the Prevalence of Delirium in Elderly Subjects Admitted to Nursing Homes.

INTRODUCTION: Delirium is common in geriatric patients admitted to nursing homes, with an incidence of 22-79% among long-term residents. AIM: To establish a predictive model of the risk of delirium episodes in a sample of elderly people living in nursing homes. MATERIAL AND METHODS: A retrospective, cross-sectional case-control study covering a period of 12 consecutive months (April 2014 - March 2015) was carried out. The included cases had suffered at least one episode of delirium during the study period. Sociodemographic and clinical variables as well as risk factors predisposing to or triggering episodes of delirium were recorded. RESULTS: A total of 193 cases and 123 controls were recruited. The mean age of the cases was 89.6 years (SD 6.9), and 75.1% were women. The mean age of the controls was 84.7 years (SD 7.42), and 75.6% were women. The prevalence of delirium was 60.7%. The presence of infections (with the exception of urinary tract infections) was the variable offering the best predictive capacity (OR=7.08; 95% CI: 3.30-15.02; p<0.001). Other predictors of delirium were also identified, such as a previous diagnosis of dementia (OR=3.14; 95% CI: 1.81-5.45; p<0.001), the use of anticholinergic drugs (OR=2.98; 95% CI: 1.34-6.60; p=0.007), a diagnosis of depression (OR=1.92; 95% CI: 1.03-3.56; p=0.039), and urinary incontinence (OR=1.73; 95% CI: 0.97-3.08; p=0.065). The area under the curve (AUC) was 0.794 (95% CI: 0.74-0.84; p<0.001). CONCLUSIONS: The prevalence of delirium among elderly subjects admitted to nursing homes was 60.7%. Infections (with the exception of urinary tract infections), dementia, anticholinergic drug use, depression and urinary incontinence were predictive of the presence of delirium.