Lisa K McCarthy

A Randomized Trial of Exothermic Mattresses for Preterm Newborns in Polyethylene Bags

BACKGROUND AND OBJECTIVE: Hypothermia on admission to the NICU is associated with increased mortality in preterm infants. Many newborns are hypothermic on admission despite using polyethylene bags (PBs). Using exothermic mattresses (EMs) in addition to PBs may reduce hypothermia but increase hyperthermia. We wished to determine whether placing preterm newborns in PBs on EMs in the DR results in more infants with rectal temperature outside the range 36.5 to 37.5°C on NICU admission. METHODS: Infants <31 weeks were randomly assigned before birth to treatment with or without an EM. All infants were placed in a PB and under radiant heat immediately after birth and brought to NICU in a transport incubator. Infants randomly assigned to EM were placed on a mattress immediately after delivery and remained on it until admission. Randomization was stratified by gestational age. Rectal temperature was measured with a digital thermometer on NICU admission. RESULTS: The data safety monitoring committee recommended stopping for efficacy after analyzing data from half the planned sample. We report data for 72 infants enrolled at this time. Fewer infants in PBs on EMs had temperatures within the target range (15/37 [41%] vs 27/35 [77%], P = .002) and more had temperatures >37.5°C (17/37 [46%] vs 6/35 [17%], P = .009). CONCLUSIONS: In very preterm newborns, using EMs in addition to PBs in the DR resulted in more infants with temperatures outside the normal range and more hyperthermia on NICU admission.

Warming preterm infants in the delivery room: polyethylene bags, exothermic mattresses or both?

Aims:  To compare the admission temperature of infants treated with polyethylene bags alone to infants treated with exothermic mattresses in addition to bags in the delivery room.

A Randomized Trial of Nasal Prong or Face Mask for Respiratory Support for Preterm Newborns

BACKGROUND AND OBJECTIVE: Resuscitation guidelines recommend that respiratory support should be given to newborns via a face mask (FM) in the delivery room (DR). Respiratory support given to preterm newborns via a single nasal prong (SNP; ie, short nasal tube, nasopharyngeal tube) may be more effective. We wished to determine whether giving respiratory support to preterm newborns with a SNP rather than a FM reduces the rate of intubation in the DR. METHODS: Infants <31 weeks’ gestation were randomized just before delivery to SNP (endotracheal tube shortened to 5 cm) or FM. Randomization was stratified by gestation (<28 weeks, 28–30+6). Infants with apnea, respiratory distress, and/or heart rate <100 received positive pressure ventilation with a T-piece. The primary outcome was intubation and mechanical ventilation in the DR. Infants in both groups were intubated for heart rate <100 and/or apnea despite PPV and not solely for surfactant administration. All other aspects of treatment in the DR and NICU were the same. Relevant secondary outcomes were recorded and data were analyzed by using the intention-to-treat principle. RESULTS: One hundred forty-four infants were enrolled. The rate of intubation in the DR was the same in both groups (11/72 [15%] vs 11/72 [15%], P = 1.000]. Infants assigned to SNP had lower SpO2 at 5 minutes and received a higher maximum concentration of oxygen in the DR. There were no significant differences in other secondary outcomes. CONCLUSIONS: Giving respiratory support to newborn infants <31 weeks’ gestation via a SNP, compared with a FM, did not result in less intubation and ventilation in the DR.

A randomised cross-over study of methods of acquiring ECG heart rate in newborns

The 2015 International Liaison Committee on Resuscitation1 treatment recommendations suggest that ECG can be used to provide rapid and accurate estimation of the newly born infant’s heart rate (HR). Studies report that it provides HR quicker than pulse oximetry (PO) in the delivery room (DR).2 3 In addition, a DR study of 53 infants reported that HR measured with PO at birth was significantly lower than that measured with ECG with clinically important differences in the first minutes.4 Pulse oximeters display the HR more quickly when the sensor is applied to the infant before it is connected to the monitor.5 We wished to determine …

In vitro effect of exothermic mattresses on temperature in the delivery room.

To minimize heat loss after birth the International Liaison Comittee on Resuscitation (ILCOR) recommends that infants <28 eeks’ are wrapped in polyethylene and placed under radiant heat n the delivery room (DR).1 Exothermic mattresses may also be sed in the DR to prevent hypothermia. These sodium acetate gellled mattresses crystallize when activated to produce heat. The anufacturers of TransWarmer® mattress (Cooper Surgical Inc.) tate that when activated at 24 ◦C, the mattress will reach a peak emperature of 40 ◦C in less than 60 s, however an in vitro study ound that it took 3 min from activation to peak target temperature 38–42 ◦C).2 In a prospective cohort of preterm infants who were placed n polyethylene bags under radiant heat after birth at our hospial, hyperthermia occurred more frequently in infants also placed n exothermic mattresses in the DR compared to those not laced on mattresses.3 Unexpectedly, we also found that more

Attittudes of staff members towards video recording in the delivery room

The first reported use of video recording in the delivery room (DR) was part of a quality assurance project at the University of California San Diego Medical Center that evaluated performance at neonatal resuscitation.1 Video recording has since been used to appraise many aspects of DR care.2 3 Although we have reported that video recording is in general widely accepted by staff attending deliveries and provides opportunities for self-evaluation,4 the attitudes of staff to video recording in the DR have not been studied. Video recording of high-risk infants in the DR was previously performed at our hospital and has recently been re-introduced. We created an …

A randomised trial of placing preterm infants on their back or left side after birth

Background Basic life support guidelines recommend placing spontaneously breathing children and adults on their side. Though the majority of preterm newborns breathe spontaneously, they are routinely placed on their back after birth. We hypothesised that they would breathe more effectively when placed on their side. Objective To determine whether preterm newborns placed on their left side at birth, compared with those placed on their back, have higher preductal oxygen saturation (SpO2) at 5 min of life. Design/methods We randomised infants <32 weeks to be placed on their back or on their left side immediately after birth. Respiratory support was given with a T-piece and face mask with initial fraction of inspired oxygen (FiO2) of 0.3. The FiO2 was increased if SpO2 was <70% at 5 min. Results We enrolled 87 infants, 41 randomised to back and 46 to left side. The groups were well matched for demographic variables. Fourteen (6 back and 8 left side) infants did not receive respiratory support in the first 5 min. The mean (SD) SpO2 was not different between the groups (back 72 (23) % versus left side 71 (24) %, p=0.956). We observed no adverse effects of placing infants on their side and found no differences in secondary outcomes between the groups. Conclusions Preterm infants on their left side did not have higher SpO2 at 5 min of life. Placing preterm infants on their side at birth is feasible and appears to be a reasonable alternative to placing them on their back. Trial registration number ISRCTN74486341.

Comparison of infant heart rate assessment by auscultation, ECG and oximetry in the delivery room

Clinical assessment of an infant’s heart rate (HR) in the delivery room (DR) has been reported to be inaccurate. We compared auscultation of the HR using a stethoscope with electrocardiography (ECG) and pulse oximetry (PO) for determining the HR in 92 low-risk newborn infants in the DR. Caregivers auscultated the HR while masked to the HR on the monitor. Auscultation underestimated ECG HR (mean difference (95% CI) by −9 (−15 to –2) beats per minute (bpm)) and PO HR (mean difference (95% CI) by −5 (−12 to 2) bpm). The median (IQR) time to HR by auscultation was 14 (10–18) s. As HR was determined quickly and with reasonable accuracy by auscultation in low-risk newborns, study in high-risk infants is warranted.

Magnifying lenses to aid umbilical catheter insertion

Umbilical venous and arterial catheters are frequently inserted into critically ill and preterm newborns in the neonatal intensive care unit (NICU) to administer fluids, drugs and parenteral nutrition; to monitor blood pressure; and for blood sampling(1). Successful catheterisation can be difficult and failure is common because the vessels are small, they are mobile, slippery and easily traumatised. Repeated probing and failure to adequately dilate the opening can cause a false passage adjacent to the vessel that is difficult to correct(2). This article is protected by copyright. All rights reserved.

1802 Randomised Trial of Single Nasal Prong or Face Mask for Respiratory Support for Preterm Infants in Delivery Room (ISRCTN59061709)

Background ILCOR recommends that newborns with inadequate breathing or HR < 100 bpm be given respiratory support via a face mask in the delivery room (DR); however, it may be more effective if given to preterm infants via a single nasal prong (AKA short nasal tube, nasopharyngeal tube). Aims To determine whether giving respiratory support to preterm infants via a nasal prong rather than a face mask results in fewer infants being intubated in the DR. Methods Normally formed infants < 31 weeks’ are eligible for inclusion. Randomisation is stratified by gestational age (< 28 weeks, 28–30+ 6) and allocation is concealed in sealed opaque envelopes. With parental consent, infants are randomised just prior to delivery to single nasal prong (ETT shortened to 5cm) or face mask (Fisher & Paykel, Auckland NZ). Infants who have apnoea, respiratory distress and/or a HR < 100 bpm receive respiratory support with a t-piece. Infants are only intubated in the DR for apnoea and/or bradycardia despite PPV, not for surfactant administration. All other aspects of treatment in the DR and NICU are the same for both groups. Relevant secondary outcomes are recorded. Results Since enrollment began (19.07.2010), 121 infants have been recruited and had the primary outcome determined. We expect the primary outcome will be determinable for the total sample of 142 infants by August 2012. Conclusions This randomised trial will provide valuable information about the preferred interface to use when giving respiratory support to newborn preterm infants in the DR.