Abstract
OBJECTIVES: To evaluate the current practice variabilities during resuscitation of preterm infants by the dedicated Resuscitation Stabilization Team (RST) using videos and respiratory function recordings of the delivery room management. DESIGN/METHODS: At our center, neonatal stabilization rooms are equipped with video recording and respiratory function monitor. We analyzed the first 10 minutes of delivery room stabilization of preterm infants at birth. The RST performance was evaluated and compared against the Canadian and regional Neonatal Resuscitation Guidelines. RESULTS: Thirty infants were video recorded over 8 months, with mean gestational age (GA) 26 (±2) weeks and birth weight 960 (±315)g. There was 100% compliance with using the plastic drape for infants less than 28 weeks GA. EKG leads and Pulse Oximetry were applied to all 30 patients. The median time[IQR] for application of the pulse oximetry was 47 seconds [35- 65] from the time of arrival at the table. Only 9/30 infants were suctioned prior to starting the respiratory support. There were inconsistencies in drying and stimulation within first minute for infants less than 28 weeks GA. There was a trend of initiating mask Continuous Positive Airway Pressure (CPAP) prior to completing initial assessment for adequacy of spontaneous breathing. 14 infants were apneic when placed on the table. The median [IQR] time to initiate positive pressure ventilation (PPV) in these apneic babies was 26 seconds [12-37.5]. 5/9 apneic babies didn’t have clinical assessment of heart rate as a part of initial assessment or to establish effectiveness of the ventilation. There were 10 events in 7 patients where PPV was interrupted by the PPV provider for purposes other than ventilation corrective steps. Early initiation of nasal CPAP i.e., less than 10 minutes was noted in 8 babies. CONCLUSION: The results of the RST performance are comparable to available literature. The results represent efficient neonatal stabilizations by a well-trained stabilization team. The variability of sequence in accomplishing each step of resuscitation could indicate resuscitator’s training and experience for individual skill set or judgement on rapidly changing clinical situation. There is a need of ongoing resuscitation training with special focus on situational awareness to prepare the NRP providers for timely strategized performance. Resuscitation videos can be a useful tool for educational and training of NRP providers.The results of the RST performance are comparable to available literature. The results represent efficient neonatal stabilizations by a well-trained stabilization team. The variability of sequence in accomplishing each step of resuscitation could indicate resuscitator’s training and experience for individual skill set or judgement on rapidly changing clinical situation. There is a need of ongoing resuscitation training with special focus on situational awareness to prepare the NRP providers for timely strategized performance. Resuscitation videos can be a useful tool for educational and training of NRP providers.The results of the RST performance are comparable to available literature. The results represent efficient neonatal stabilizations by a well-trained stabilization team. The variability of sequence in accomplishing each step of resuscitation could indicate resuscitator’s training and experience for individual skill set or judgement on rapidly changing clinical situation. There is a need of ongoing resuscitation training with special focus on situational awareness to prepare the NRP providers for timely strategized performance. Resuscitation videos can be a useful tool for educational and training of NRP providers.