Abstract 187: Incidence, Timing and Duration of Newborn Resuscitations: Challenges for Implementation of International Treatment Recommendations
INTRODUCTION: International consensus recommendations for newborn resuscitation allocate <60 seconds following birth to dry, stimulate, and assess heart rate and respirations before initiating time critical interventions such as positive-pressure ventilation (PPV). However, there is scarce data on the incidence, actual timing and duration of interventions for newborn resuscitations in a normal-risk delivery room.
METHODS: Prospective, observational study conducted in the delivery unit at an academic training hospital. All deliveries during selected random weekday/evening 8-hours shifts were attended by a highly trained observer. Real-time data was collected on all newborns ≥32 weeks gestational age who received PPV immediately after birth. Time was recorded as from time of birth. Descriptive summaries were compared to international recommendations for time critical assessments and interventions.
RESULTS: Between Jan-June 2014, 295 (22%) of 1372 live deliveries were observed. PPV was required in 22/295 (7%) of those deliveries. Mean gestational age was 38 ±2.6 weeks. At 60s, heart rate was <60/m in 3 (14%), 60-100/m in 12 (55%) and >100/m in 6 (27%). Within the first 60s, 100% received suction. Pulse oximetry was eventually placed on 21 (95%), but only 2 (17%) within time critical recommended target of 60s: mean time to placement 138 ± 96s. PPV was started within 60s in 10 (45%), between 60-<120s in 7 (32%), and >120s in 5 (23%). PPV duration was <60s in 3 (14%), 60-<120s in 7 (32%), and ≥120s in 12 (54%). Time to spontaneous respirations (PPV stopped) was <120s in 6 (27%) and >5m in 7 (32%). Tracheal intubation was required in 3 (14%); mean time to intubation 5:42m ± 35s.
CONCLUSION: Most (93%) newborns ≥32 weeks GA spontaneously initiate respirations. Providers applied international resuscitation recommendations for assessment and treatment (e.g. suction, pulse oximetry, initiation of PPV for HR <100), but were challenged to meet time-critical targets for assessments and interventions for newborns requiring assisted ventilation. Incidence, actual timing and duration of interventions for newborn resuscitations in normal-risk delivery rooms should inform future guidelines for simple and pragmatic resuscitation guidelines.
Author Disclosures: D.E. Niles: None. E. Foglia: None. D. Kim: None. A. Murray: None. R. Olivere: None. S. Christiane: None. T. Olasveengen: None. A. Ades: None. M. Posencheg: None. V. Nadkarni: None. J. Kramer-Johansen: None.
- © 2014 by American Heart Association, Inc.