Abstract 347: “No-Blow Time” During the First Minute of Neonatal Resuscitation
Background: Most newborns manage the transition from intra- to extrauterine life without interventions. Still, approximately 5 % need positive pressure ventilation (PPV) for successful transition. Guidelines urge providers to ensure good quality PPV for at least 30 seconds before considering chest compressions and intravenous therapy. Pauses in PPV during this first minute may delay recovery of spontaneous respiration and heart rate.
Objective: To find the proportion of no-blow time during the first minute of PPV in non-breathing babies.
Methods: Prospective observational study at Oslo University Hospital, Norway. All newborns (gestational age > 32 weeks) receiving PPV immediately after delivery were included. Six cameras with motion detectors were installed at every resuscitation bay capturing both expected and unexpected compromised newborns. We determined no-blow time as the cumulative number of seconds without PPV efforts and without spontaneous breathing and report fraction of no-blow time during the first minute. Data are presented as median (range). Approval was obtained from our institutional review board. All providers and parents were informed in writing about the project and could opt-out at any time.
Results: 277 of 1276 (22 %) newborns were filmed in the resuscitation bays and 49 (4 %) received PPV, weight 3.2 (1.4-4.2) kg and gestational age 40 (32-43) weeks. PPV started 44 (3-244) s after arrival at the resuscitation bay and lasted for more than one minute in 40 cases. Median duration was 128 (25-2052) s. One newborn was admitted to NICU with ongoing PPV. Nineteen infants (40 %) were ventilated continuously, or with minimal pause (< 6 seconds/10 %) during the first minute of PPV. For the remaining 30 infants no-blow fraction was 54 (13-90) %. PPV was halted due to distractions, reposition of mask or change of equipment between 1 and 5 times.
Conclusion: In 60 % of the neonatal resuscitations interruptions in ventilation are frequent with 50 % no-blow fraction during the first minute of PPV. Eliminating disruption for improved quality of PPV delivery should be emphasized when training newborn resuscitation providers.
Author Disclosures: C. Skåre: None. J. Kramer-Johansen: None. D.E. Niles: None. V.M. Nadkarni: None. T.M. Olasveengen: None.
- © 2014 by American Heart Association, Inc.