Consensus on Science with Treatment Recommendations (CoSTR)
I appreciate it is not exactly the question of this review however, The first question that needs to be addressed is, "should epinephrine be used at all during neonatal resuscitation". There are increasing number of areas where it has been realised that neonatal treatments that have used for ever, without good evidence, are not effective and are possibly harmful. It would be a pity to recommend epinephrine to later realise it was harming the infants.
Of course outcome data is hard to collect but with large well organised collaborative randomised studies it should be possible to get some answers. I suggest this point should be strongly made in this review.
We no longer suction unless there is an obstruction, ie., mucous plug or blood/clot, and then only is requiring respiratory resuscitation. Experientially babies do fine on their own. Would be great to have some formal trials though to determine factual objective data.
Dear Sir/Madam,NRP/ILCOR are doing amazing job.
I really appreciated all your comments but keeping the blue babies blue up to 10 minutes are not helping sick children.
NRP present guidelines for pre and post ductal saturations need to revisit and seriously consider to change to help newborn sick, blue babies to avoid hypoxia and future brain damages.
There is an undeniable truth that brain needs oxygen and glucose every minutes of our lives.
The pendulum of normal oxygen saturation was shifted in 2010.
The pendulum of room air resuscitation was shifted in 2006 even when sick, blue babies are gasping for oxygen and try to survive in this beautiful World and we should help in their sufferings.
GOD BLESS YOU ALL AND MAY GOD BLESS OUR NEWBORN BABIES
Thanks and Highest Regards
I believe that the pre-resuscitation discussion is very important in the involvement of all who participate in it: nurses, doctors and technicians. As long as the risk is known in advance, I believe it is important to involve the family so that procedures can be proposed and the risks discussed before they happen.
The use of the T-piece has significantly reduced the statistic of the need for orotracheal intubation in full-term newborns in our hospital, in Rio de Janeiro/Brazil. In addition, we have a lower incidence of bronchopulmonary dysplasia in children under 34 weeks who receive PEEP at birth through the T-piece. The use of the T-piece is not only easier, it facilitates the dynamics of positive pressure ventilation in the delivery room. I believe that studies will bring this perception up soon.
The use of adrenaline in our hospital (in Rio de Janeiro / Brazil) is preferably done intravenously, in full dose (0.03mg / kg) every 5 minutes. When venous route is not available, we do it through the tracheal route, also at the maximum dose (0.1 mg / kg). However, in practically all situations where tracheal adrenaline was administered, a new dose was necessary (usually by the intravenous route). We use a maximum of 3 doses of adrenaline, with an interval of 5 minutes between each dose, regardless of the route of administration. In particular, many case outcomes are unfavorable because of the severity of asphyxia and myocardial injury suffered by newborns.
Being worked in Canada and in resource limited settings abroad, I believe using T-piece for ventilation is much easier vs. Self inflating bag, especially for all those working in resource limited area. It does not need lots of skills, additionally better pressure can be maintained with less leaks. There is less probability of inadvertent pressure delivery and less chances of pneumothorax.
Dear Ms. Raffay et al,
Thank you very much for creating this task force scoping review. With the increase of scientific literature about effect of physical fatigue on CPR quality, this review becomes strongly necessary.
Maybe studies with feedback devices were not considered, but there is a recent publication that, a priori, might be included in the PICO question proposed: PLoS One. 2018 Sep 19;13(9):e0203576. Doi: 10.1371/journal.pone.0203576. Fatigue was assessed in terms of muscle activity and CPR quality was also measured.
Thank you for your attention.
Without doubting the use of the resuscitator T piece, it has been reducing intubation rates in the delivery room, especially for extremely premature infants and reducing unnecessary exposure to invasive ventilation, which by logic should reduce chronic lung injury in addition to other undesirable outcomes.