Recent discussions
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Silvia Heloisa Moscatel Loffredo
Being a decisive moment in the resuscitation of the newborn in the delivery room, the explanation of the concerns that refer to the technique during neonatal chest compressions mentioned in this CoSTR must be performed. The continuation of further studies are extremely important for this reason. -
Jamie Tegart
Our hospital currently has access to stethoscope, pulse oximeter & ECG. For most codes, initial HR is still obtained by stethoscope as it does not require infant to be moved from Mom unless necessary. ECG monitors are brought to codes or pre-set when time allows. The use of pulse oximetry is more common if the infant is not responding to initial steps, however it is not generally accurate if the HR remains low and shouldn't be solely relied on. While more costly, increasing access to ECG monitors could allow for improved outcomes during resuscitations. -
Jamie Tegart
Currently, our unit performs initial steps on mom with stable infants only. All preterm infants or those deemed as high risk are immediately transferred to the infant warmer. An interesting topic for future review/research would be to analyze temperature differences in infants (greater than 32 weeks?) receiving delayed cord clamping and ongoing care compared to those infants requiring resus on moms chest while the cord is still intact. -
Jamie Tegart
Currently, our unit performs initial steps on mom with stable infants only. All preterm infants or those deemed as high risk are immediately transferred to the infant warmer. An interesting topic for future review/research would be to analyze temperature differences in infants (greater than 32 weeks?) receiving delayed cord clamping and ongoing care compared to those infants requiring resus on moms chest while the cord is still intact. -
Jamie Tegart
Our unit currently only provides care on the Mother beyond the initial stage for stable infants. Unstable or preterm infants are moved to the warmer. What would be beneficial would be to compare temperature differences in cases of longer delayed cord clamping and ongoing care or resus done on the mother or while the cord is intact -
Mohammad Abdul MANNAN
Cord pulsation (6 sec x 10) for assessing heart rate is better for both LMICs and others to avoid pulseless electrical activity (PEA) and other errors of pulse oximetry. -
Mohammad Abdul MANNAN
Just after birth when there is minimum or no aeration in the lungs probably chest compression : ventilation ratio 3 : 1 is quite satisfactory but anytime later during neonatal period may be chest compression : ventilation ratio 15 : 2 or any new rate as lung fields are different now and small volume of cardiac output. -
Colin Morley
The review mentions potential concerns with the use of exhaled CO2 to guide IPPV by facemask at birth. It is possible that dead-space ventilation of the mask, oropharynx, and trachea causes insufficient renewal of the expired volume. Although dead space ventilation might be a problem it is unlikely because there is commonly a leak around the face mask or ETT and so there is a continuous flushing of gas in the mask. -
Mohammad Abdul MANNAN
The difficult breathing of a term newborn interferes oxygenation, metabolism and heart rate so supplemental oxygen, instead of room air should be provided to a term newborn during resuscitation/CPR/chest compression. Controlled oxygenation (30%) for preterm and 100% oxygenation for chest compression will remain the same with intubation. -
Colin Morley
Most neonates have a healthy heart and the bradycardia mainly occurs because the myocardium is hypoxic. The best way to improve bradycardia just after birth is good lung fluid clearance, formation and maintenance of an FRC and thereby aeration to oxygenate the blood. This review assumes the cardiac compression is being started, "after successful inflation of the lungs." Unfortunately, there is no way resuscitators can determine successful aeration of the lungs. If there is bradycardia the first thing to do is improve ventilation by increasing the peak inflation pressure, or tidal volume if measured, maintaining the inflation for at least 1 second, and ensuring adequate PEEP to maintain lung volume. This review is about chest compression but before that is done either this, or another PICOST should does mention techniques of ensuring adequate lung aeration before chest compression.