Recent discussions
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Camilla Tovar
In our service, we use CPAP for all newborns over 34 weeks after resuscitation if there is no improvement after 2 h of mild respiratory distress or immediately after delivery in cases of more severe discomfort, in an attempt to avoid a more invasive intervention. Starting CPAP right after resuscitation, while still in the delivery room, for all NB > 34 weeks with respiratory distress can speed up the recovery process and start oral feeding, reducing hospital stay! More studies are needed to assess the risk of air leak syndrome! -
Camilla Tovar
In our reality, the laryngeal mask still does not have an appropriate space! Considering that one of the main reasons for tracheal intubation during resuscitation is failure of mask ventilation, investing in training in laryngeal mask ventilation could actually reduce the number of intubations in over 34 weeks! -
Clarice Adelaide Ramacciotti Graça
I’m afraid tactile stimulation cause a delay in the beginning of intermitent Positive pressure. -
Simon Gould
There are two significant flaws in the assumptions made by the hospital-based and academic developers of BLS treatment recommendations. Firstly that cardiac arrest is a homogenous set of etiologies that cannot be distinguished or separated at the BLS level to provide appropriate interventions over generic ones. Secondly, as CCO is already established as a form of passive ventilation that has utility and efficacy, the resultant treatment recommendation is therefore contradictory and inconsistent with BLS practice. A treatment recommendation made with insufficient relevant studies or consideration of the contradictions is nevertheless a recommendation. ILCOR should have come to no conclusion (which is an option under the review process) given the nature of the subject and the knowledge gaps i.e. that there is benefit in some circumstances, however, more research needs to be undertaken to determine the best implementation practices and circumstances where passive ventilation is of the most value. -
Laura Gregol
Indicating tactile stimulation in the Neonatal Resuscitation Manual may delay the really necessary measures such as positive pressure ventilation. The time spent drying the skin would be sufficient and necessary tactile stimulation. Not delaying really effective measures. -
LEONARDO SIQUEIRA
Tactile stimulation nowadays are in desuse because risk of hemorrhage intracranial and somekind of lesion skin,principally at newborn under 34 weeks. -
Nicole Udsen Luis
More studies are needed as to outcomes of respiratory support in early respiratory distress. Use of CPAP seems to reduce time of O2 dependence and discomfort, but may delay initiation of oral feeds. Studies should review time to discharge and complications. At our service we use early CPAP in term and preterm infants. -
Nicole Udsen Luis
We use supraglottic device only in difficult airway at the moment. The recommendation has interesting points, I beleive failure to correctly ventilate with face masks can be one of the reasons of needing to intubate and that may possibly be corrected with supraglottic devices. -
Marinice Ponte
In the past, for each late preterm or term neonate who developed respiratory distress after delivery, were submitted to hood for 3, 4, 6 hours of life before admission in NCIU. During this period, many of them became better, but about 25% sustained distress and your complications (pneumothorax or pulmonary hypertension, for instance). Since 2020 we have used CPAP instead hood, in according to the manual of care post reanimation. We have followed the Downes Index recommendations, and offer oxigen, CPAP or only observation in delivery room around one hour, if they are stable. If they become better, stay with their mothers. If they don’t normalize their status or became worse , they are admitted in NCIU. Changing our procedures have showed us this babys (around 40 neonates/month) have better disclosure. We have 800 -1000 deliveries per month, most of them by cesarean before the beginning of labour, as in most of private hospitals here in Brasil. So, I think our not controlled experience (we don’t have any indicators) justify for us at least, we need mantain this approach. If ILCOR could help and teach us to develop studies in this field, perhaps we could contribute to this theme. -
Nicole Udsen Luis
In term infants I beleive tactile stimulation without delaying initiation of ventilation is appropriate and can be beneficial, but should not be used in preterm infants under 34 weeks as it could increase risk of skin lesions and intra cerebral hemorrage.