Recent discussions
-
Виктория Антонова
I agree wholeheartedly with this statement. There have been some studies in adults regarding adrenaline administration which suggest this area (whether adrenaline should be used) requires study urgently in the neonatal population. -
Виктория Антонова
Although there is evidence that manual ventilation using T-Piece resuscitator is superior to self-inflating bag regarding to the delivered tidal-volume and inspiratory pressure, some questions still need to be addressed, including the advantage of using PEEP valve in the self-inflating bag compared to this equipment without the PEEP valve and compared with the T-piece. -
Виктория Антонова
I think it may be important to point out that there are many different self inflating bags and they do not function in the same way. See refs: Arch Dis Child Fetal Neonatal Ed. 2019 Jul;104(4):F403-F408. Newborn self-inflating manual resuscitators: precision robotic testing of safety and reliability. Tracy MB, Halliday R, Tracy SK, Hinder MK. In particular this paper shows that of 20 tested 10 did not work at all well. Also: "Born not breathing: A randomised trial comparing two self-inflating bag-masks during newborn resuscitation in Tanzania. Thallinger M, Ersdal HL, Francis F, Yeconia A, Mduma E, Kidanto H, Linde JE, Eilevstjønn J, Gunnes N, Størdal K. Resuscitation. 2017 Jul;116:66-72. Also the different T piece devices work in different ways see: Arch Dis Child Fetal Neonatal Ed. 2019 Mar;104(2):F122-F127. T-piece resuscitators: how do they compare? Hinder M, McEwan A, Drevhammer T, Donaldson S, Tracy MB. -
Виктория Антонова
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. -
Виктория Антонова
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. -
Виктория Антонова
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 Dr. Kanjilal -
Виктория Антонова
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. -
Виктория Антонова
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. -
Виктория Антонова
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. -
Виктория Антонова
Dear Dr. Kanjilal, I agree with your comment, but as per NRP guideline, at 1 minute, the preductal target SpO2 is 60-65% for both full term and preterm. Thanks, Mosarrat Qureshi