Recent discussions
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Виктория Антонова
In my experience in the delivery room, especially with neonatology and pediatric residents, having a previous conversation with the multiprofessional team about the care to be provided, considering the possible needs of the child, defining roles for each member of the team, qualifies the care. Debriefing is essential to identify possible inadequacies in care, discuss the reasons that led to the inadequacy so that they do not recur, in addition to sedimenting the sequence of resuscitation procedures. -
Виктория Антонова
The use of a manual T-ventilator in the care of premature newborns in the delivery room has greatly reduced the indication for intubation during resuscitation procedures in the services where I work. The big difference seems to be the possibility of offering CPAP. Establishing and maintaining functional residual capacity soon after initial care and during transport makes a difference. The main problems we face is the quality of the equipment available. Very fragile, the pieces are lost in the sector of sterilization of the components and the great difficulty of acquiring compressed air for the gas mixture to be used during transport. The self-inflating bag is cheaper and easily available in our services. -
Виктория Антонова
Dear Sir/Madam,I have tremendous respect for the committee members for their diligent work but the following improvements could be done to make the babies better quickly without any delay to avoid brain damages from hypoxia and hypoglycemia. The whole life is ahead of them: 1) Suctioning of amniotic fluid causes more hypoxia because it delays the oxygen delivery and delays babies own breathing. It is simply not helping the newborn babies to breathe. It is simply harmful than helpful. 2) 90% of newborn babies are pink without any intervention and achieve Apgar 9 within 1 minute. Therefore remaining 10% who needs help from us, we should help them aggressively to achieve normal oxygen saturation (FT 95-100%; PT 90-94%) within 1 minute; keeping the newborn babies blue up to 10 minutes of life is simply defying the gravity of physiologic needs because babies brain needs 3-4 mL of oxygen/ 100 gm of brain tissues/ minute. During hypoxia babies are not getting any glucose that should be checked in the delivery room, Babies brain needs 3-4 mg of glucose/ 100 gm of brain tissues/ minute. Both hypoxia and hypoglycemia causes brain damages and delays speech, languages and other developmental delays. 3) Babies heart rate should be normal within 15-30 seconds. Adequate oxygen delivery and positive pressure ventilation should be started within 15 seconds without any delay in sick babies. That is the only way we can make babies better quickly and we can avoid medications. As soon as the oxygen reaches the heart, heart rate picks up rapidly and babies improve quickly. Thanks and Highest Regards Dr. Kanjilal -
Виктория Антонова
Thank you for a very well written review of this topic. A problem with all the studies is that there are no measures of the duration of inflation or the peak inflation pressures reported. So it is not possible to know whether the clinicians delivered the randomised treatment and particularly worrying when the subgroups are analysed. This would be a problem with any treatment and needs to be acknowledged in the review. -
Виктория Антонова
When assessing the effect of nasopharyngeal suction just after birth is that there are no measures of how much fluid is removed. This is an important knowledge gap. I question the use of Apgar score as a main outcome. Apgar score is very subjective and imprecise because it is recorded after the event and depends on the resuscitator's recall. The same people who are involved in the suction are giving the Apgar score. This is a major source of bias and should be mention in the assessments using Apgar score. The term SaO2 is used. However, that is the terminology for arterial oxygen saturation. Peripheral arterial oxygen saturation measurements are not just arterial oxygen. The correct term to use for measurements of peripheral arterial oxygen saturation is SpO2. -
Виктория Антонова
Thank you -
Виктория Антонова
Thank you -
Виктория Антонова
Thanks you - this is up to the Individual Resuscitation Councils/ Healthcare systems involved in delivering tracing and training of CPR -
Виктория Антонова
Thanks for the encouraging comment, we will consider if your suggestions need to be included in the gap of knowledge. -
Виктория Антонова
Thanks for the comment. We were aware of the secondary outcome survival in your study. The inclusion criteria defined in this systematic review every article that reports outcomes of technology engagement on OHCAs, without specifying if it is a primary or secondary outcome. Therefore, we used the outcomes form your study. Because such studies are not powered for secondary outcomes GRADE downgrades these studies in the risk of bias assessment. Despite of that, your results are a very important contribution in the field of first responders engagement with the help of modern technology.