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The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation
Published on: August 15, 2018
Early initiation of basic resuscitation interventions including face mask ventilation may reduce birth asphyxia
Hege Langli Ersdal1, Estomih Mduma, Erling Svensen
1Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Norway. lehe@sus.no
Insights
Timely resuscitation is crucial for newborns. Delays in starting face mask ventilation (FMV) increase the risk of death or prolonged admission in infants requiring this intervention.
Area of Science:
- Neonatal Resuscitation
- Perinatal Physiology
- Global Health
Background:
- Early resuscitation within 60 seconds is vital for apneic newborns to prevent circulatory collapse.
- Understanding normal transitional respiratory adaptation at birth is key to assessing resuscitation effectiveness.
Purpose of the Study:
- To describe normal neonatal respiratory adaptation at birth in a rural Tanzanian hospital.
- To evaluate the impact of initiating basic resuscitation interventions promptly on neonatal outcomes.
Main Methods:
- Observational study involving 5845 deliveries in Tanzania.
- Monitoring of newborn infants and birth attendant responses to depressed neonates.
- Recording time to spontaneous respirations, onset of breathing after stimulation/suctioning, and duration of face mask ventilation (FMV).
Main Results:
- 84% of liveborn infants initiated spontaneous respirations within 60 seconds.
- Basic resuscitation was initiated in 16% of infants, with 49.9% receiving FMV.
- A 16% increase in risk for death or prolonged admission for every 30-second delay in FMV initiation up to six minutes was observed.
Conclusions:
- Most infants in primary apnea responded to stimulation, suctioning, and/or FMV.
- Infants requiring FMV faced higher mortality risks, especially with delayed or prolonged ventilation.
- Prompt initiation of basic resuscitation, particularly FMV, is critical for improving neonatal survival rates.
Aim Of The Study:
Early initiation of basic resuscitation interventions within 60 s in apneic newborn infants is thought to be essential in preventing progression to circulatory collapse based on experimental cardio-respiratory responses to asphyxia. The objectives were to describe normal transitional respiratory adaption at birth and to assess the importance of initiating basic resuscitation within the first minutes after birth as it relates to neonatal outcome.
Methods:
This is an observational study of neonatal respiratory adaptation at birth in a rural hospital in Tanzania. Research assistants (n=14) monitored every newborn infant delivery and the response of birth attendants to a depressed baby. Time to initiation of spontaneous respirations or time to onset of breathing following stimulation/suctioning, or face mask ventilation (FMV) in apneic infants, and duration of FMV were recorded.
Results:
5845 infants were born; 5689 were liveborn, among these 4769(84%) initiated spontaneous respirations; 93% in ≤30 s and 99% in ≤60 s. Basic resuscitation (stimulation, suction, and/or FMV) was attempted in 920/5689(16.0%); of these 459(49.9%) received FMV. Outcomes included normal n=5613(96.0%), neonatal deaths n=56(1.0%), admitted neonatal area n=20(0.3%), and stillbirths n=156(2.7%). The risk for death or prolonged admission increases 16% for every 30 s delay in initiating FMV up to six minutes (p=0.045) and 6% for every minute of applied FMV (p=0.001).
Conclusions:
The majority of lifeless babies were in primary apnea and responded to stimulation/suctioning and/or FMV. Infants who required FMV were more likely to die particularly when ventilation was delayed or prolonged.
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