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Safety and Ergonomic Challenges of Ventilating a Premature Infant During Delayed Cord Clamping

Wannasiri Lapcharoensap1, Allison Cong2, Jules Sherman3

  • 1Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA. lapcharo@ohsu.edu.

Children (Basel, Switzerland)
|April 25, 2019
PubMed

Insights

Delayed cord clamping (DCC) with ventilation may improve infant health but presents logistical challenges. Simulation identified safety and ergonomic concerns for providers during this procedure.

Area of Science:

  • Neonatal resuscitation
  • Perinatal medicine
  • Medical simulation

Background:

  • Delayed cord clamping (DCC) is recommended for term and preterm infants, offering benefits like reduced intraventricular hemorrhage and necrotizing enterocolitis in preterm neonates.
  • Ventilation during DCC in preterm animal models suggests improved hemodynamic stability.
  • Implementing ventilation and CPAP during DCC poses logistical complexities for healthcare providers.

Purpose of the Study:

  • To explore provider attitudes towards performing ventilation during delayed cord clamping (DCC).
  • To identify safety and ergonomic challenges associated with resuscitating a newborn attached to the placenta.
  • To assess the feasibility of providing positive pressure ventilation and CPAP during simulated DCC.

Main Methods:

  • A simulation-based study using multidisciplinary workshops.
  • Simulated both vaginal and Caesarean delivery scenarios.
  • Providers practiced initiating positive pressure ventilation and transitioning to continuous positive airway pressure (CPAP) on a preterm manikin during simulated DCC.

Main Results:

  • Five key themes of concern were identified: sterility, equipment, mobility, space and workflow, and communication.
  • Video review highlighted various safety and ergonomic issues.
  • Simulation proved effective in identifying challenges for implementing ventilation during DCC.

Conclusions:

  • Simulation is a valuable tool for identifying safety and ergonomic issues before clinical implementation of ventilation during DCC.
  • Multidisciplinary workgroups and simulations are recommended for centers planning to implement DCC with ventilation.
  • Addressing identified challenges is crucial for the safe and effective application of ventilation during DCC.

Keywords:
delayed cord clampingdelivery roomneonatologypremature infantsresuscitationsimulation

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