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Caregivers' response to cardiorespiratory events in preterm infants in the NICU - A quantitative overview
Sophie J E Cramer1, Henriette A van Zanten1, Hylke H Salverda1
1Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Cardiorespiratory events are frequent in preterm infants in the Neonatal Intensive Care Unit (NICU). Caregivers rarely intervened, with responses like alarm pausing and tactile stimulation being inconsistent.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Infant Physiology
Background:
- Cardiorespiratory events are a significant concern for preterm infants in the Neonatal Intensive Care Unit (NICU).
- Prompt caregiver response is crucial for managing these events effectively.
- Understanding current caregiver response patterns is essential for improving infant care.
Purpose of the Study:
- To characterize caregiver responses to cardiorespiratory events in preterm infants.
- To quantify the frequency and types of interventions provided by caregivers.
- To analyze the timing and variability of caregiver actions.
Main Methods:
- Prospective observational study involving 19 preterm infants (28±2 weeks) on non-invasive respiratory support.
- Video recordings of incubator interiors were used to capture events and caregiver interactions over 72 hours.
- Caregiver responses to 1851 recorded cardiorespiratory events were identified and analyzed.
Main Results:
- Over 1851 cardiorespiratory events were observed, with most (91.5%) receiving no caregiver response.
- In 8.5% of events, caregivers responded by pausing alarms, adjusting devices, or providing tactile stimulation.
- Response times averaged 25.4 seconds, with tactile stimulation being the most common intervention.
Conclusions:
- Cardiorespiratory events in preterm infants within the NICU are common but frequently unaddressed by caregivers.
- The decision-making process, timing, and methods of caregiver intervention for these events show significant variability.
- Further research is needed to standardize and optimize caregiver responses to cardiorespiratory events in preterm infants.
Aim:
Cardiorespiratory events in preterm infants pose a major challenge in the Neonatal Intensive Care Unit as they require a prompt response. We aimed to describe caregivers' responses to these events.
Methods:
We performed a prospective observational study in 19 preterm infants (28 ± 2 weeks) on non-invasive respiratory support using video recordings of the inside of the incubator for 72 (55-72) h. Caregivers' responses to these events were then identified from the videos.
Results:
We recorded and assessed 1851 cardiorespiratory events with a median duration of 11.0 (5.0-23.0) s. No response was observed in the majority of the events (91.5%). In the remaining 8.5% events, caregivers responded by pausing the alarm, adjusting devices and/or providing tactile stimulation with an average response time of 25.4 (13.8-35.9) s. Stimulation was the most observed response and was applied in 38 different ways. On average, stimulation lasted 18.7 (11.6-44.6) s and the cardiorespiratory events were resolved 30.6 (19.5-47.6) s after stimulation started.
Conclusion:
Our study showed that cardiorespiratory events are common in preterm infants in the NICU, but often not followed by intervention of the caregiver. The indication, timing and execution of responses to cardiorespiratory events is highly variable.
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