Clinical paperThe relation between given volume and heart rate during newborn resuscitation☆
Section snippets
Background
An estimated 10 million newborns are born apneic every year [1]. Although advances in management of newborns requiring resuscitation have been made over the past decades, approximately 700,000 annual deaths result from a failure to restore cardio-respiratory function [2].
Establishment of functional residual capacity (FRC) and delivery of effective inflation volumes are essential for a good outcome in depressed newborns requiring positive pressure ventilation (PPV). Rapid increase in heart rate
Methods
This cross-sectional observational study was performed June 2013- October 2014 at Haydom Hospital in Tanzania, a rural hospital with ∼4500 births annually, providing emergency obstetric and basic emergency newborn care. Deliveries are conducted by midwives. Doctors on call are trained to perform cesarean section. Eighteen research assistants have been trained to observe and document time of birth events, clinical characteristics of the newborns, and outcome [10]. Newborn Resuscitation Monitors
General characteristics
During the study period, 5914 newborns were delivered, and 459 (7.8%) received PPV. In 113 newborns, the monitor was not used. Newborns (n = 131) were excluded for the following indications: PPV initiated before application of HR sensor (n = 103), delay in initiating PPV for more than four minutes (n = 5), immediate outcome of death or fresh stillbirth on the resuscitation table (n = 18), other (n = 5). The remaining 215 newborns were included in the study. The included newborns had a GA of 37.3 ± 1.9
Discussion
These findings demonstrate a significant non-linear relationship between delivered TV and HR increase during initial resuscitation of the non-breathing newborn. The volumes from 6 ml/kg up to 9.3 ml/kg resulted in a positive change in HR in our model. A change in HR over a ventilation sequence was influenced by the initial HR and the number of added PPV sequences. This was particularly evident in newborns with an initial HR <100 bpm with a more rapid increase in HR during the initial two PPV
Conclusions
This study showed a positive relationship between HR increase and application of PPV in non-breathing newborns, with TV up to 9.3 ml/kg producing a rapid increase in HR. This adds evidence to the longstanding notion that effective ventilation is critical to HR recovery at birth. The increase in HR occurred despite frequent pauses, suggesting that most neonates were in primary apnea. Despite the favorable responses in most newborns, future educational strategies should emphasize the importance of
Conflict of interest statement
We wish to draw the attention of the Editor to the following facts which may be considered as potential conflicts of interest, Jørgen Linde is married to an employee of Laerdal Global Health.
Further we wish to confirm that there are no other known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.
We confirm that the manuscript has been read and approved by all named authors and that
Source of support
This study was partly supported by the Research Council of Norway through the Global Health and Vaccination Program (GLOBVAC), project number 228203. Jørgen Linde has received research grants, and Haydom Lutheran Hospital has received project funds from The Laerdal Foundation for Acute Medicine. Jeffrey Perlman has received a travel grant to oversee the Helping Babies Breathe Program in Tanzania from the Laerdal Foundation for Acute Medicine.
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Respiratory function monitoring during neonatal resuscitation: A systematic review
2022, Resuscitation PlusCitation Excerpt :In randomized controlled trials (RCTs) the use of respiratory function monitoring reduces face mask leak.11–14 Studies with respiratory function monitoring have demonstrated that changes in tidal volume occur during transition at birth,15 a positive relationship between tidal volume delivered and increase of heart rate during this transition,16 the contribution of spontaneous breathing to the tidal volume in newborn infants being provided positive pressure ventilation17–18 and tidal volume changes during cardiac compressions.19 Clinically, respiratory function monitoring via mechanical ventilators is commonly used in the neonatal intensive care unit (NICU) as a feedback tool.20
Positive pressure ventilation at birth
2022, Seminars in PerinatologyA multi-centre randomised controlled trial of respiratory function monitoring during stabilisation of very preterm infants at birth
2021, ResuscitationCitation Excerpt :However, there is still uncertainty what Vte is necessary for lung aeration and it is likely to change with time and breathing. Linde et al. reported that during PPV in apnoeic term infants higher Vte’s were used.33 The recommendation of 4–8 mL/kg is largely based on ventilation via an endotracheal tube.
European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth
2021, ResuscitationCitation Excerpt :In a retrospective video based observational study of 62 preterm infants delivered at <28 weeks or with birth weight <1000 g 80% were assessed as showing signs of breathing but all received respiratory support with CPAP or intubation.125 Immediately after birth, the heart rate is assessed to evaluate the condition of the infant and subsequently, heart rate is the most sensitive indicator of a successful response to interventions.126–128 There is no published evidence unambiguously defining the thresholds for intervention during newborn resuscitation.
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“A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2017.06.007”