The Experts below are selected from a list of 22422 Experts worldwide ranked by ideXlab platform
Haresh Kirpalani - One of the best experts on this subject based on the ideXlab platform.
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Delivery Room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants
Journal of Perinatology, 2017Co-Authors: E E Foglia, Erik A Jensen, Haresh KirpalaniAbstract:Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory complication of preterm birth. Preterm infants are at risk for acute lung injury immediately after birth, which predisposes to BPD. In this article, we review the current evidence for interventions applied during neonatal transition (Delivery Room and first postnatal hours of life) to prevent BPD in extremely preterm infants: continuous positive airway pressure (CPAP), sustained lung inflation, supplemental oxygen use during neonatal resuscitation, and surfactant therapy including less-invasive surfactant administration. Preterm infants should be stabilized with CPAP in the Delivery Room, reserving invasive mechanical ventilation for infants who fail non-invasive respiratory support. For infants who require endotracheal intubation and mechanical ventilation soon after birth, surfactant should be given early (
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Delivery Room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants
Journal of Perinatology, 2017Co-Authors: Elizabeth E. Foglia, Erik A Jensen, Haresh KirpalaniAbstract:Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory complication of preterm birth. Preterm infants are at risk for acute lung injury immediately after birth, which predisposes to BPD. In this article, we review the current evidence for interventions applied during neonatal transition (Delivery Room and first postnatal hours of life) to prevent BPD in extremely preterm infants: continuous positive airway pressure (CPAP), sustained lung inflation, supplemental oxygen use during neonatal resuscitation, and surfactant therapy including less-invasive surfactant administration. Preterm infants should be stabilized with CPAP in the Delivery Room, reserving invasive mechanical ventilation for infants who fail non-invasive respiratory support. For infants who require endotracheal intubation and mechanical ventilation soon after birth, surfactant should be given early (<2 h of life). We recommend prudent titration of supplemental oxygen in the Delivery Room to achieve targeted oxygen saturations. Promising interventions that may further reduce BPD, such as sustained inflation and non-invasive surfactant administration, are currently under investigation.
Elizabeth E. Foglia - One of the best experts on this subject based on the ideXlab platform.
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Impact of flow disruptions in the Delivery Room
Resuscitation, 2020Co-Authors: Heidi Meredith Herrick, Scott A. Lorch, Jesse Y. Hsu, Ken Catchpole, Elizabeth E. FogliaAbstract:Abstract Aim Flow disruptions (FDs) are deviations from the progression of care that compromise safety and efficiency of a specific process. The study aim was to identify the impact of FDs during neonatal resuscitation and determine their association with key process and outcome measures. Methods Prospective observational study of video recorded Delivery Room resuscitations of neonates Results Between 10/2017–7/2018, 32 videos were included. A mean of 52.6 FDs (standard deviation 17.9) occurred per resuscitation. Extraneous FDs were the most common FDs. FDs were associated with an adjusted odds ratio of 0.92 (95% confidence interval [CI] 0.80–1.05) of achieving target saturation at 5 min and 0.94 (95% CI 0.84–1.05) at 10 min. There was no significant evidence to show FDs were associated with time to event outcomes. Conclusions FDs occurred frequently during neonatal resuscitation. Measuring FDs is a feasible method to assess the impact of human factors in the Delivery Room and identify modifiable factors and practices to improve patient care.
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Corrective steps to enhance ventilation in the Delivery Room.
Archives of disease in childhood. Fetal and neonatal edition, 2020Co-Authors: Kesi C Yang, Danielle Weinberg, Arjan B. Te Pas, Elizabeth E. FogliaAbstract:Objective The clinical impact of ventilation corrective steps for Delivery Room positive pressure ventilation (PPV) is not well studied. We aimed to characterise the performance and effect of ventilation corrective steps (MRSOPA (Mask adjustment, Reposition airway, Suction mouth and nose, Open mouth, Pressure increase and Alternative airway)) during Delivery Room resuscitation of preterm infants. Design Prospective observational study of Delivery Room PPV using video and respiratory function monitor recordings. Setting Tertiary academic Delivery hospital. Patients Preterm infants Main outcome measure Mean exhaled tidal volume (Vte) of PPV inflations before and after MRSOPA interventions, categorised as inadequate ( 8 mL/kg). Secondary outcomes were leak (>30%) and obstruction (Vte Results There were 41 corrective interventions in 30 infants, with a median duration of 15 (IQR 7–29) s. The most frequent intervention was a combination of Mask/Reposition and Suction/Open. Mean Vte was inadequate before 16/41 interventions and became adequate following 6/16. Mean Vte became excessive after 6/41 interventions. Mask leak, present before 13/41 interventions, was unchanged after 4 and resolved after 9. Obstruction was present before five interventions and was subsequently resolved only once. MRSOPA interventions introduced leak in two cases and led to obstruction in one case. The heart rate was 100 beats per minute after 14/31 of these. Conclusions Ventilation correction interventions improve tidal volume Delivery in some cases, but lead to ineffective or excessive tidal volumes in others. Mask leak and obstruction can be induced by MRSOPA manoeuvres.
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accuracy of real time Delivery Room resuscitation documentation
Archives of Disease in Childhood, 2020Co-Authors: Claire E Fishman, Danielle Weinberg, Ashley Murray, Elizabeth E. FogliaAbstract:Objective To assess the accuracy of real-time Delivery Room resuscitation documentation. Design Retrospective observational study. Setting Level 3 academic neonatal intensive care unit. Participants Fifty infants with video recording of neonatal resuscitation. Main outcome measures Vital sign assessments and interventions performed during resuscitation. The accuracy of written documentation was compared with video gold standard. Results Timing of initial heart rate assessment agreed with video in 44/50 (88%) records; the documented heart rate was correct in 34/44 (77%) of these. Heart rate and oxygen saturation were documented at 5 min of life in 90% of resuscitations. Of these, 100% of heart rate and 93% of oxygen saturation values were correctly recorded. Written records accurately reflected the mode(s) of respiratory support for 89%–100%, procedures for 91%–100% and medications for 100% of events. Conclusion Real-time documentation correctly reflects interventions performed during Delivery Room resuscitation but is less accurate for early vital sign assessments.
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Video Recording Delivery Room Resuscitation
NeoReviews, 2017Co-Authors: Elizabeth E. Foglia, Jennifer James, Michael A. PosenchegAbstract:Video recording provides an objective and reliable method to record and assess Delivery Room resuscitation. This tool supports Delivery Room quality improvement projects, research, and education. Initiating video recording entails consideration of patient and staff consent, privacy, data management and security, medical-legal issues, training and implementation, and equipment. In this article, we review these issues and present our institutional experience implementing a Delivery Room video program as a case example.
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Delivery Room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants
Journal of Perinatology, 2017Co-Authors: Elizabeth E. Foglia, Erik A Jensen, Haresh KirpalaniAbstract:Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory complication of preterm birth. Preterm infants are at risk for acute lung injury immediately after birth, which predisposes to BPD. In this article, we review the current evidence for interventions applied during neonatal transition (Delivery Room and first postnatal hours of life) to prevent BPD in extremely preterm infants: continuous positive airway pressure (CPAP), sustained lung inflation, supplemental oxygen use during neonatal resuscitation, and surfactant therapy including less-invasive surfactant administration. Preterm infants should be stabilized with CPAP in the Delivery Room, reserving invasive mechanical ventilation for infants who fail non-invasive respiratory support. For infants who require endotracheal intubation and mechanical ventilation soon after birth, surfactant should be given early (<2 h of life). We recommend prudent titration of supplemental oxygen in the Delivery Room to achieve targeted oxygen saturations. Promising interventions that may further reduce BPD, such as sustained inflation and non-invasive surfactant administration, are currently under investigation.
Louis P. Halamek - One of the best experts on this subject based on the ideXlab platform.
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A national survey of pediatric residents and Delivery Room training experience.
The Journal of pediatrics, 2010Co-Authors: Henry C. Lee, Ritu Chitkara, Louis P. Halamek, Susan R. HintzAbstract:Objective To investigate current Delivery Room training experience in US pediatric residency programs and the relationship between volume of Delivery Room training and confidence in neonatal resuscitation skills. Study design Links to a web-based survey were sent to pediatric residency programs and distributed to residents. The survey concerned Delivery Room attendance during training and comfort level in leading neonatal resuscitation for various scenarios. Comfort level was rated on a 1 to 9 scale. Mixed models accounted for residency programs as random effects. Results For PL-3s, the mean number of deliveries attended was 60 (standard deviation, 43), ranging from 13 to 143 deliveries for individual residency programs. Residents' confidence level in leading neonatal resuscitation was higher when attending more deliveries, with 90.3% of those attending >48 deliveries having average score 5 or greater vs 51.5% of those attending Conclusions Wide variability existed within and among residency programs in number of deliveries attended. Volume of experience correlated with confidence in leading neonatal resuscitation and related procedural skills.
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Delivery Room management of the newborn.
Pediatric clinics of North America, 2009Co-Authors: Anand K. Rajani, Ritu Chitkara, Louis P. HalamekAbstract:Neonatal resuscitation is an attempt to facilitate the dynamic transition from fetal to neonatal physiology. This article outlines the current practices in Delivery Room management of the neonate. Developments in cardiopulmonary resuscitation techniques for term and preterm infants and advances in the areas of cerebral resuscitation and thermoregulation are reviewed. Resuscitation in special circumstances (such as the presence of congenital anomalies) are also covered. The importance of communication with other members of the health care team and the family is discussed. Finally, future trends in neonatal resuscitation are explored.
Erik A Jensen - One of the best experts on this subject based on the ideXlab platform.
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Delivery Room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants
Journal of Perinatology, 2017Co-Authors: E E Foglia, Erik A Jensen, Haresh KirpalaniAbstract:Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory complication of preterm birth. Preterm infants are at risk for acute lung injury immediately after birth, which predisposes to BPD. In this article, we review the current evidence for interventions applied during neonatal transition (Delivery Room and first postnatal hours of life) to prevent BPD in extremely preterm infants: continuous positive airway pressure (CPAP), sustained lung inflation, supplemental oxygen use during neonatal resuscitation, and surfactant therapy including less-invasive surfactant administration. Preterm infants should be stabilized with CPAP in the Delivery Room, reserving invasive mechanical ventilation for infants who fail non-invasive respiratory support. For infants who require endotracheal intubation and mechanical ventilation soon after birth, surfactant should be given early (
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Delivery Room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants
Journal of Perinatology, 2017Co-Authors: Elizabeth E. Foglia, Erik A Jensen, Haresh KirpalaniAbstract:Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory complication of preterm birth. Preterm infants are at risk for acute lung injury immediately after birth, which predisposes to BPD. In this article, we review the current evidence for interventions applied during neonatal transition (Delivery Room and first postnatal hours of life) to prevent BPD in extremely preterm infants: continuous positive airway pressure (CPAP), sustained lung inflation, supplemental oxygen use during neonatal resuscitation, and surfactant therapy including less-invasive surfactant administration. Preterm infants should be stabilized with CPAP in the Delivery Room, reserving invasive mechanical ventilation for infants who fail non-invasive respiratory support. For infants who require endotracheal intubation and mechanical ventilation soon after birth, surfactant should be given early (<2 h of life). We recommend prudent titration of supplemental oxygen in the Delivery Room to achieve targeted oxygen saturations. Promising interventions that may further reduce BPD, such as sustained inflation and non-invasive surfactant administration, are currently under investigation.
Wade Rich - One of the best experts on this subject based on the ideXlab platform.
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Circulatory emergencies in the Delivery Room.
Seminars in fetal & neonatal medicine, 2019Co-Authors: Anup C. Katheria, Wade Rich, Satyan LakshminrusimhaAbstract:Abstract The transition from fetal to neonatal life is a dramatic and complex process involving extensive physiologic changes, which are most obvious at the time of birth. Individuals who care for newly born infants must monitor the progress of the transition and be prepared to intervene when necessary. In the majority of births, this transition occurs without a requirement for any significant assistance. If newborns require assistance, the majority of the time respiratory support is all that is required. In some instances, however, there are circulatory emergencies that need to be rapidly identified or there may be dire consequences including death in the Delivery Room. This chapter will review various pathologies that are circulatory emergencies, and discuss how to assess them. We will also review new technologies which may help providers better understand the circulatory status or hemodynamic changes in the Delivery Room including heart rate, cardiac output, cerebral oxygenation and echocardiography.
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Delivery Room Respiratory Management of the Term and Preterm Infant
Clinics in perinatology, 2012Co-Authors: Tina A. Leone, Neil N. Finer, Wade RichAbstract:The immediate newborn transition is a time of great physiologic adjustments and many infants need assistance to make a successful transition to newborn life. Assisted ventilation is the most important intervention performed during this transitional period. Noninvasive ventilation is a necessary skill for all pediatric providers because it is the most frequently required lifesaving measure provided in the Delivery Room. Providing ventilation in the least injurious manner is also necessary and many aspects of how this can best be done are still unknown. Following the normal physiology of fetal to neonatal transition continues to be a logical, but challenging, approach to initial ventilatory support of the newborn in the Delivery Room.
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Delivery Room intervention: improving the outcome.
Clinics in perinatology, 2010Co-Authors: Wade Rich, Tina A. Leone, Neil N. FinerAbstract:The authors have conducted video review of neonatal resuscitations since 1999. Over this 10-year period 3 phases of our experience have been recognized. Our early reviews helped us recognize what we were doing in the Delivery Room, an area that had been ignored in improved intervention. It was noted that on many occasions multiple people were trying to accomplish the same task, that bag and mask ventilation was almost exclusively the purview of the respiratory therapists and was not performed well by others, and that infants with low birth weight were often hypothermic on admission. After determining what was being done and how well it was being done, we moved on to how to do it better. This period included making environmental changes by warming the Room, the use of occlusive wrap, determining the effectiveness of bag and mask ventilation with colorimetric CO2 detectors, and the introduction of crew resource management to develop consistent and effective communication. The third and current phase of our experience is to determine how these interventions affect Delivery Room and potentially later outcomes. Well-designed clinical trials are still needed to further establish the most optimal resuscitation interventions.