Providing newborn resuscitation at the mother’s bedside: assessing the safety, usability and acceptability of a mobile trolley

BMC Pediatrics

Lelia Duley²  Andrew D Weeks³  Charles W Yoxall¹  Margaret R Thomas¹ 

[1] Neonatal Unit, Liverpool Women’s Hospital, Crown Street, Liverpool L8 7SS, UK;Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK;Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK

关键词: Newborn;    Infant;    Resuscitation;   

Others  :  1138839
DOI  :  10.1186/1471-2431-14-135

 received in 2013-12-16, accepted in 2014-05-23,  发布年份 2014

【 摘 要 】

Background

Deferring cord clamping at very preterm births may be beneficial for babies. However, deferring cord clamping should not mean that newborn resuscitation is deferred. Providing initial care at birth at the mother’s bedside would allow parents to be present during resuscitation, and would potentially allow initial care to be given with the cord intact. The aim of this study was to evaluate the usability of a new mobile trolley for providing newborn resuscitation by describing the range of resuscitation procedures performed on a group of babies, to assess the acceptability to clinicians compared with standard equipment, based on a questionnaire survey, to assess safety from post resuscitation temperature measurements and serious adverse event reports and to assess whether the trolley allowed resuscitation with the umbilical cord intact by assessing the proportion of babies that could be placed on the trolley to allow resuscitation with the cord intact.

Methods

The trolley was used when the attendance of a clinician trained in newborn life support was required at a birth. Clinicians were asked to complete a questionnaire about their experience of using the trolley. Serious adverse events were reported.

Results

78 babies were managed on the trolley. Median (range) gestation was 34 weeks (24 to 41 weeks). Median (range) birth weight was2470 grams (520 to 4080 grams). The full range of resuscitation procedures has been successfully provided, although only one baby required emergency umbilical venous catheterisation. 77/78 babies had a post resuscitation temperature above 36°C. There were no adverse events. Most clinicians rated the trolley as ‘the same’, ‘better’ or ’much better’ than conventional resuscitation equipment. In most situations, the baby could be resuscitated with umbilical cord intact, although on 18 occasions the cord was too short to reach the trolley.

Conclusions

Immediate stabilisation at birth and resuscitation can be performed successfully and safely at the bedside using this trolley. In most cases this could be achieved with an intact umbilical cord.

【 授权许可】

   
2014 Thomas et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Kroll L, Twohey L, Daubeney PE, Lynch D, Ducker DA: Risk factors at delivery and the need for skilled resuscitation. Eur J Obstet Gynaecol Reprod Biol 1994, 44:175-177.
• [2]McDonald SJ, Middleton P: Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2008., Issue 2Art. No.: CD004074. doi:10.1002/14651858.CD004074.pub2
• [3]Rabe H, Diaz-Rossello JL, Duley L, Doswell T: Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012., 8Art. No.: CD003248. doi:10.1002/14651858.CD003248.pub3
• [4]Bhatt S, Alison BJ, Wallace EM, Crossley KJ, Gill AW, Kluckow M, te Pas AB, Morley CJ, Polglase GR, Hooper SB: Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 2013, 591(Pt 8):2113-2126.
• [5]RCOG: Prevention and management of postpartum haemorrhage. 2009. (Green Top Guidelines no 52). [http://www.rcog.org.uk/files/rcog-corp/GT52PostpartumHaemorrhage0411.pdf webcite]
• [6]Richmond S, Wyllie J: European resuscitation council guidelines for resuscitation 2010 section 7. Resuscitation of babies at birth. Resuscitation 2010, 81:1389-1399.
• [7]Arnold L, Sawyer A, Rabe H, Abbott J, Gyte G, Duley L: Parents’ first moments with their very preterm babies: a qualitative study. BMJ Open 2013, 3:e002487. doi:10.1136/bmjopen-2012-002487
• [8]Harvey ME, Pattison HM: Being there: a qualitative interview study with fathers present during the resuscitation of their baby at delivery. Arch Dis Child 2012, 97:F439-F443.
• [9]Critchell CD, Marik PE: Should family members be present during cardiopulmonary resuscitation? A review of the literature. Am J Hosp Palliat Care 2007, 24:311-317.
• [10]Moons P, Norekval TM: European nursing organizations stand up for family presence during cardiopulmonary resuscitation: a joint position statement. Prog Cardiovasc Nurs 2008, 23:136-139.
• [11]Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, Egleston CV, Prevost AT: Psychological effect of witnessed resuscitation on bereaved relatives. Lancet 1998, 352:614-617.
• [12]Weeks AD, Watt RJP, Hutchon DJR, Yoxall CW, Gallagher A, Burleigh A, Bewley S, Heuchan AM, Duley L: Innovation in immediate neonatal care: development of the Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support (BASICS) Trolley. 2014. [http://www.nottingham.ac.uk/nctu/documents/preterm-birth/basics-development-report-29april2014.pdf webcite]
• [13]Cord Pilot trial 2012. [http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=13070 webcite]
• [14]National Research Ethics Service: Defining research. 2014. [http://www.nres.nhs.uk/applications/guidance/research-guidance/?entryid62=66985 webcite]
• [15]British Association of Perinatal medicine: Early care of the newborn infant. Statement on current level of evidence. 2005. [http://www.bapm.org/publications/documents/guidelines/RDS_position-statement.pdf webcite]