Acceptability of Bedside Resuscitation With Intact Umbilical Cord to Clinicians and Patients' Families in the United States

Anup C Katheria, Samuel R Sorkhi, Kasim Hassen, Arij Faksh, Zahra Ghorishi, Debra Poeltler, Anup C Katheria, Samuel R Sorkhi, Kasim Hassen, Arij Faksh, Zahra Ghorishi, Debra Poeltler

Abstract

Background: While delayed umbilical cord clamping in preterm infants has shown to improve long-term neurological outcomes, infants who are thought to need resuscitation do not receive delayed cord clamping even though they may benefit the most. A mobile resuscitation platform allows infants to be resuscitated at the mother's bedside with the cord intact. The newborn is supplied with placental blood during the resuscitation in view of the mother. The objective of the study is to assess the usability and acceptability of mobile resuscitation platform, LifeStart trolley, among the infants' parents and perinatal providers.

Methods: A resuscitation platform was present during every delivery that required advanced neonatal providers for high-risk deliveries. Perinatal providers and parents of the infants were given a questionnaire shortly after the delivery.

Results: 60 neonatal subjects were placed on the trolley. The majority of deliveries were high risk for meconium-stained amniotic fluid (43%), and non-reassuring fetal heart rate (45%). About 50% of neonatal providers felt that there were some concerns regarding access to the baby. No parents were uncomfortable with the bedside neonatal interventions, and most parents perceived that communication was improved because of the proximity to the care team.

Conclusion: Bedside resuscitation with umbilical cord intact through the use of a mobile resuscitation trolley is feasible, safe, and effective, but about half of the perinatal providers expressed concerns. Logistical issues such as improved space management and/or delivery setup should be considered in centers planning to perform neonatal resuscitation with an intact cord.

Keywords: delayed cord clamping; neonatology; obstetrics and gynecology; resuscitation; survey research.

Figures

Figure 1
Figure 1
Setup for vaginal delivery in the United States.
Figure 2
Figure 2
Setup for vaginal delivery in the United Kingdom.

References

    1. Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation (2015) 132(18 Suppl 2):S543–60.10.1161/CIR.0000000000000267
    1. Thomas MR, Yoxall CW, Weeks AD, Duley L. Providing newborn resuscitation at the mother’s bedside: assessing the safety, usability and acceptability of a mobile trolley. BMC Pediatr (2014) 14:135.10.1186/1471-2431-14-135
    1. American Academy of Pediatrics. Textbook of Neonatal Resuscitation (NRP). 7th ed Elk Grove Village, IL: American Academy of Pediatrics; (2016).
    1. Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellof M, Hellstrom-Westas L. Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr (2015) 169(7):631–8.10.1001/jamapediatrics.2015.0358
    1. Glass HC, Costarino AT, Stayer SA, Brett CM, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg (2015) 120(6):1337–51.10.1213/ANE.0000000000000705
    1. Yoxall CW, Ayers S, Sawyer A, Bertullies S, Thomas M, Weeks AD, et al. Providing immediate neonatal care and resuscitation at birth beside the mother: clinicians’ views, a qualitative study. BMJ Open (2015) 5(9):e008494.10.1136/bmjopen-2015-008494
    1. Katheria A, Poeltler D, Durham J, Steen J, Rich W, Arnell K, et al. Neonatal resuscitation with an intact cord: a randomized clinical trial. J Pediatr (2016) 178:75–80.e73.10.1016/j.jpeds.2016.07.053
    1. Katheria AC, Brown MK, Faksh A, Hassen KO, Rich W, Lazarus D, et al. Delayed cord clamping in newborns born at term at risk for resuscitation: a feasibility randomized clinical trial. J Pediatr (2017) 187:313–7.e311.10.1016/j.jpeds.2017.04.033
    1. Harvey ME, Pattison HM. Being there: a qualitative interview study with fathers present during the resuscitation of their baby at delivery. Arch Dis Child Fetal Neonatal Ed (2012) 97(6):F439–43.10.1136/archdischild-2011-301482
    1. Duley L, Dorling J, Pushpa-Rajah A, Oddie SJ, Yoxall CW, Schoonakker B, et al. Randomised trial of cord clamping and initial stabilisation at very preterm birth. Arch Dis Child Fetal Neonatal Ed (2017) 103(1):F6–14.10.1136/archdischild-2016-312567
    1. Critchell CD, Marik PE. Should family members be present during cardiopulmonary resuscitation? A review of the literature. Am J Hosp Palliat Care (2007) 24(4):311–7.10.1177/1049909107304554
    1. Moons P, Norekval TM. European nursing organizations stand up for family presence during cardiopulmonary resuscitation: a joint position statement. Prog Cardiovasc Nurs (2008) 23(3):136–9.10.1111/j.1751-7117.2008.00004.x

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren