Neonatal tactile stimulation at birth in a low-resource setting

Andrea Pietravalle, Francesco Cavallin, Anna Opocher, Stefania Madella, Maria Elena Cavicchiolo, Damiano Pizzol, Giovanni Putoto, Daniele Trevisanuto, Andrea Pietravalle, Francesco Cavallin, Anna Opocher, Stefania Madella, Maria Elena Cavicchiolo, Damiano Pizzol, Giovanni Putoto, Daniele Trevisanuto

Abstract

Background: Stimulation is the most common intervention during neonatal resuscitation at birth, but scarce information is available on the actual methods, timing and efficacy of this basic step. To evaluate the occurrence, patterns and response to tactile stimulation at birth in a low-resource setting.

Methods: We reviewed 150 video recordings of neonatal resuscitation at Beira Central Hospital (Beira, Mozambique). Timing, method, duration and response to tactile stimulation were evaluated.

Results: One hundred two out of 150 neonates (68.0%) received stimulation, while the remaining 48 (32.0%) received positive pressure ventilation and/or chest compressions directly. Overall, 546 stimulation episodes (median 4 episodes per subject, IQR 2-7) were performed. Median time to the first stimulation episode was 134 s (IQR 53-251); 29 neonates (28.4%) received stimulation within the first minute after birth. Multiple techniques of stimulation were administered in 66 neonates (64.7%), while recommended techniques (rubbing the back or flicking the soles of the feet) only in 9 (8.8%). Median duration of stimulation was 17 s (IQR 9-33). Only 9 neonates (8.8%) responded to stimulation.

Conclusions: In a low-resource setting, stimulation of newly born infants at birth is underperformed. Adherence to international guidelines is low, resulting in delayed initiation, inadequate technique, prolonged duration and low response to stimulation. Back rubs may provide some benefits, but large prospective studies comparing different methods of stimulation are required.

Keywords: Delivery room; Low-resource setting; Neonatal resuscitation; Newborn; Stimulation.

Conflict of interest statement

Ethics approval and consent to participate

The research protocol was approved by the National Committee of Bioethics (Ref. 315/CNBS/13; November, 1, 2013) and by the Minister of Health of the Republic of Mozambique (Ref. 08/GMS/002/2014; January, 7, 2014). Parental consent to record neonatal delivery room management and to use the data was obtained before every delivery. Written informed consent was given by parents and caregivers for clinical records to be used in this study.

Consent for publication

Consent from parents of participants was obtained for this study, which included consent for publication without any identifying participant information.

Competing interests

The authors declare that they have no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of included neonates
Fig. 2
Fig. 2
Total time of stimulation
Fig. 3
Fig. 3
Response to stimulation

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