Ola-Saugstad-Resuscitation-UENPS-2018

The Optimization of Preterm Newborn Resuscitation Ola Didrik Saugstad Dep of Pediatric Research University of Oslo Norway & Ann and Robert H Lurie Children’s Hospital of Chicago / Northwestern University Feinberg School of Medicine USA Outline Need of ventilation Resuscitation algorithms Oxygen in DR Recommendations for use of oxygen SpO2 and HR at as predictors Heat loss prevention DISCLOSURE STATEMENT Dr Ola Didrik Saugstad has disclosed the following financial relationships Any real or apparent conflicts of interest related to the content of this presentation have been resolved Affiliation / Financial Interest Organization An unrestricted grant Chiesi Farmaceutici Reseach grants Laerdal Medical Interventions in term or near term newborn in the delivery room INTERVENTION 130 mill 20 mill Assess baby’s response to birth Dry, keep baby warm, position correctly Stimulate to breathe by drying Clear airways – only if needed 4-6 mill mill 0.8 mill 0.8 mill 0.1 mill Saugstad OD 2016 Establish effective bag & mask ventilation Start with air Endotracheal intubation FREQUENCY 100/100 15/100 – 5/100 2/100 Provide chest compressions with oxygen Adrenaline < 1/1000 6/10 000 Volume expansion 1/12000 B A S I C A D V A N C E D 29-34 w Variable Routine Level % 24 GA w OR Multiples OR ANS OR Death % 0.6 O2/CPAP 32.5 0.55 (0.51-0.59) 1.29 (1.05-1.59) 0.69 (0.53-0.89) Bag/Mask ET CPR 26.1 14.7 2.7 0.52 (0.48-0.55 0.95 (0.79-1.13) 0.77 (0.58-1.01) 1.0 1.6 0.37 (0.34-0.41) 0.41 (0.35-0.48 0.69 (0.55-0.86) 0.40 (0.22-0.73) 0.56 (0.41 -0.77) 0.22 (0.12-0.34) 7.2 Bajaj M et al J Pediatr 2018;195:33-8 Need of CPR in 500-1500 g 6% with survival 63% Vs 89% not needing CPR Finer NN et al Pediatrics1999;104:428-34 21.0 eNewborn Summary of Data 2014-16 eNewborn: Networking with Modern Technology Dominique Haumont Brussels Decomposition of Infant Mortality GA Early Neonatal Late Neonatal Early Postneonatal Late Postneonatal Infant mortality Died Total Died Total Died Total Died Total Died Total 22 16 37 21 14 12 26 37 23 205 698 103 493 60 390 330 371 698 24 316 1700 167 1384 104 1217 1113 591 1700 25 235 2138 142 1903 93 1761 1668 473 2138 26 172 2602 115 2430 84 2315 2231 376 2602 27 119 3179 60 3060 56 3000 2944 236 3179 28 115 4049 62 3934 53 3872 3819 232 4049 29 91 4743 44 4652 25 4608 4583 161 4743 30 84 6111 38 6027 13 5989 5976 136 6111 31 78 7818 24 7740 24 7716 7692 126 7818 32 41 5272 34 5231 25 5197 5172 100 5272 1472 38347 796 36875 539 36079 21 35540 2828 38347 Total D is t r ib u t io n p e r G e s t a t io n a l W e e k 10000 num ber 8000 6000 4000 2000 22 23 24 25 26 27 28 29 30 31 32 G e s ta tio n a l a g e w e e k s eNewborn: Total 38347 infants 22-32 Weeks Gestational Age 2014-16 European Data base – E newborn Saturation at minutes •Almost 50% of infants < 32 weeks not reach SpO2 study targets at minutes of age •Those who not reach SpO2 80% by minutes are at increased risk of death and IVH •Randomized studies to test signifcance of saturation at of age highly needed Oei, J L, Finer N, Saugstad OD, Wright I, Rabi Y, Tarnow-Mordi W, Rich, W, Kapadia V, Rook D, Vento M Arch Dis Child Fetal Neonatal ed 2017; The Impact of Heart Rate at 05:00 Impact of Bradycardia after Birth on Neonatal Morbidity and Mortality in Preterm Infants BradyPrem Study Objective: To study the incidence of bradycardia in preterm infants < 32 weeks GA in the delivery room and its impact on neonatal morbidity and mortality Non-randomized data No Bradycardia: No HR value recorded < 100 bpm Transient Bradycardia: HR < 100 bpm for ≤ minute Prolonged Bradycardia: HR < 100 bpm for ≥ minutes Vishal Kapadia, MD University of Texas Southwestern Medical Ctr Neonatal Resuscitation Tuesday May 8th 12.15-2.15 # 107 Prolonged Bradycardia and Initial FiO2 Kapadia V et al in preparation Impact of Prolonged Bradycardia on Mortality Kapadia V et al in preparation Duration of Bradycardia and Mortality Heart rate at minutes •Those who did not reach HR of 100 bpm by minutes were at increased risk of death (observational data) •Randomized studies to test significance of heart rate at of age highly needed Khapadia et al in preparation HEAT LOSS! ILCOR 2015 HEAT LOSS PREVENTION Placing or covering infants with an occlusive wrap immediately after birth will reduce the incidence of hypothermia and result in decreased morbidity and mortality Prevention of hypothermia at birth – Plastic wrap versus routine care Death within hospital stay McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants Cochrane Database Syst Rev 2010 Mar 17;(3):CD004210 Prevention of hypothermia at birth – Plastic wrap versus routine care Major brain injury McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants Cochrane Database Syst Rev 2010 Mar 17;(3):CD004210 Randomized Trial of Occlusive Wrap for Heat Loss Prevention in Preterm Infants 36.3 Vs 35.7 oC 36.6 Vs 36.2 oC Mortality rates of all infants according to baseline and poststabilization temperature No effect on mortality of wrapping! OR 1.0 (95% CI 0.7-1.5) Less pulmonary hemorrhage Maureen C Reilly , et al The Journal of Pediatrics, Volume 166, Issue 2, 2015, 262 - 268.e2 Thermal care for preterm newborns 7.0: Kangaroo mother care is recommended for the routine care of neonates weighing ≤2000g at birth as soon as they are clinically stable 7.1 Neonates weighing ≤2000g at birth should be provided as close to continuous Kangaroo mother care as possible 7.2 Intermittent Kangaroo mother care, rather than conventional care is recommended for newborns weighing ≤2000g at birth, if continuous Kangaroo mother care is not possible 2015 Thank you so much for your attention!