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Stichtenoth G, Gonser M, Hentschel R, Janke E, Maul H, Schmitt A, Steppat S, Werner J, Herting E. Betreuung von Neugeborenen in der Geburtsklinik (Entwicklungsstufe
S2k, AWMF-Leitlinien-Register-Nr. 024–005, März 2021). Z Geburtshilfe Neonatol 2024; 228:137-150. [PMID: 38608666 DOI: 10.1055/a-2195-3995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Guido Stichtenoth
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - Markus Gonser
- Universitätsspital Zürich, Klinik für Geburtshilfe, Zürich, Schweiz
| | - Roland Hentschel
- Neonatologie/Intensivmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg
| | - Evelin Janke
- Katholische Bildungsstätte für Berufe im Sozial- und Gesundheitswesen GmbH, Akademie St. Franziskus, Lingen (Ems)
| | - Holger Maul
- Geburtshilfe und Pränatalmedizin, Asklepios Klinik Barmbek, Hamburg
| | - Anne Schmitt
- Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken
| | | | - Janne Werner
- Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Düsseldorf
| | - Egbert Herting
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
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Standards for Professional Registered Nurse Staffing for Perinatal Units. Nurs Womens Health 2022; 26:e1-e94. [PMID: 35750618 DOI: 10.1016/j.nwh.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Standards for Professional Registered Nurse Staffing for Perinatal Units. J Obstet Gynecol Neonatal Nurs 2022; 51:e5-e98. [PMID: 35738987 DOI: 10.1016/j.jogn.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Rodríguez-López J, De la Cruz Bértolo J, García-Lara NR, Asla Elorriaga I, Román Echevarría L, Vento M, Parra-Llorca A, Cabañas F, Lozano P, García-Algar Ó, Martín-Ancel A, Copons Fernández C, González Carrasco E, Olabarrieta Arnal I, Pellicer A, Marín Huarte N, Pallás-Alonso CR. Maternal and Neonatal Prognostic Factors for Cardiorespiratory Events in Healthy Term Neonates During Early Skin-to-Skin Contact. Front Pediatr 2022; 10:907570. [PMID: 35712622 PMCID: PMC9194510 DOI: 10.3389/fped.2022.907570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND During early skin-to-skin contact (ESSC), alterations in peripheral oxygen saturation (SpO2) and heart rate (HR) have been frequently observed. OBJECTIVES This study aimed to determine the incidence of cardiorespiratory events (CREs) during ESSC in healthy term newborns (HTNs) and estimate the association of maternal and neonatal prognostic factors with the risk of CREs. METHODS A pooled analysis of the cohort from a clinical trial involving healthy mother-child dyads during ESSC was performed. Pulse oximetry was employed to continuously monitor SpO2 and HR within 2 h after birth. The individual and combined prognostic relevance of the demographic and clinical characteristics of dyads for the occurrence of a CRE (SpO2 <91% or HR <111 or >180 bpm) was analyzed through logistic regression models. RESULTS Of the 254 children assessed, 169 [66.5%; 95% confidence interval (95% CI), 60.5-72.5%] had at least one CRE. The characteristics that increased the risk of CRE were maternal age ≥35 years (odds ratio, 2.21; 95% CI, 1.19-4.09), primiparity (1.96; 1.03-3.72), gestational body mass index (BMI) >25 kg/m2 (1.92; 1.05-3.53), and birth time between 09:00 p.m. and 08:59 a.m. (2.47; 1.02-5.97). CONCLUSION CREs were more frequent in HTNs born during nighttime and in HTNs born to first-time mothers, mothers ≥35 years, and mothers with a gestational BMI >25 kg/m2. These predictor variables can be determined during childbirth. Identification of neonates at higher risk of developing CREs would allow for closer surveillance during ESSC.
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Affiliation(s)
- Jesús Rodríguez-López
- Department of Neonatology, Health Research Institute Imas12, 12 de Octubre University Hospital, Complutense University, Madrid, Spain
| | | | - Nadia Raquela García-Lara
- Department of Neonatology, Health Research Institute Imas12, 12 de Octubre University Hospital, Complutense University, Madrid, Spain
| | | | | | - Máximo Vento
- Division of Neonatology, Neonatal Research Group, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Anna Parra-Llorca
- Division of Neonatology, Neonatal Research Group, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Fernando Cabañas
- Department of Pediatrics and Neonatology, Quirónsalud Madrid University Hospital, Madrid, Spain
| | - Pedro Lozano
- Department of Pediatrics and Neonatology, Quirónsalud Madrid University Hospital, Madrid, Spain
| | - Óscar García-Algar
- Neonatology Unit, Institut Clínic de Ginecologia, Obstetrícia i Nonatologia (ICGON), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic-Maternitat, Barcelona, Spain
| | - Ana Martín-Ancel
- Neonatology Unit, Sant Joan de Déu University Hospital and Clínic University Hospital, BCNatal, Barcelona, Spain
| | | | | | | | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | | | - Carmen Rosa Pallás-Alonso
- Department of Neonatology, Health Research Institute Imas12, 12 de Octubre University Hospital, Complutense University, Madrid, Spain
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Anderson TM, Ferres JML, Ramirez JM, Mitchell EA. Sudden Unexpected Postnatal Collapse Resulting in Newborn Death in the United States. MCN Am J Matern Child Nurs 2021; 46:130-136. [PMID: 33587345 PMCID: PMC8349372 DOI: 10.1097/nmc.0000000000000711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The sudden collapse of an apparently healthy newborn, or sudden unexpected postnatal collapse (SUPC) is fatal in about half of cases. Epidemiological characteristics of sudden unexpected infant death (SUID) in the first week of life differ from those in the postperinatal age group (7-365 days). AIM To describe the characteristics of SUPC resulting in neonatal death. METHODS We analyzed the Centers for Disease Control and Prevention Birth Cohort Linked Birth/Infant Death Data Set (2003-2013: 41,125,233 births and 37,624 SUIDs). SUPC was defined as infants born ≥35 weeks gestational age, with a 5-minute Apgar score of ≥7, who died suddenly and unexpectedly in the first week of life. RESULTS Of the 37,624 deaths categorized as SUID during the study period, 616 met the SUPC criteria (1.5/100,000 live births). Eleven percent occurred on the first day of life and nearly three quarters occurred during postnatal days 3-6. SUPC deaths differed statistically from SUID deaths occurring 7-364 days of age, in particular for sex, marital status, and live birth order. IMPLICATIONS These data support the need for adequate nurse staffing during the immediate recovery period and for the entire postpartum stay as well as nurse rounding for new mothers in the hospital setting.
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Nadjafizadeh M, Caron FM. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Newborn care in the delivery room]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:944-952. [PMID: 33011378 DOI: 10.1016/j.gofs.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The purpose of this literature review is to make recommendations regarding the first steps and care provided to the healthy newborn. METHODS Consultation of the Medline database, and of national and international guidelines. RESULTS The initial assessment of the newborn should quickly determine whether resuscitation is necessary or not. Any anomaly requires the help of the pediatrician (Consensus agreement). For a newborn with no cardiorespiratory adaptation, delayed cord clamping may be considered more as a physiological modality of delivery, which may help prevent iron deficiency in the first months of life, without deleterious effects for the child or his/her mother, apart from a slightly increased risk of neonatal jaundice (gradeC). In order to avoid separating a woman and her child, it is recommended to postpone routine postnatal procedures, to allow for skin-to-skin contact between the mother and the newborn, if she wishes, according to a defined/specified surveillance protocol (grade B). Breastfeeding should be encouraged, and supported, especially the first time (Consensus agreement). In the absence of suggestive clinical signs, aspiration of the upper airways and systematic verification of the permeability of posterior nasal apertures and of the esophagus are not recommended (Consensus agreement). The prevention of hemorrhagic disease of the newborn by the oral administration of vitamin K1 to all healthy term babies begins in the delivery room, preferably in the presence of the parents and after having obtained their consent (Consensus agreement). CONCLUSION Regarding the birth of a healthy newborn, it is strongly advised to avoid unnecessary technical actions and to favor the mother-child relationship in a safe environment.
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Affiliation(s)
- M Nadjafizadeh
- Département Universitaire de Maieutique, UFR de Médecine, Université de Lorraine, 54505 Vandoeuvre-les-Nancy, France; CHRU de Nancy, 10, rue du Dr-Heydenreich, 54000 Nancy, France.
| | - F-M Caron
- Pôle femme enfant Victor-Pauchet, 80000 Amiens, France
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Is there a common denominator for Brief Resolved Unexplained Events, Sudden Infant Death Syndrome, and alleged Shaken Baby Syndrome? Med Hypotheses 2020; 144:109939. [DOI: 10.1016/j.mehy.2020.109939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022]
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Miyazawa T, Itabashi K, Tamura M, Suzuki H, Ikenoue T, Ikeda T, Ichizuka K, Satoh S, Takeda S, Tamiya N, Nakai A, Fujimori K, Maeda T. Unsupervised breastfeeding was related to sudden unexpected postnatal collapse during early skin-to-skin contact in cerebral palsy cases. Acta Paediatr 2020; 109:1154-1161. [PMID: 31385353 PMCID: PMC7318205 DOI: 10.1111/apa.14961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/12/2019] [Accepted: 08/02/2019] [Indexed: 12/02/2022]
Abstract
Aim This study aimed to identify the clinical features of infants who were healthy at birth, but developed sudden unexpected collapse and were then diagnosed with cerebral palsy before 5 years of age. Methods We retrospectively analysed 1182 records from the no‐fault Japan Obstetric Compensation System for Cerebral Palsy database up to 2016. This identified 45 subjects (3.8%) who were subsequently diagnosed with severe cerebral palsy due to sudden unexpected postnatal collapse (SUPC). They were all healthy at birth, based on the criteria of five‐minute Apgar scores of seven or more, with normal umbilical cord blood gases and no need for neonatal resuscitation within five minutes of birth. Results The median birth weight of the 45 subjects (26 males) was 2770 g (range 2006‐3695 g). Of these, 10 developed SUPC during early skin‐to‐skin contact (SSC). Medical personnel were not present in all 10 cases: nine were being breastfed at the time and eight of the mothers did not notice their infant's abnormal condition until medical staff alerted them. Conclusion This national study of children with cerebral palsy who appeared healthy at birth found that unsupervised breastfeeding was a common factor in cases of SUPC during early SSC.
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Affiliation(s)
- Tokuo Miyazawa
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation Japan Council for Quality Health Care Tokyo Japan
- Department of Pediatrics Showa University School of Medicine Tokyo Japan
| | | | - Masanori Tamura
- Department of Pediatrics Saitama Medical Center Saitama Medical University Kawagoe Japan
| | - Hideaki Suzuki
- Department of the Japan Obstetric Compensation System for Cerebral Palsy in Public Interest Incorporated Foundation Japan Council for Quality Health Care Tokyo Japan
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Burgmann DM, Foerster K, Klemme M, Delius M, Hübener C, Wisskott R, Boulesteix AL, Flemmer AW. Delivery room desaturations and bradycardia in the early postnatal period of healthy term neonates - a prospective observational study. J Matern Fetal Neonatal Med 2020; 35:1457-1461. [PMID: 32375581 DOI: 10.1080/14767058.2020.1757064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE It has been suggested that desaturations and bradycardia precede acute life-threatening events (ALTE) and that ALTE is more common in the delivery room than later in life. However, frequency, duration and severity of desaturations in the first hours of life and additional risk factors have not readily been studied. METHODS Term neonates (n = 100) were monitored for the first two hours after birth by pulse oximetry. The impact of maternal and perinatal factors on the frequency and severity of desaturations (<85%) and bradycardia (<80/min) was evaluated. RESULTS Desaturations were detected in 30%, prolonged desaturations in 25% of infants. Desaturations were observed significantly more often in infants born by planned Cesarean section (pCs) compared to other modes of delivery (pCs 20/49; others 10/51; p = .029). Desaturations were also more frequent in infants diagnosed with neonatal infection (NI) or infants born to a mother with gestational diabetes (GDM), although not significantly. No bradycardia <80/min was detected. CONCLUSIONS In our collective 4% of healthy term neonates had prolonged, clinically relevant desaturations in the first hours after birth. The mode of delivery and maternal risk factors may increase the risk for these events. However, our cohort was too small to detect any ALTE or SIDS and determine potential risk factors for these events. Our data lay ground for a large-scale prospective trial to investigate whether the mode of delivery could be an indication for general pulse oximetry monitoring of newborn in the delivery room.
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Affiliation(s)
- D-M Burgmann
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - K Foerster
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - M Klemme
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - M Delius
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - C Hübener
- Department of Obstetrics and Gynecology, Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
| | - R Wisskott
- Department of Medical Information Processing, Biometry and Epidemiology, University Hospital, LMU Munich, Munich, Germany
| | - A L Boulesteix
- Department of Medical Information Processing, Biometry and Epidemiology, University Hospital, LMU Munich, Munich, Germany
| | - A W Flemmer
- Division of Neonatology, University Children's Hospital and Perinatal Center, University Hospital, Campus Grosshadern, LMU Munich, Munich, Germany
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Barbaglia M, Finale E, Noce S, Vigo A, Arioni C, Visentin R, Scurati-Manzoni E, Guala A. Skin-to-skin contact and delivery room practices: a longitudinal survey conducted in Piedmont and the Aosta Valley. Ital J Pediatr 2019; 45:95. [PMID: 31375123 PMCID: PMC6679473 DOI: 10.1186/s13052-019-0688-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/24/2019] [Indexed: 01/25/2023] Open
Abstract
Background Sudden unexpected postnatal collapse of presumably healthy neonates during early skin-to-skin contact is a rare, yet recognized occurrence, associated with a high risk of mortality and morbidity. A survey was conducted in 2012 in 30 delivery wards throughout Piedmont and the Aosta Valley to evaluate the environmental and logistical aspects that could be linked to SUPC. The survey was again conducted in 2016 in 28 delivery wards in Piedmont and the Aosta Valley in order to evaluate organizational improvements introduced after ministerial indications and recommendations by the Italian Society of Neonatology were published in 2014, in light of new findings regarding the phenomenon. Methods A questionnaire specifically asking about the organization of delivery wards, and surveillance or supervision during early skin-to-skin contact, was sent to all of the hospitals taking part in the survey in both 2012 and 2016. The collected data were elaborated anonymously and the statistical analysis was performed by using the two by two table. Results In 2012, 28 out of 30 delivery wards in Piedmont and Aosta, with a total of 31,074 newborns out of 35,435, were evaluated in all of the environmental and logistical aspects that might be cause for SUPC to occur. An identical survey was taken again in 2016; 26 out of 28 wards participated with a total of 27,484 newborns out of 30,339. In 2012, early skin-to-skin contact took place immediately in all the delivery rooms in 27 wards, and soon after in the post-partum room in one; in 11 out of 28 wards there was early skin-to-skin contact in the operating theater itself, following caesarean sections (11/26 in 2016). Routine newborn care was given after 3 h in 8 delivery wards (7/26 in 2016); after 2 h in 12 (7/26 in 2016); after 1 h in 2 (4/26 in 2016); after 30 min in 3 (2/26 in 2016); after 10 min in 1 (0/26 in 2016); after 1 or 2 min in 1 (0/26 in 2016) and at any time in one ward (6/26 in 2016). Conclusion Periodic surveys of delivery wards are useful for the assessment of all the aspects and risk factors that need to be changed in order to implement safe early skin-to-skin contact. Electronic supplementary material The online version of this article (10.1186/s13052-019-0688-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelangelo Barbaglia
- Struttura Complessa Pediatria, Ospedale Castelli, Azienda Sanitaria Locale VCO, Verbania, Italy
| | - Enrico Finale
- Struttura Complessa Pediatria, Ospedale Castelli, Azienda Sanitaria Locale VCO, Verbania, Italy. .,Dipartimento Materno Infantile VCO, Ospedale Castelli, Verbania, Italy.
| | - Silvia Noce
- Centro di Riferimento Regionale per la SIDS, ASO/ OIRM/Sant'Anna, Torino, Italy
| | - Alessandro Vigo
- Centro di Riferimento Regionale per la SIDS, ASO/ OIRM/Sant'Anna, Torino, Italy
| | - Cesare Arioni
- Struttura Complessa Pediatria, Ospedale Umberto Parini, Azienda Sanitaria Locale della Valle d'Aosta, Aosta, Italy
| | - Raffaella Visentin
- Struttura Complessa Pediatria, Ospedale Castelli, Azienda Sanitaria Locale VCO, Verbania, Italy
| | | | - Andrea Guala
- Struttura Complessa Pediatria, Ospedale Castelli, Azienda Sanitaria Locale VCO, Verbania, Italy
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Rodríguez López J, García Lara NR, López Maestro M, De la Cruz Bértolo J, Martínez Ávila JC, Vento M, Parra Llorca A, Izquierdo Macián I, Pellicer A, Marín Huarte N, Asla Elorriaga I, Román Echevarría L, Copons Fernández C, Martín Ancel A, Cabañas F, García Algar Ó, Pallás Alonso CR. What is the impact of mother's bed incline on episodes of decreased oxygen saturation in healthy newborns in skin-to-skin contact after delivery: Study protocol for a randomized controlled trial. Trials 2019; 20:179. [PMID: 30894206 PMCID: PMC6427856 DOI: 10.1186/s13063-019-3256-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/27/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Early mother-child skin-to-skin contact (SSC) in the first 2 h postpartum is highly beneficial for both mother and child. However, cases have been reported of newborns who have experienced apparently life-threatening events (ALTEs) or sudden death during this procedure. The causes of these events are unknown. Newborn's prone position could influence the onset of these events but there is very little evidence to support any recommendation. We hypothesize that newborns' breathing obstruction episodes increase as mothers lie more horizontally. The main objective of this study is to compare the occurrence of desaturation and bradycardia episodes as a function of mother's bed incline. The study is designed as a randomized, controlled, assessor blind, multicenter, superiority trial with two parallel groups and 1:1 allocation ratio. METHODS The study participants will be full-term healthy mother-newborn dyads from ten hospitals in Spain. Participants will be randomly assigned to one of two study arms defined by mother's bed inclination (45° or 15°). The planned sample size is 5866. Centralized permuted blocks randomization and assessor blinding will be implemented. The newborns will be monitored remotely with pulse oximetry, from 10 min to 2 h after delivery. We established SO2 and heart rate (HR) limit alarms, as well as an action protocol in the event of alarm activation. The primary outcome is the number of healthy newborns who undergo episodes of SO2 ≤ 90%. Secondary outcomes are the mean SO2 level, the number of newborns who experience episodes of SO2 ≤ 85%, the time to SSC discontinuation due to abnormal SO2 or HR, and episodes of HR < 111 beats per minute (bpm) or > 180 bpm. Subgroups and pooled analysis will be performed to identify if breast-feeding and mother and child positions favor the occurrence of desaturation or bradycardia episodes. DISCUSSION A simple intervention such as modifying mother's bed angle of inclination while in SSC with her child during the first 2 h postpartum could favor newborn's hemodynamic and respiratory stabilization and thus contribute to reducing the onset of ALTEs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02585492 . Registered on 22nd October 2015. PROTOCOL VERSION 2 (30th June 2015).
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Affiliation(s)
- Jesús Rodríguez López
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Nadia Raquel García Lara
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - María López Maestro
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Javier De la Cruz Bértolo
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | | | - Máximo Vento
- Neonatology Department, La Fe University Hospital, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Ana Parra Llorca
- Neonatology Department, La Fe University Hospital, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Isabel Izquierdo Macián
- Neonatology Department, La Fe University Hospital, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Adelina Pellicer
- Neonatology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Natalia Marín Huarte
- Neonatology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Izaskun Asla Elorriaga
- Neonatology Department, Cruces University Hospital, Plaza de Cruces, S/N, 48903 Baracaldo, Vizcaya Spain
| | - Lourdes Román Echevarría
- Neonatology Department, Cruces University Hospital, Plaza de Cruces, S/N, 48903 Baracaldo, Vizcaya Spain
| | - Cristina Copons Fernández
- Neonatology Department, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119-129, 08035 Barcelona, Spain
| | - Ana Martín Ancel
- Neonatology Department, San Joan de Déu University Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Fernando Cabañas
- Neonatology Department, Quironsalud Madrid University Hospital, Calle Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Óscar García Algar
- Maternal, Fetal and Neonatal Department, Hospital Sant Joan de Déu- Clínic University Hospital, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Carmen Rosa Pallás Alonso
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
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[Skin-to-skin during caesarean section: Assessment of professional practices]. ACTA ACUST UNITED AC 2019; 47:342-346. [PMID: 30686726 DOI: 10.1016/j.gofs.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Considering its benefits, immediate skin-to-skin should be applied irrespective of the way of delivery. While it is increasingly applied in case of vaginal delivery, it remains difficult to implement in case of caesarean section. OBJECTIVE To estimate the degree of implementation of skin-to-skin in case of caesarean section. METHODS Survey in immediate postpartum with a continuous series of patients having given birth by caesarean - whether scheduled or not - in a level 3 hospital systematically realizing skin-to-skin in case of vaginal delivery. The patients were included if the caesarean section had been realized between 16/11/17 and 28/11/17. RESULTS Thirty-five women gave birth by caesarean section during the period of study, among which 26 were planned (74%). The emergency levels were varied: 18 had a green code (51%), 12 an orange code (34%) and 5 a red code (14%). Forty-six percent of the newborn children were placed skin-to-skin. The frequency of skin-to-skin was closely linked to the planned character of the caesarean section (89 vs. 31%, P=0.005), as well as its color code (green 72%, orange 25%, red 0%). In case of impossibility to realize skin-to-skin in the course of the caesarean, the reasons were mainly related to the maternal state (63%) (malaise, bleeding, pain). In this situation, skin-to-skin was proposed to the spouse in 83% of cases and realized in recovery room with the mother in 82% of the cases. CONCLUSION Skin-to-skin is feasible during caesarean section, regardless of the color code of the procedure.
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Tasseau A, Walter-Nicolet E, Autret F. Management of healthy newborns in the delivery room and maternal satisfaction. Arch Pediatr 2018; 25:S0929-693X(18)30116-7. [PMID: 29909940 DOI: 10.1016/j.arcped.2018.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/29/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The first exchanges between a newborn baby and its mother are essential. Any separation can have negative effects on the establishment of the first connections as well as breastfeeding. OBJECTIVE To establish the current state of management of healthy newborn babies in the delivery room and assess the reasons for possible separation and the feelings of mothers facing this separation. MATERIALS AND METHODS Observational descriptive single-center study, made up of two parts: 1/a questionnaire given to the mothers, postpartum; 2/the collection of data concerning the transfer of healthy newborn babies to the nursery. RESULTS The study took place over a period of 8 weeks. Eighty-five mothers were interviewed. Seventy-two percent of the newborn babies left the delivery room during the first 2h of life. For 67 %, the duration of skin-to-skin contact was less than 1h. For 49 %, the main reason was the performance of routine care. The mothers were satisfied with the care provided in the delivery room. CONCLUSION Too many healthy newborn babies are separated from their mothers during the first 2h of life, mainly for routine care. Skin-to-skin contact must be part of the physiological reception of newborn babies in the delivery room. The medical staff and parents must be informed of this aspect and its beneficial effects. It is necessary to reconsider the organization of practices to propose a management system that promotes the establishment of a strong mother-child bond.
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Affiliation(s)
- A Tasseau
- Service de néonatologie, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, cedex 14, France.
| | - E Walter-Nicolet
- Service de néonatologie, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, cedex 14, France
| | - F Autret
- Service de néonatologie, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, cedex 14, France
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The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature. J Perinatol 2018; 38:623-632. [PMID: 29416115 DOI: 10.1038/s41372-018-0068-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/01/2018] [Accepted: 01/18/2018] [Indexed: 11/08/2022]
Abstract
There is no doubt regarding the multiple benefits of breastfeeding for infants and society in general. Therefore, the World Health Organization (WHO) in a conjoint effort with United Nations International Children's Emergency Fund (UNICEF) developed the "Ten Steps to Successful Breastfeeding" in 1992, which became the backbone of the Baby Friendly Hospital Initiative (BFHI). Following this development, many hospitals and countries intensified their position towards creating a "breastfeeding oriented" practice. Over the past two decades, the interest increased in the BFHI and the Ten Steps. However, alongside the implementation of the initiative, extensive research continues to evaluate the benefits and dangers of the suggested practices. Hence, it is our intention to make a critical evaluation of the current BFHI and the Ten Steps recommendations in consideration of the importance of providing an evidence-based breastfeeding supported environment for our mothers and infants.
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Narayen IC, Mulder EEM, Boers KE, van Vonderen JJ, Wolters VERA, Freeman LM, Te Pas AB. Neonatal Safety of Elective Family-Centered Caesarean Sections: A Cohort Study. Front Pediatr 2018; 6:20. [PMID: 29484289 PMCID: PMC5816568 DOI: 10.3389/fped.2018.00020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although little data are available concerning safety for newborns, family-centered caesarean sections (FCS) are increasingly implemented. With FCS mothers can see the delivery of their baby, followed by direct skin-to-skin contact. We evaluated the safety for newborns born with FCS in the Leiden University Medical Center (LUMC), where FCS was implemented in June 2014 for singleton pregnancies with a gestational age (GA) ≥38 weeks and without increased risks for respiratory morbidity. METHODS The incidence of respiratory pathology, unplanned admission, and hypothermia in infants born after FCS in LUMC were retrospectively reviewed and compared with a historical cohort of standard elective cesarean sections (CS). RESULTS From June 2014 to November 2015, 92 FCS were performed and compared to 71 standard CS in 2013. Incidence of respiratory morbidity, hypothermia, temperatures at arrival at the department, GA, and birth weight were comparable (ns). Unplanned admission occurred more often after FCS when compared to standard CS (21 vs 7%; p = 0.03), probably due to peripheral oxygen saturation (SpO2) monitoring. There was no increase in respiratory pathology (8 vs 6%, ns). One-third of the babies were separated from their mother during or after FCS. CONCLUSION Unplanned neonatal admissions after elective CS increased after implementing FCS, without an increase in respiratory morbidity or hypothermia. SpO2 monitoring might have a contribution. Separation from the mother occurred often.
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Affiliation(s)
- Ilona C Narayen
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Kim E Boers
- Department of Obstetrics, Bronovo Hospital, The Hague, Netherlands
| | | | | | - Liv M Freeman
- Department of Obstetrics, Leiden University Medical Center, Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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18
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Zwedberg S, Huss M, Karlsson E, Poignant M. Intensive care nurses' experiences of infants and partners' presence on the postoperative ward after an emergency caesarean section; An interview study. Intensive Crit Care Nurs 2017; 41:71-76. [PMID: 28385278 DOI: 10.1016/j.iccn.2017.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/18/2017] [Indexed: 11/27/2022]
Abstract
It is evident that immediate skin-to-skin care after birth has the potential to improve breastfeeding outcomes and maternal satisfaction after a caesarean section; hence partners and infants should be present on the postoperative ward. OBJECTIVE To investigate the intensive care nurses' experiences of having the infant and partner present on the postoperative ward after emergency caesarean sections. DESIGN Interviews with semi-structured interviews were conducted and analysed using qualitative content analysis. SETTING The interviews were conducted at a hospital in Stockholm, Sweden; where close to 10,000 births occur each year. After a caesarean section the mother is treated on a postoperative ward for at least two hours. Eight intensive care nurses participated in the study. RESULT The analysis yields the theme 'The challenges of caring for infants on a postoperative unit' covering the following categories; collision between the intensive care nurse and midwife, responsibility versus knowledge and organisational issues. The study concluded that improved routines and increased continuity between involved clinics could improve care. There is also a need for education for staff involved in caesarean section regarding the benefits of early skin-to-skin care between the mother and her infant.
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Affiliation(s)
- Sofia Zwedberg
- Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm, Sweden; Children's & Women's Health Theme; PA Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden.
| | - Matilda Huss
- Children's & Women's Health Theme; PA Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden
| | - Emma Karlsson
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Marie Poignant
- Children's & Women's Health Theme; PA Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden
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Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2016; 11:CD003519. [PMID: 27885658 PMCID: PMC6464366 DOI: 10.1002/14651858.cd003519.pub4] [Citation(s) in RCA: 308] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior. OBJECTIVES To assess the effects of immediate or early SSC for healthy newborn infants compared to standard contact on establishment and maintenance of breastfeeding and infant physiology. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 December 2015), made personal contact with trialists, consulted the bibliography on kangaroo mother care (KMC) maintained by Dr Susan Ludington, and reviewed reference lists of retrieved studies. SELECTION CRITERIA Randomized controlled trials that compared immediate or early SSC with usual hospital care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups. Results for womenSSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07 to 1.43; participants = 887; studies = 14; I² = 41%; GRADE: moderate quality). SSC women also breast fed their infants longer, though data were limited (mean difference (MD) 64 days, 95% CI 37.96 to 89.50; participants = 264; studies = six; GRADE:low quality); this result was from a sensitivity analysis excluding one trial contributing all of the heterogeneity in the primary analysis. SSC women were probably more likely to exclusively breast feed from hospital discharge to one month post birth and from six weeks to six months post birth, though both analyses had substantial heterogeneity (from discharge average RR 1.30, 95% CI 1.12 to 1.49; participants = 711; studies = six; I² = 44%; GRADE: moderate quality; from six weeks average RR 1.50, 95% CI 1.18 to 1.90; participants = 640; studies = seven; I² = 62%; GRADE: moderate quality).Women in the SCC group had higher mean scores for breastfeeding effectiveness, with moderate heterogeneity (IBFAT (Infant Breastfeeding Assessment Tool) score MD 2.28, 95% CI 1.41 to 3.15; participants = 384; studies = four; I² = 41%). SSC infants were more likely to breast feed successfully during their first feed, with high heterogeneity (average RR 1.32, 95% CI 1.04 to 1.67; participants = 575; studies = five; I² = 85%). Results for infantsSSC infants had higher SCRIP (stability of the cardio-respiratory system) scores overall, suggesting better stabilization on three physiological parameters. However, there were few infants, and the clinical significance of the test was unclear because trialists reported averages of multiple time points (standardized mean difference (SMD) 1.24, 95% CI 0.76 to 1.72; participants = 81; studies = two; GRADE low quality). SSC infants had higher blood glucose levels (MD 10.49, 95% CI 8.39 to 12.59; participants = 144; studies = three; GRADE: low quality), but similar temperature to infants in standard care (MD 0.30 degree Celcius (°C) 95% CI 0.13 °C to 0.47 °C; participants = 558; studies = six; I² = 88%; GRADE: low quality). Women and infants after cesarean birthWomen practicing SSC after cesarean birth were probably more likely to breast feed one to four months post birth and to breast feed successfully (IBFAT score), but analyses were based on just two trials and few women. Evidence was insufficient to determine whether SSC could improve breastfeeding at other times after cesarean. Single trials contributed to infant respiratory rate, maternal pain and maternal state anxiety with no power to detect group differences. SubgroupsWe found no differences for any outcome when we compared times of initiation (immediate less than 10 minutes post birth versus early 10 minutes or more post birth) or lengths of contact time (60 minutes or less contact versus more than 60 minutes contact). AUTHORS' CONCLUSIONS Evidence supports the use of SSC to promote breastfeeding. Studies with larger sample sizes are necessary to confirm physiological benefit for infants during transition to extra-uterine life and to establish possible dose-response effects and optimal initiation time. Methodological quality of trials remains problematic, and small trials reporting different outcomes with different scales and limited data limit our confidence in the benefits of SSC for infants. Our review included only healthy infants, which limits the range of physiological parameters observed and makes their interpretation difficult.
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Affiliation(s)
- Elizabeth R Moore
- Vanderbilt UniversitySchool of Nursing314 Godchaux Hall21st Avenue SouthNashvilleTennesseeUSA37240‐0008
| | - Nils Bergman
- University of Cape TownSchool of Child and Adolescent Health, and Department of Human BiologyCape TownSouth Africa
| | - Gene C Anderson
- Professor Emerita, University of FloridaCase Western Reserve UniversityOak Hammock at the University of Florida5000 SW 25th Boulevard #2108GainesvilleFLUSA32608‐8901
| | - Nancy Medley
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Lutz TL, Elliott EJ, Jeffery HE. Sudden unexplained early neonatal death or collapse: a national surveillance study. Pediatr Res 2016; 80:493-8. [PMID: 27384403 DOI: 10.1038/pr.2016.110] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/30/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND The incidence of sudden unexpected early neonatal death (SUEND) or acute life-threatening events (ALTEs) is reported as 0.05/1,000 to 0.38/1,000 live births. There is currently no national system in Australia for reporting and investigating such cases. METHODS A 3-y prospective, national surveillance study, run in collaboration with the Australian Pediatric Surveillance Unit (APSU). Data were provided by pediatricians reporting to APSU; and independently ascertained by the Coroner in two states (NSW and QLD) and the Newborn Early Transport Network in NSW. A detailed deidentified questionnaire was created. RESULTS In NSW and QLD, the incidence was 0.1 and 0.08/1,000 live births, respectively. Forty-eight definitive cases were identified. Common causes included accidental asphyxia, cardiac disease, persistent pulmonary hypertension of the newborn, and sudden infant death syndrome. Twenty-six babies collapsed on day 1 and 19 were found on the carer's chest. CONCLUSION The incidence in NSW and QLD is higher than previously published. The first postnatal day is a vulnerable period for newborns, who require close observation particularly during skin-to-skin contact. Development and implementation of guidelines for safe sleeping in hospital are needed. Collaboration between obstetricians, midwives, and pediatricians is essential to ensure safety of the newborn.
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Affiliation(s)
- Tracey L Lutz
- Department of Public Health, University of Sydney, Sydney, Australia.,The Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
| | - Elizabeth J Elliott
- The Sydney Children's Hospitals Network, Westmead, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, Sydney, Australia
| | - Heather E Jeffery
- Department of Public Health, University of Sydney, Sydney, Australia.,The Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
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21
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Feldman-Winter L, Goldsmith JP. Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns. Pediatrics 2016; 138:peds.2016-1889. [PMID: 27550975 DOI: 10.1542/peds.2016-1889] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Skin-to-skin care (SSC) and rooming-in have become common practice in the newborn period for healthy newborns with the implementation of maternity care practices that support breastfeeding as delineated in the World Health Organization's "Ten Steps to Successful Breastfeeding." SSC and rooming-in are supported by evidence that indicates that the implementation of these practices increases overall and exclusive breastfeeding, safer and healthier transitions, and improved maternal-infant bonding. In some cases, however, the practice of SSC and rooming-in may pose safety concerns, particularly with regard to sleep. There have been several recent case reports and case series of severe and sudden unexpected postnatal collapse in the neonatal period among otherwise healthy newborns and near fatal or fatal events related to sleep, suffocation, and falls from adult hospital beds. Although these are largely case reports, there are potential dangers of unobserved SSC immediately after birth and throughout the postpartum hospital period as well as with unobserved rooming-in for at-risk situations. Moreover, behaviors that are modeled in the hospital after birth, such as sleep position, are likely to influence sleeping practices after discharge. Hospitals and birthing centers have found it difficult to develop policies that will allow SSC and rooming-in to continue in a safe manner. This clinical report is intended for birthing centers and delivery hospitals caring for healthy newborns to assist in the establishment of appropriate SSC and safe sleep policies.
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22
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Affiliation(s)
| | - Dhruv Gupta
- Children's Hospital of Michigan, Detroit, MI, USA
| | - Deepak Kamat
- Children's Hospital of Michigan, Detroit, MI, USA
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23
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Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, Kajeepeta S, Wall S, Chan GJ. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics 2016; 137:peds.2015-2238. [PMID: 26702029 PMCID: PMC4702019 DOI: 10.1542/peds.2015-2238] [Citation(s) in RCA: 312] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Kangaroo mother care (KMC) is an intervention aimed at improving outcomes among preterm and low birth weight newborns. OBJECTIVE Conduct a systematic review and meta-analysis estimating the association between KMC and neonatal outcomes. DATA SOURCES PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Latin American and Caribbean Health Sciences Information System (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR), and Western Pacific Region Index Medicus (WPRIM). STUDY SELECTION We included randomized trials and observational studies through April 2014 examining the relationship between KMC and neonatal outcomes among infants of any birth weight or gestational age. Studies with <10 participants, lack of a comparison group without KMC, and those not reporting a quantitative association were excluded. DATA EXTRACTION Two reviewers extracted data on study design, risk of bias, KMC intervention, neonatal outcomes, relative risk (RR) or mean difference measures. RESULTS 1035 studies were screened; 124 met inclusion criteria. Among LBW newborns, KMC compared to conventional care was associated with 36% lower mortality(RR 0.64; 95% [CI] 0.46, 0.89). KMC decreased risk of neonatal sepsis (RR 0.53, 95% CI 0.34, 0.83), hypothermia (RR 0.22; 95% CI 0.12, 0.41), hypoglycemia (RR 0.12; 95% CI 0.05, 0.32), and hospital readmission (RR 0.42; 95% CI 0.23, 0.76) and increased exclusive breastfeeding (RR 1.50; 95% CI 1.26, 1.78). Newborns receiving KMC had lower mean respiratory rate and pain measures, and higher oxygen saturation, temperature, and head circumference growth. LIMITATIONS Lack of data on KMC limited the ability to assess dose-response. CONCLUSIONS Interventions to scale up KMC implementation are warranted.
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Affiliation(s)
| | | | - Donna Spiegelman
- Departments of Epidemiology,,Biostatistics, and,Departments of Global Health and Population, and
| | - Wafaie W. Fawzi
- Departments of Epidemiology,,Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;,Departments of Global Health and Population, and
| | - Stacey A. Missmer
- Departments of Epidemiology,,Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ellice Lieberman
- Departments of Epidemiology,,Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts;,Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Grace J. Chan
- Departments of Global Health and Population, and,Save the Children, Washington, DC; and,Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
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24
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Dangers of death on the first day of life by the minute. J Perinatol 2015; 35:958-64. [PMID: 26334397 DOI: 10.1038/jp.2015.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/23/2015] [Accepted: 07/28/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate mortality on the first day of life by minute and hour, and examine changes in major causes of death in the past three decades. STUDY DESIGN We evaluated mortality on the first day of life by the hour (0, 1, …, 23 h), and in the first hour by 5-min block (0-4, 5-9, …, 55-59 min) using data on cause of death for 15,690 infants in Canada from 1981 to 2012. RESULTS Infant mortality on the first day declined from 2.60 per 1000 in the 1980s to 1.26 in the 2000s. The decline was greater at 6-23 h than at 0-5 h of life, and among infants with congenital anomalies compared with prematurity and birth asphyxia. CONCLUSION Infant mortality is highest on the first day of life. More focus on prematurity and birth asphyxia in the first 5 h of life is needed to improve infant mortality.
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Wennergren G, Nordstrand K, Alm B, Möllborg P, Öhman A, Berlin A, Katz‐Salamon M, Lagercrantz H. Updated Swedish advice on reducing the risk of sudden infant death syndrome. Acta Paediatr 2015; 104:444-8. [PMID: 25656219 PMCID: PMC6680202 DOI: 10.1111/apa.12966] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/25/2015] [Accepted: 02/02/2015] [Indexed: 12/27/2022]
Abstract
This article reviews updated advice and factual material from the Swedish National Board of Health and Welfare on reducing the risk of sudden infant death syndrome. Issues covered by the guidance for parents and healthcare professionals include sleeping positions, smoking, breastfeeding, bed sharing and using pacifiers. Conclusion The guidelines conclude that infants under three months of age are safest sleeping in their own cot and that a pacifier can be used when they are going to sleep.
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Affiliation(s)
- Göran Wennergren
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | | | - Bernt Alm
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Per Möllborg
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Anna Öhman
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Anita Berlin
- Centre for Family and Community Medicine Department of Neurobiology, Care Sciences and Society Karolinska Institute Stockholm Sweden
| | - Miriam Katz‐Salamon
- Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
| | - Hugo Lagercrantz
- Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
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Friedman F, Adrouche-Amrani L, Holzman IR. Breastfeeding and delivery room neonatal collapse. J Hum Lact 2015; 31:230-2. [PMID: 25389125 DOI: 10.1177/0890334414558597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/14/2014] [Indexed: 11/17/2022]
Abstract
Sudden unexpected neonatal collapse in the delivery room is a rare occurrence in healthy term infants. Upper airway obstruction may occur from improper positioning of the newborn even while breastfeeding. Such occlusion may have dire consequences if not recognized immediately. We report 2 healthy term neonates who suffered respiratory arrest while in the mother's arms and attempting breastfeeding. In each case, rapid response by the delivery room nurse averted tragedy. Metabolic and infectious evaluations were unremarkable. Both babies have been well on subsequent examinations. We conclude that proper education of mothers and safe positioning of neonates is critical during the initiation of breastfeeding.
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Affiliation(s)
- Frederick Friedman
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | | | - Ian R Holzman
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine, Mount Sinai, New York, NY, USA Department of Pediatrics, Icahn School of Medicine, Mount Sinai, New York, NY, USA
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Davanzo R, De Cunto A, Paviotti G, Travan L, Inglese S, Brovedani P, Crocetta A, Calligaris C, Corubolo E, Dussich V, Verardi G, Causin E, Kennedy J, Marrazzo F, Strajn T, Sanesi C, Demarini S. Making the first days of life safer: preventing sudden unexpected postnatal collapse while promoting breastfeeding. J Hum Lact 2015; 31:47-52. [PMID: 25339551 DOI: 10.1177/0890334414554927] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Early and prolonged skin-to-skin contact (SSC) after birth between a mother and her newborn has been shown to generate beneficial effects on the mother-infant relationship and breastfeeding. Close mother-infant body contact immediately after birth positively enhances exclusive breastfeeding during the hospital stay, with a dose-response relationship. Skin-to-skin contact may ease the infant's transition to extra-uterine life and helps regulate the infant's body temperature and nursing behavior. However, reports of sudden unexpected postnatal collapse (SUPC) soon after birth, in healthy term neonates, in association with SSC, have raised concerns about the safety of this practice. Based on available evidence, we developed a surveillance protocol in the delivery room and postnatal ward of the Institute for Maternal and Child Health of Trieste (Italy). The aim of our protocol is (a) to promote safe mother and infant bonding and (b) to establish successful breastfeeding, without increasing the risk of SUPC. As there is no known effective intervention to prevent SUPC, our protocol has been conceived as a potential best practice.
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Affiliation(s)
- Riccardo Davanzo
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Angela De Cunto
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Giulia Paviotti
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Laura Travan
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Stefania Inglese
- Division of Obstetrics & Gynecology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Pierpaolo Brovedani
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Anna Crocetta
- Division of Pediatrics, San Polo Hospital, Monfalcone, Italy
| | | | - Elisa Corubolo
- Division of Obstetrics & Gynecology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Valentina Dussich
- Division of Obstetrics & Gynecology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Giuseppa Verardi
- Division of Obstetrics & Gynecology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Enrica Causin
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Jaquelyn Kennedy
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Francesca Marrazzo
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Tamara Strajn
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Cecilia Sanesi
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Sergio Demarini
- Department of Perinatal Medicine, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
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Paviotti G, Demarini S, Verardi G, De Cunto A, Davanzo R. Making the first days of life safer: time for a new protocol? J Perinatol 2014; 34:957. [PMID: 25421134 DOI: 10.1038/jp.2014.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- G Paviotti
- Division of Neonatology, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
| | - S Demarini
- Division of Neonatology, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
| | - G Verardi
- Division of Obstetrics and Gynecology, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
| | - A De Cunto
- Division of Neonatology, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
| | - R Davanzo
- Division of Neonatology, Institute for Maternal and Child Health IRCCS 'Burlo Garofolo', Trieste, Italy
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Feldman K, Whyte RK. Two cases of apparent suffocation of newborns during side-lying breastfeeding. Nurs Womens Health 2014; 17:337-41. [PMID: 23957800 DOI: 10.1111/1751-486x.12053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The side-lying position is one of several options offered to women in the postpartum period to assist with early establishment of breastfeeding. Many new mothers are exhausted and experiencing significant pain following birth. While the side-lying position for breastfeeding can allow women to get needed rest, it can increase their risk of falling asleep while in this position and potentially smothering their babies. We report two cases of apparent suffocation in newborns on the maternity ward when women unintentionally fell asleep while breastfeeding in the side-lying position. Interventions that may help to prevent such events are suggested.
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Affiliation(s)
- Kayla Feldman
- North York General Hospital in Toronto, Ontario, Canada.
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Sudden unexpected death in infancy (SUDI) in the early neonatal period: the role of bed-sharing. Forensic Sci Med Pathol 2014; 10:157-62. [DOI: 10.1007/s12024-013-9518-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2013] [Indexed: 11/27/2022]
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Stevens J, Schmied V, Burns E, Dahlen H. Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature. MATERNAL AND CHILD NUTRITION 2014; 10:456-73. [PMID: 24720501 DOI: 10.1111/mcn.12128] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The World Health Organization and the United Nations International Children's Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress.
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Affiliation(s)
- Jeni Stevens
- School of Nursing and Midwifery, University of Western Sydney, Penrith, New South Wales, Australia
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Consideraciones en relación con la seguridad del contacto precoz piel con piel tras el parto. An Pediatr (Barc) 2014; 80:203-5. [DOI: 10.1016/j.anpedi.2014.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/29/2014] [Accepted: 02/06/2014] [Indexed: 11/23/2022] Open
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Ludington-Hoe SM, Morgan K. Infant Assessment and Reduction of Sudden Unexpected Postnatal Collapse Risk During Skin-to-Skin Contact. ACTA ACUST UNITED AC 2014. [DOI: 10.1053/j.nainr.2013.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Marin N, Valverde E, Cabañas F. [Severe apparent life-threatening event during "skin-to-skin": treatment with hypothermia]. An Pediatr (Barc) 2013; 79:253-6. [PMID: 24051185 DOI: 10.1016/j.anpedi.2013.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 06/25/2013] [Indexed: 02/05/2023] Open
Abstract
'Skin-to-skin' in healthy newborn infants is currently routine practice in Spanish maternity wards. This practice has shown benefits in increasing the duration of breast-feeding and maternal bonding behaviour with no significant adverse events. Early sudden deaths and severe apparent life-threatening events (ALTE) during the first 24 hours of life are infrequent, but well recognised. Risk factors during 'skin to skin' have been established. These events can lead to high neonatal morbidity and mortality. Hypothermia is now the standard of care for moderate to severe hypoxic-ischaemic encephalopathy and has shown to reduce mortality and neurological morbidity in children with hypoxic-ischaemic brain injury. Although there are no clinical trials that evaluate hypothermia after a severe ALTE, neonates who suffer it should be considered for this treatment. We present a case of a healthy newborn who had an ALTE during skin-to-skin with his mother and was treated with hypothermia.
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Affiliation(s)
- N Marin
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España.
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Pejovic NJ, Herlenius E. Unexpected collapse of healthy newborn infants: risk factors, supervision and hypothermia treatment. Acta Paediatr 2013; 102:680-8. [PMID: 23551812 PMCID: PMC3709122 DOI: 10.1111/apa.12244] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 01/13/2023]
Abstract
AIM To determine the occurrence and risk factors of sudden unexpected postnatal collapse (SUPC) in presumably healthy newborn infants. METHODS All live-born infants during a 30-month period, in five major delivery wards in Stockholm, were screened, and possible cases of SUPC thoroughly investigated. Infants were ≥35 weeks of gestation, had an Apgar score >8 at 10 min and collapsed within 24 h after birth. Maternal, infant, event characteristics and outcome data were collected. RESULTS Twenty-six cases of SUPC were found among 68 364 live-born infants, an incidence of 38/100 000 live births. Sixteen of these cases of SUPC required resuscitation with ventilation >1 min, and 14 of these remained unexplained (21/100 000). Fifteen of the 26 children were found in a prone position, during skin-to-skin contact, 18 were primipara, and 13 occurred during unsupervised breastfeeding at <2 h of age. Three cases occurred during smart cellular phone use by the mother. Five developed hypoxic-ischaemic encephalopathy (HIE) grade 2, and 4 underwent hypothermia treatment. Twenty-five infants had a favourable neurological outcome. CONCLUSION SUPC in apparent healthy babies is associated with initial, unsupervised breastfeeding, prone position, primiparity and distractions. Guidelines outlining the appropriate monitoring of newborns and safe early skin-to-skin contact should be implemented.
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Affiliation(s)
- Nicolas J Pejovic
- Department of Neonatology, Sachs' Children and Youth Hospital, Stockholm, Sweden
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Sudden unexpected postnatal collapse of newborn infants: a review of cases, definitions, risks, and preventive measures. Transl Stroke Res 2013; 4:236-47. [PMID: 23518795 PMCID: PMC3599160 DOI: 10.1007/s12975-013-0255-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/31/2013] [Accepted: 02/04/2013] [Indexed: 11/15/2022]
Abstract
This study aimed to review available published reports concerning sudden unexpected postnatal collapse (SUPC) of apparently healthy infants within the first days of postnatal life, establish a structured presentation and delineate recommendations for preventive measures. All published reports of SUPC cases were retrospectively analyzed, and three not previously published SUPC cases at Karolinska University Hospital were detailed to exemplify the varying presentations and outcomes of SUPC. We found 398 published cases of SUPC occurring during first postnatal week. Estimated incidence of the SUPC of a presumably healthy infant after birth differs widely, ranging from 2.6 cases to 133 cases/100,000. However, definition, inclusion, and exclusion criteria vary substantially between reports. Our summary indicates that reported SUPC occurs more frequently than expected from recent surveys. About half of the infants die, and of the remaining survivors, half have neurological sequela. Of the 233 cases of sudden unexpected death described, no etiology was found in 153 cases. When a defined time for the SUPC event is described, approximately one third of reported events occur during the first 2 h, between 2 and 24 h and between 1 and 7 days after birth, respectively. Adequate education of caregivers and appropriate surveillance during the first days of newborns should enable us to save hundreds of lives.
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Abstract
Based on strong research evidence, the most common causes of apparent life-threatening events (ALTEs) are gastroesophageal reflux, lower respiratory tract infection, and seizure. • The minimum initial diagnostic panel for ALTE should include complete blood cell (CBC) count with differential; blood levels of C-reactive protein,glucose, sodium, potassium, urea, calcium,magnesium, ammonia, lactate, and pyruvate; arterial blood gas determination, urinalysis, and toxicology screen; electrocardiography; and assessments for Bordetella pertussis and respiratory syncytial virus in season. • Other testing should be done based on the infant’s clinical presentation and clinician’s degree of suspicion.• Most infants should be hospitalized for cardiorespiratory monitoring for 23 hours after an ALTE. • There is strong evidence that newborns are at higher risk of ALTE and sudden infant death syndrome (SIDS)within the first 24 hours after birth and therefore should be frequently monitored as much as possible while room sharing with their mothers. • Evidence suggests that maternal smoking may place an infant for higher risk of SIDS after an ALTE.
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Affiliation(s)
- Linda Y Fu
- Division of General Pediatrics and Community Health, Goldberg Center for Community Pediatric Health, Children's National Medical Center; George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Moore ER, Anderson GC, Bergman N, Dowswell T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2012; 5:CD003519. [PMID: 22592691 PMCID: PMC3979156 DOI: 10.1002/14651858.cd003519.pub3] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Mother-infant separation postbirth is common in Western culture. Early skin-to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, head covered with a dry cap and a warm blanket across the back, prone on the mother's bare chest. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neurobehaviors ensuring fulfillment of basic biological needs. This time may represent a psychophysiologically 'sensitive period' for programming future physiology and behavior. OBJECTIVES To assess the effects of early SSC on breastfeeding, physiological adaptation, and behavior in healthy mother-newborn dyads. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2011), made personal contact with trialists, and consulted the bibliography on kangaroo mother care (KMC) maintained by Dr. Susan Ludington. SELECTION CRITERIA Randomized controlled trials comparing early SSC with usual hospital care. DATA COLLECTION AND ANALYSIS We independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS Thirty-four randomized controlled trials were included involving 2177 participants (mother-infant dyads). Data from more than two trials were available for only eight outcome measures. For primary outcomes, we found a statistically significant positive effect of early SSC on breastfeeding at one to four months postbirth (13 trials; 702 participants) (risk ratio (RR) 1.27, 95% confidence interval (CI) 1.06 to 1.53, and SSC increased breastfeeding duration (seven trials; 324 participants) (mean difference (MD) 42.55 days, 95% CI -1.69 to 86.79) but the results did not quite reach statistical significance (P = 0.06). Late preterm infants had better cardio-respiratory stability with early SSC (one trial; 31 participants) (MD 2.88, 95% CI 0.53 to 5.23). Blood glucose 75 to 90 minutes following the birth was significantly higher in SSC infants (two trials, 94 infants) (MD 10.56 mg/dL, 95% CI 8.40 to 12.72).The overall methodological quality of trials was mixed, and there was high heterogeneity for some outcomes. AUTHORS' CONCLUSIONS Limitations included methodological quality, variations in intervention implementation, and outcomes. The intervention appears to benefit breastfeeding outcomes, and cardio-respiratory stability and decrease infant crying, and has no apparent short- or long-term negative effects. Further investigation is recommended. To facilitate meta-analysis, future research should be done using outcome measures consistent with those in the studies included here. Published reports should clearly indicate if the intervention was SSC with time of initiation and duration and include means, standard deviations and exact probability values.
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Andres V, Garcia P, Rimet Y, Nicaise C, Simeoni U. Apparent life-threatening events in presumably healthy newborns during early skin-to-skin contact. Pediatrics 2011; 127:e1073-6. [PMID: 21402632 DOI: 10.1542/peds.2009-3095] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The death or near death of a presumably healthy newborn in the delivery room is uncommon. We report here 6 cases of apparent life-threatening events (ALTEs) in the delivery room during the first 2 hours of life. In each case, the incident occurred in a healthy infant who was in a prone position on his or her mother's abdomen during early skin-to-skin contact. In most cases, the mother was primiparous, and in all cases the mother and infant were not observed during the initiation of skin-to-skin contact and breastfeeding. There are many benefits of early skin-to-skin contact and breastfeeding in the delivery room. However, in view of the risk of a rare but significant ALTE, we suggest that surveillance of newborns is needed. Although many ALTEs are apparently caused by obstruction, we suggest that a standardized investigational workup be performed after an ALTE.
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Affiliation(s)
- Virginie Andres
- Neonatal Intensive Care Unit, La Conception University Hospital, Marseille, France.
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Poets A, Steinfeldt R, Poets CF. Sudden deaths and severe apparent life-threatening events in term infants within 24 hours of birth. Pediatrics 2011; 127:e869-73. [PMID: 21444593 DOI: 10.1542/peds.2010-2189] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE AND DESIGN To determine the incidence of and possible risk factors for unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) that occurred within 24 hours of birth. This was a monthly epidemiologic survey. PATIENTS AND METHODS Throughout 2009, every pediatric department in Germany was asked to report such cases of unexplained SID or S-ALTE in term infants after a good postnatal adaptation (10-minute Apgar score ≥ 8) to the Surveillance Unit for Rare Pediatric Conditions in Germany. The latter has a capture rate of > 95%. S-ALTE was defined as acute cyanosis/pallor and unconsciousness, requiring bagging, intubation and/or cardiac compressions. Hospitals that reported a case were asked to return an anonymized questionnaire and discharge letter as well as the autopsy protocol in SID cases. RESULTS Of 43 cases reported, 17 fulfilled entry criteria, yielding an incidence of 2.6 in 100 000 live births. There were 7 deaths (ie, 1.1/100 000); 6 of the 10 S-ALTE infants were neurologically abnormal at discharge. Twelve infants were found lying on their mother's chest or abdomen, or very close to and facing her. Nine events occurred in the first 2 hours after birth; 7, were only noticed by a health professional despite the mother being present and awake. CONCLUSIONS SID or S-ALTE may occur in the first 24 hours after birth, particularly within the first 2 hours. Events seem often related to a potentially asphyxiating position. Parents may be too fatigued or otherwise not able to assess their infant's condition correctly. Closer observation during these earliest hours seems warranted.
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Affiliation(s)
- Anette Poets
- Department of Neonatology, Tuebingen University Hospital, Calwerstr. 7, 72076 Tuebingen, Germany.
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Rodriguez-Alarcón Gómez J, Elorriaga IA, Fernández-Llebrez L, Fernández AP, Avellanal CU, Sierra CO. Episodios aparentemente letales en las primeras dos horas de vida durante el contacto piel con piel. Incidencia y factores de riesgo. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.pog.2010.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schrewe B, Janvier A, Barrington K. Life-threatening event during skin-to-skin contact in the delivery room. BMJ Case Rep 2010; 2010:2010/dec21_1/bcr1120103475. [PMID: 22802486 DOI: 10.1136/bcr.11.2010.3475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
After an uncomplicated term delivery, a newborn infant experienced a life-threatening even a few minutes after being born. Few such events have been described before, they may be due to suffocation; minor changes in surveillance can probably prevent these potentially devastating events.
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Affiliation(s)
- Brett Schrewe
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
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