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Malheiros J, Amaral C, da Silva LS, Guinsburg R, Covolan L. Neonatal nociceptive stimulation results in pain sensitization, reduction of hippocampal 5-HT 1A receptor, and p-CREB expression in adult female rats. Behav Brain Res 2024; 466:114975. [PMID: 38552745 DOI: 10.1016/j.bbr.2024.114975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
Painful invasive procedures are often performed on newborns admitted to intensive care units (ICU). The acute and long-term effects caused by these stimuli can be investigated in animal models, such as newborn rats. Previous studies have shown that animals subjected to nociceptive stimuli in the neonatal period show sex-specific behavioral changes such as signs of anxiety or depression. Under the same conditions, neonatal stimuli also provoke an increase in the rate of neurogenesis and cell activation in the hippocampal dentate gyrus. So, this study aims to identify the possible roles of central monoamines, receptor expression (5-HT1A), and signaling factors (p-CREB) underlying the long-term effects of neonatal nociceptive stimulation. For this, noxious stimulation was induced by intra-plantar injection of Complete Freund´s adjuvant (CFA) on the postnatal day 1 (P1) or 8 (P8). Control animals were not stimulated. On P75 the behavioral tests were conducted (hotplate and elevated plus maze), followed by sacrifice and molecular studies. Our results showed that neonatal nociceptive stimulation alters pain sensitization specially in females, while stimulation on P1 increases pain threshold, P8-stimulated animals respond with reduced pain threshold (P < 0.001). Hippocampal expression of 5-HT1A receptor and p-CREB were reduced in P8 F group (P < 0.001) in opposition to the increased utilization rate of dopamine and serotonin in this group (P < 0.05). This study shows sex- and age-specific responses of signaling pathways within the hippocampus accompanied by altered behavioral repertoire, at long-term after neonatal painful stimulation.
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Affiliation(s)
- Jackeline Malheiros
- Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, SP 04023-062, Brazil
| | - Cristiane Amaral
- Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, SP 04023-062, Brazil
| | - Luiz Severino da Silva
- Departamento de Micro Imuno Parasitologia, Universidade Federal de São Paulo, São Paulo, SP 04023-062, Brazil
| | - Ruth Guinsburg
- Disciplina de Pediatria Neonatal, Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, SP 04023-062, Brazil
| | - Luciene Covolan
- Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, SP 04023-062, Brazil.
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Stolz C, Costa-Nobre DT, Sanudo A, Ferreira DMDLM, Sales Alves JM, Dos Santos JP, Miyoshi MH, Silva NMDM, Melo FPDG, da Silva RVC, Barcala D, Vale MS, de Souza Rugolo LMS, Diniz EMA, Ribeiro M, Marba STM, Cwajg S, Duarte JLMB, Gonçalves Ferri WA, Procianoy RS, Anchieta LM, de Andrade Lopes JM, de Almeida MFB, Guinsburg R. Bronchopulmonary dysplasia: temporal trend from 2010 to 2019 in the Brazilian Network on Neonatal Research. Arch Dis Child Fetal Neonatal Ed 2024; 109:328-335. [PMID: 38071522 DOI: 10.1136/archdischild-2023-325826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/15/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To evaluate the temporal trend of bronchopulmonary dysplasia (BPD) in preterm infants who survived to at least 36 weeks' post-menstrual age (PMA) and BPD or death at 36 weeks' PMA, and to analyse variables associated with both outcomes. DESIGN Retrospective cohort with data retrieved from an ongoing national registry. SETTING 19 Brazilian university public hospitals. PATIENTS Infants born between 2010 and 2019 with 23-31 weeks and birth weight 400-1499 g. MAIN OUTCOME MEASURES Temporal trend was evaluated by Prais-Winsten model and variables associated with BPD in survivors or BPD or death were analysed by logistic regression. RESULTS Of the 11 128 included infants, BPD in survivors occurred in 22%, being constant over time (annual per cent change (APC): -0.80%; 95% CI: -2.59%; 1.03%) and BPD or death in 45%, decreasing over time (APC: -1.05%; 95% CI: -1.67%; -0.43%). Being male, small for gestational age, presenting with respiratory distress syndrome, air leaks, needing longer duration of mechanical ventilation, presenting with treated patent ductus arteriosus and late-onset sepsis were associated with an increase in the chance of BPD. For the outcome BPD or death, maternal bleeding, multiple gestation, 5-minute Apgar <7, late-onset sepsis, necrotising enterocolitis and intraventricular haemorrhage were added to the variables reported above as increasing the chance of the outcome. CONCLUSION The frequency of BPD in survivors was constant and BPD or death decreased by 1.05% at each study year. These results show some improvement in perinatal care in Brazilian units which resulted in a reduction of BPD or death, but further improvements are still needed to reduce BPD in survivors.
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Affiliation(s)
- Camila Stolz
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Milton Harumi Miyoshi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital Geral de Pirajussara, Taboão da Serra, São Paulo, Brazil
| | | | | | | | - Dafne Barcala
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | | | | | | | - Manoel Ribeiro
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sérgio T M Marba
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Silvia Cwajg
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, Brazil
| | | | | | - Renato S Procianoy
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leni Marcia Anchieta
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Maria de Andrade Lopes
- Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, Brazil
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Guinsburg R. The touch of science: the Petal trial. Lancet Child Adolesc Health 2024; 8:246-247. [PMID: 38373430 DOI: 10.1016/s2352-4642(24)00001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Ruth Guinsburg
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, 01410-020, Brazil.
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, Fernanda de Almeida M, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Daripa Kawakami M, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, John Madar R, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Gene Ong YK, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2024; 195:109992. [PMID: 37937881 DOI: 10.1016/j.resuscitation.2023.109992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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Carlini LP, Coutrin GDAS, Ferreira LA, Soares JDCA, Silva GVT, Heiderich TM, Balda RDCX, Barros MCDM, Guinsburg R, Thomaz CE. Human vs machine towards neonatal pain assessment: A comprehensive analysis of the facial features extracted by health professionals, parents, and convolutional neural networks. Artif Intell Med 2024; 147:102724. [PMID: 38184347 DOI: 10.1016/j.artmed.2023.102724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 01/08/2024]
Abstract
Neonates are not able to verbally communicate pain, hindering the correct identification of this phenomenon. Several clinical scales have been proposed to assess pain, mainly using the facial features of the neonate, but a better comprehension of these features is yet required, since several related works have shown the subjectivity of these scales. Meanwhile, computational methods have been implemented to automate neonatal pain assessment and, although performing accurately, these methods still lack the interpretability of the corresponding decision-making processes. To address this issue, we propose in this work a facial feature extraction framework to gather information and investigate the human and machine neonatal pain assessments, comparing the visual attention of the facial features perceived by health-professionals and parents of neonates with the most relevant ones extracted by eXplainable Artificial Intelligence (XAI) methods, considering the VGG-Face and N-CNN deep learning architectures. Our experimental results show that the information extracted by the computational methods are clinically relevant to neonatal pain assessment, but yet do not agree with the facial visual attention of health-professionals and parents, suggesting that humans and machines can learn from each other to improve their decision-making processes. We believe that these findings might advance our understanding of how humans and machines code and decode neonatal facial responses to pain, enabling further improvements in clinical scales widely used in practical situations and in face-based automatic pain assessment tools as well.
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Affiliation(s)
- Lucas Pereira Carlini
- Department of Electrical Engineering, University College FEI, Av. Humberto de Alencar Castelo Branco, 3972-B, Sao Bernardo do Campo, 09850-901, Sao Paulo, Brazil.
| | - Gabriel de Almeida Sá Coutrin
- Department of Electrical Engineering, University College FEI, Av. Humberto de Alencar Castelo Branco, 3972-B, Sao Bernardo do Campo, 09850-901, Sao Paulo, Brazil
| | - Leonardo Antunes Ferreira
- Department of Electrical Engineering, University College FEI, Av. Humberto de Alencar Castelo Branco, 3972-B, Sao Bernardo do Campo, 09850-901, Sao Paulo, Brazil
| | | | | | - Tatiany Marcondes Heiderich
- Department of Electrical Engineering, University College FEI, Av. Humberto de Alencar Castelo Branco, 3972-B, Sao Bernardo do Campo, 09850-901, Sao Paulo, Brazil; Department of Paediatrics, Federal University of Sao Paulo, R. Botucatu, 740, Sao Paulo, 04024-002, Sao Paulo, Brazil
| | - Rita de Cássia Xavier Balda
- Department of Paediatrics, Federal University of Sao Paulo, R. Botucatu, 740, Sao Paulo, 04024-002, Sao Paulo, Brazil
| | | | - Ruth Guinsburg
- Department of Paediatrics, Federal University of Sao Paulo, R. Botucatu, 740, Sao Paulo, 04024-002, Sao Paulo, Brazil
| | - Carlos Eduardo Thomaz
- Department of Electrical Engineering, University College FEI, Av. Humberto de Alencar Castelo Branco, 3972-B, Sao Bernardo do Campo, 09850-901, Sao Paulo, Brazil
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Borten JBL, Barros MCM, Silva ES, Carlini LP, Balda RCX, Orsi RN, Heiderich TM, Sanudo A, Thomaz CE, Guinsburg R. Looking through Providers' Eyes: Pain in the Neonatal Intensive Care Unit. Am J Perinatol 2023. [PMID: 37973154 DOI: 10.1055/a-2212-0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Evaluate the pain of critically ill newborns is a challenge because of the devices for cardiorespiratory support. This study aim to verify the adults' gaze when assessing the critically ill neonates' pain at bedside. STUDY DESIGN Cross-sectional study in which pediatricians, nursing technicians, and parents evaluated critically ill neonates' pain at bedside, for 20 seconds with eye-tracking glasses. At the end, they answered whether the neonate was in pain or not. Visual tracking outcomes: number and time of visual fixations in four areas of interest (AOI) (face, trunk, and upper [UL] and lower [LL] limbs) were compared between groups and according to pain perception (present/absent). RESULTS A total of 62 adults (21 pediatricians, 23 nursing technicians, 18 parents) evaluated 27 neonates (gestational age: 31.8 ± 4.4 weeks; birth weight: 1,645 ± 1,234 g). More adults fixed their gaze on the face (96.8%) and trunk (96.8%), followed by UL (74.2%) and LL (66.1%). Parents performed a greater number of fixations on the trunk than nursing technicians (11.0 vs. 5.5 vs. 6.0; p = 0.023). Controlled for visual tracking variables, each second of eye fixation in AOI (1.21; 95% confidence interval [CI]: 1.03-1.42; p = 0.018) and UL (1.07; 95% CI: 1.03-1.10; p < 0.001) increased the chance of perceiving the presence of pain. CONCLUSION Adults, when assessing at bedside critically ill newborns' pain, fixed their eyes mainly on the face and trunk. The time spent looking at the UL was associated with the perception of pain presence. KEY POINTS · Pain assessment in critically ill newborns is a challenge.. · To assess critically ill neonates' pain, adults mainly look at the face and trunk.. · Looking at the upper limbs also helps in assessing critically ill neonates' pain..
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Affiliation(s)
- Julia B L Borten
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marina C M Barros
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Erica S Silva
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucas P Carlini
- Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, Sao Bernardo do Campo, São Paulo, Brazil
| | - Rita C X Balda
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rafael N Orsi
- Epidemiology and Biostatistics, Department of Preventive Medicine at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tatiany M Heiderich
- Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, Sao Bernardo do Campo, São Paulo, Brazil
| | - Adriana Sanudo
- Epidemiology and Biostatistics, Department of Preventive Medicine at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carlos E Thomaz
- Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, Sao Bernardo do Campo, São Paulo, Brazil
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Monnelly V, Josephsen JB, Isayama T, de Almeida MFB, Guinsburg R, Schmölzer GM, Rabi Y, Wyckoff MH, Weiner G, Liley HG, Solevåg AL. Exhaled CO 2 monitoring to guide non-invasive ventilation at birth: a systematic review. Arch Dis Child Fetal Neonatal Ed 2023; 109:74-80. [PMID: 37558397 DOI: 10.1136/archdischild-2023-325698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Measuring exhaled carbon dioxide (ECO2) during non-invasive ventilation at birth may provide information about lung aeration. However, the International Liaison Committee on Resuscitation (ILCOR) only recommends ECO2 detection for confirming endotracheal tube placement. ILCOR has therefore prioritised a research question that needs to be urgently evaluated: 'In newborn infants receiving intermittent positive pressure ventilation by any non-invasive interface at birth, does the use of an ECO2 monitor in addition to clinical assessment, pulse oximetry and/or ECG, compared with clinical assessment, pulse oximetry and/or ECG only, decrease endotracheal intubation in the delivery room, improve response to resuscitation, improve survival or reduce morbidity?'. DESIGN Systematic review of randomised and non-randomised studies identified by Ovid MEDLINE, Embase and Cochrane CENTRAL search until 1 August 2022. SETTING Delivery room. PATIENTS Newborn infants receiving non-invasive ventilation at birth. INTERVENTION ECO2 measurement plus routine assessment compared with routine assessment alone. MAIN OUTCOME MEASURES Endotracheal intubation in the delivery room, response to resuscitation, survival and morbidity. RESULTS Among 2370 articles, 23 were included; however, none had a relevant control group. Although studies indicated that the absence of ECO2 may signify airway obstruction and ECO2 detection may precede a heart rate increase in adequately ventilated infants, they did not directly address the research question. CONCLUSIONS Evidence to support the use of an ECO2 monitor to guide non-invasive positive pressure ventilation at birth is lacking. More research on the effectiveness of ECO2 measurement in addition to routine assessment during non-invasive ventilation of newborn infants at birth is needed. PROSPERO REGISTRATION NUMBER CRD42022344849.
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Affiliation(s)
- Vix Monnelly
- Department of Neonatology, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Justin B Josephsen
- Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Maria Fernanda B de Almeida
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Yacov Rabi
- Department of Pediatrics, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Myra H Wyckoff
- Pediatrics, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA
| | - Gary Weiner
- Department of Pediatrics, Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Helen G Liley
- Mater Research Institute, The University of Queensland, South Brisbane, QLD, Australia
| | - Anne Lee Solevåg
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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8
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Berg KM, Bray JE, Ng KC, Liley HG, Greif R, Carlson JN, Morley PT, Drennan IR, Smyth M, Scholefield BR, Weiner GM, Cheng A, Djärv T, Abelairas-Gómez C, Acworth J, Andersen LW, Atkins DL, Berry DC, Bhanji F, Bierens J, Bittencourt Couto T, Borra V, Böttiger BW, Bradley RN, Breckwoldt J, Cassan P, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Dassanayake V, Davis PG, Dawson JA, de Almeida MF, De Caen AR, Deakin CD, Dicker B, Douma MJ, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Fijacko N, Finn JC, Flores GE, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman ME, Kloeck DA, Kudenchuk P, Kule A, Kurosawa H, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin Y, Lockey AS, Macneil F, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Monnelly V, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, Ohshimo S, Olasveengen TM, Ong YKG, Orkin AM, Parr MJ, Patocka C, Perkins GD, Perlman JM, Rabi Y, Raitt J, Ramachandran S, Ramaswamy VV, Raymond TT, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Singletary EM, Skrifvars MB, Smith CM, Soar J, Stassen W, Sugiura T, Tijssen JA, Topjian AA, Trevisanuto D, Vaillancourt C, Wyckoff MH, Wyllie JP, Yang CW, Yeung J, Zelop CM, Zideman DA, Nolan JP. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2023; 148:e187-e280. [PMID: 37942682 PMCID: PMC10713008 DOI: 10.1161/cir.0000000000001179] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
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9
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Silva ES, Barros MCDM, Borten JBL, Carlini LP, Balda RDCX, Orsi RN, Heiderich TM, Thomaz CE, Guinsburg R. Pediatricians' focus of sight at pain assessment during a neonatal heel puncture. Rev Paul Pediatr 2023; 42:e2023089. [PMID: 38088681 PMCID: PMC10712942 DOI: 10.1590/1984-0462/2024/42/2023089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/18/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To evaluate the focus of pediatricians' gaze during the heel prick of neonates. METHODS Prospective study in which pediatricians wearing eye tracker glasses evaluated neonatal pain before/after a heel prtick. Pediatricians scored the pain they perceived in the neonate in a verbal analogue numerical scale (0=no pain; 10=maximum pain). The outcomes measured were number and time of visual fixations in upper face, lower face, and hands, in two 10-second periods, before (pre) and after the puncture (post). These outcomes were compared between the periods, and according to pediatricians' pain perception: absent/mild (score: 0-5) and moderate/intense (score: 6-10). RESULTS 24 pediatricians (31 years old, 92% female) evaluated 24 neonates. The median score attributed to neonatal pain during the heel prick was 7.0 (Interquartile range: 5-8). Compared to pre-, in the post-periods, more pediatricians fixed their gaze on the lower face (63 vs. 92%; p=0.036) and the number of visual fixations was greater on the lower face (2.0 vs. 5.0; p=0.018). There was no difference in the number and time of visual fixations according to the intensity of pain. CONCLUSIONS At bedside, pediatricians change their focus of attention on the neonatal face after a painful procedure, focusing mainly on the lower part of the face.
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Affiliation(s)
- Erica Souza Silva
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Pediatria, Disciplina de Pediatria Neonatal – São Paulo, SP, Brasil
| | - Marina Carvalho de Moraes Barros
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Pediatria, Disciplina de Pediatria Neonatal – São Paulo, SP, Brasil
| | - Julia Baptista Lopes Borten
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Pediatria, Disciplina de Pediatria Neonatal – São Paulo, SP, Brasil
| | - Lucas Pereira Carlini
- Centro Universitario FEI, Departamento de Engenharia Elétrica, Laboratório de Processamento de Imagens – São Bernardo do Campo, SP, Brasil
| | - Rita de Cássia Xavier Balda
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Pediatria, Disciplina de Pediatria Neonatal – São Paulo, SP, Brasil
| | - Rafael Nobre Orsi
- Centro Universitario FEI, Departamento de Engenharia Elétrica, Laboratório de Processamento de Imagens – São Bernardo do Campo, SP, Brasil
| | - Tatiany Marcondes Heiderich
- Centro Universitario FEI, Departamento de Engenharia Elétrica, Laboratório de Processamento de Imagens – São Bernardo do Campo, SP, Brasil
| | - Carlos Eduardo Thomaz
- Centro Universitario FEI, Departamento de Engenharia Elétrica, Laboratório de Processamento de Imagens – São Bernardo do Campo, SP, Brasil
| | - Ruth Guinsburg
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Pediatria, Disciplina de Pediatria Neonatal – São Paulo, SP, Brasil
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Scavacini Marinonio AS, Xavier Balda RDC, Testoni Costa-Nobre D, Sanudo A, Miyoshi MH, Nema Areco KC, Daripa Kawakami M, Konstantyner T, Bandiera-Paiva P, Vieira de Freitas RM, Correia Morais LC, La Porte Teixeira M, Cunha Waldvogel B, Kiffer CRV, de Almeida MFB, Guinsburg R. Epidemiological trends of isolated and non-isolated central nervous system congenital malformations in live births in a middle-income setting. J Matern Fetal Neonatal Med 2023; 36:2289349. [PMID: 38057123 DOI: 10.1080/14767058.2023.2289349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES This study aimed to analyze, in the São Paulo state of Brazil, time trends in prevalence, neonatal mortality, and neonatal lethality of central nervous system congenital malformations (CNS-CM) between 2004 and 2015. METHODS Population-based study of all live births with gestational age ≥22 weeks and/or birthweight ≥400 g from mothers living in São Paulo State, during 2004-2015. CNS-CM was defined by the presence of International Classification Disease 10th edition codes Q00-Q07 in the death and/or live birth certificates. CNS-CM was classified as isolated (only Q00-Q07 codes), and non-isolated (with congenital anomalies codes nonrelated to CNS-CM). CNS-CM associated neonatal death was defined as death between 0 and 27 days after birth in infants with CNS-CM. CNS-CM prevalence, neonatal mortality, and lethality rates were calculated, and their annual trends were analyzed by Prais-Winsten Model. The annual percent change (APC) with 95% confidence interval (95%CI) was obtained. RESULTS 7,237,628 live births were included in the study and CNS-CM were reported in 7526 (0.1%). CNS-CM associated neonatal deaths occurred in 2935 (39.0%). Isolated CNS-CM and non-isolated CNS-CM were found respectively in 5475 and 2051 livebirths, with 1525 (28%) and 1410 (69%) neonatal deaths. CNS-CM prevalence and neonatal lethality were stationary, however neonatal mortality decreased (APC -1.66; 95%CI -3.09 to -0.21) during the study. For isolated CNS-CM, prevalence, neonatal mortality, and lethality decreased over the period. For non-isolated CNS-CM, the prevalence increased, neonatal mortality was stationary, and lethality decreased during the period. The median time of CNS-CM associated neonatal deaths was 18 h after birth. CONCLUSIONS During a 12-year period in São Paulo State, Brazil, neonatal mortality of infants with CNS-CM in general and with isolated CNS-CM showed a decreasing pattern. Nevertheless CNS-CM mortality remained elevated, mostly in the first day after birth.
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Affiliation(s)
| | | | | | - Adriana Sanudo
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Milton Harumi Miyoshi
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Mandira Daripa Kawakami
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | | | | | | | | | - Ruth Guinsburg
- Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Heiderich TM, Carlini LP, Buzuti LF, Balda RDCX, Barros MCM, Guinsburg R, Thomaz CE. Face-based automatic pain assessment: challenges and perspectives in neonatal intensive care units. J Pediatr (Rio J) 2023; 99:546-560. [PMID: 37331703 PMCID: PMC10594024 DOI: 10.1016/j.jped.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE To describe the challenges and perspectives of the automation of pain assessment in the Neonatal Intensive Care Unit. DATA SOURCES A search for scientific articles published in the last 10 years on automated neonatal pain assessment was conducted in the main Databases of the Health Area and Engineering Journal Portals, using the descriptors: Pain Measurement, Newborn, Artificial Intelligence, Computer Systems, Software, Automated Facial Recognition. SUMMARY OF FINDINGS Fifteen articles were selected and allowed a broad reflection on first, the literature search did not return the various automatic methods that exist to date, and those that exist are not effective enough to replace the human eye; second, computational methods are not yet able to automatically detect pain on partially covered faces and need to be tested during the natural movement of the neonate and with different light intensities; third, for research to advance in this area, databases are needed with more neonatal facial images available for the study of computational methods. CONCLUSION There is still a gap between computational methods developed for automated neonatal pain assessment and a practical application that can be used at the bedside in real-time, that is sensitive, specific, and with good accuracy. The studies reviewed described limitations that could be minimized with the development of a tool that identifies pain by analyzing only free facial regions, and the creation and feasibility of a synthetic database of neonatal facial images that is freely available to researchers.
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Affiliation(s)
- Tatiany M Heiderich
- Centro Universitário da Fundação Educacional Inaciana (FEI), São Bernardo do Campo, SP, Brazil.
| | - Lucas P Carlini
- Centro Universitário da Fundação Educacional Inaciana (FEI), São Bernardo do Campo, SP, Brazil
| | - Lucas F Buzuti
- Centro Universitário da Fundação Educacional Inaciana (FEI), São Bernardo do Campo, SP, Brazil
| | | | | | - Ruth Guinsburg
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Carlos E Thomaz
- Centro Universitário da Fundação Educacional Inaciana (FEI), São Bernardo do Campo, SP, Brazil
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Lima ROD, Marba STM, Almeida MFBD, Guinsburg R. Impact of resuscitation training program on neonatal outcomes in a region of high socioeconomic vulnerability in Brazil: an interventional study. J Pediatr (Rio J) 2023; 99:561-567. [PMID: 37210289 PMCID: PMC10594021 DOI: 10.1016/j.jped.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVES This pre/post-intervention study aimed to evaluate neonatal outcomes after the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. METHOD This interventional study was conducted across five secondary healthcare regions that supported 62 cities in the southwestern mesoregion of Piauí. It included 431 healthcare professionals responsible for neonatal care in the study region. The participants were trained in neonatal resuscitation through the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Delivery room structuring, healthcare professionals' knowledge, and neonatal care outcomes were analyzed immediately before and after intervention and after 12 months between February 2018 and March 2019, and healthcare professionals were evaluated. RESULTS Training was conducted for over 106 courses. As a participant could take multiple courses, 700 training sessions were conducted. Regarding delivery room structuring, the acquisition of materials required for resuscitation increased from 28.4 to 80.6% immediately after the intervention and to 83.3% after 12 months. Knowledge retention was significant in the post-training period, with a 95.5% approval rate, and knowledge acquisition was satisfactory after 12 months. The number of newborns transferred during the study period increased significantly. A 72.6% reduction in mortality at birth was recorded, and 479 newborns were resuscitated. CONCLUSION Following the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, structural improvements in delivery rooms, adequate knowledge retention regarding neonatal resuscitation, and a consequent reduction in neonatal mortality were observed.
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Affiliation(s)
| | | | | | - Ruth Guinsburg
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Rent S, Rocha T, Silva L, Souza JVP, Guinsburg R, Filho AC, Staton C, Vissoci JRN. The Impact of Time, Region, and Income Level on Stillbirth and Neonatal Mortality in Brazil, 2000-2019. J Pediatr 2023; 262:113613. [PMID: 37459908 DOI: 10.1016/j.jpeds.2023.113613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/06/2023] [Accepted: 07/11/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To describe trends in perinatal loss across Brazil, a country that transitioned in 2006 from a lower-middle income to an upper-middle income country, from 2000 to 2019 and analyze the effect of municipal wealth status on perinatal outcomes. STUDY DESIGN We conducted an ecological cohort study, based on publicly available data from the Brazilian Ministry of Health's data repository on live births and deaths. The Atlas of Human Development in Brazil was used to associate each region with a World Bank income classification. RESULTS The national neonatal mortality rate (NMR) for infants born at ≥22 weeks of gestation decreased from 21.2 in 2000 to 12.4 in 2019. The stillbirth rate (SBR) decreased from 12.0 to 10.2 during this period. For infants born between 22 and 27 weeks of gestation, worsening perinatal outcomes were seen after 2012. In 2019, the median rates of neonatal mortality and stillbirth were both 4 points higher in lower- to middle-income municipalities compared with high-income municipalities (P < .01). CONCLUSION Brazil has made significant progress in neonatal mortality and stillbirth from 2000 to 2019, yet inequity in perinatal outcomes remains and is correlated with municipal economic status. Nationally, ongoing improvement is needed for infants <28 weeks of gestation, and closer exploration is needed into why there are increasing rates of negative perinatal outcomes among infants born at 22-27 weeks of gestation after 2012.
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Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Global Health Institute, Durham, NC.
| | - Thiago Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC; Global Emergency Medicine Innovation and Implementation Center, Duke University, Durham, NC
| | - Lincoln Silva
- Global Emergency Medicine Innovation and Implementation Center, Duke University, Durham, NC
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Catherine Staton
- Duke Global Health Institute, Durham, NC; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Durham, NC; Department of Emergency Medicine, Duke University School of Medicine, Durham, NC
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Cabral NC, Figueira SDANN, Zamith MM, de Oliveira AC, Padrini L, Sanudo A, de Almeida MFB, Guinsburg R. Neonatal performed echocardiography course: Can we face it? J Perinatol 2023; 43:1262-1267. [PMID: 36739361 PMCID: PMC9898855 DOI: 10.1038/s41372-023-01617-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate students' qualification after a six-month basic course of Neonatal Performed Echocardiography (NPEcho), adjusted by the motivational profile. STUDY DESIGN Prospective cohort of 16 neonatologists/neonatal fellows who underwent the basic NPEcho course in 2019 (18 h face-to-face theoretical classes; 36 h hands-on training) and 12 in 2020 (18 h online theoretical classes; 36 h hands-on training). Students' qualification was defined as ≥70% in post-test, video test, and practical evaluation in neonates. Academic Motivation Scale was applied. RESULTS Scores in 2019 vs. 2020 were: pre-test -32% vs. 40% (p = 0.029), final theoretical score -78% vs. 69% (p = 0.007), and practical evaluation -88% vs. 65% (p = 0.003), resulting in 68.8% in 2019 vs. 33.3% in 2020 qualified students. Students' motivational profile were similar in 2019 and 2020. CONCLUSION The NPEcho was successful in qualifying students with face-to-face theoretical classes, but the online format was inadequate to achieve the learning goals.
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Affiliation(s)
- Nádia Canale Cabral
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | - Marina Maccagnano Zamith
- Department of Internal Medicine, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Allan Chiaratti de Oliveira
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Lucio Padrini
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Adriana Sanudo
- Department of Preventive Medicine, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Maria Fernanda Branco de Almeida
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, SP, Brazil
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de Abreu MFCW, Ogata JFM, Fonseca MCM, Sansone D, Guinsburg R. The financial impact of neonatal sepsis on the Brazilian Unified Health System. Clinics (Sao Paulo) 2023; 78:100277. [PMID: 37647843 PMCID: PMC10472220 DOI: 10.1016/j.clinsp.2023.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 07/21/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE To evaluate the hospital cost of newborn infants diagnosed with sepsis from the perspective of the Brazilian Public Health System over 11 years. METHOD Cross-sectional study that analyzed secondary data from the databases of the Hospital Information System of the Brazilian Public Health System. Infants hospitalized between 0‒29 days after birth with a diagnosis of sepsis from 2008 to 2018 were included. The diagnosis used in the study was the one that the hospital considered the main diagnosis at admission. Costs were analyzed in US dollars and reflected the amount paid by the Brazilian Public Health System to the hospitals for the informed diagnosis upon admission. The costs were evaluated as the total per admission, and they were compared among Brazilian geographic regions, among etiologic agents, and between neonates with the diagnosis of sepsis that survived or died. RESULTS From 2008 to 2018, 47,554 newborns were hospitalized with sepsis (148.04 cases per 100,000 live births), with an average cost of US$ 3345.59 per hospitalization, ranging from US$ 2970.60 in the North region to US$ 4305.03 in the Midwest. Among sepsis with identified agents, the highest mean cost was related to Gram-negative agents, and the lowest to Streptococcus agalactiae sepsis. Patients with sepsis who died had a higher cost than the survivors (t-test; p = 0.046). CONCLUSIONS The evaluation of costs related to neonatal sepsis in the country during an 11-year period shows the economic impact of morbidity that may be avoided by improving the quality of neonatal care.
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Affiliation(s)
| | - Joice Fabíola Meneguel Ogata
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Dayan Sansone
- Health Technology Assessment Center, Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ruth Guinsburg
- Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Konstantyner T, Areco KCN, Bandiera-Paiva P, Marinonio ASS, Kawakami MD, Balda RDCX, Miyoshi MH, Sanudo A, Costa-Nobre DT, de Freitas RMV, Morais LCC, Teixeira MLP, Waldvogel BC, Kiffer CRV, de Almeida MFB, Guinsburg R. The burden of inappropriate birth weight on neonatal survival in term newborns: a population-based study in a middle-income setting. Front Pediatr 2023; 11:1147496. [PMID: 37360363 PMCID: PMC10285294 DOI: 10.3389/fped.2023.1147496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births. Methods This is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0-27 days). Survival functions were calculated using the Kaplan-Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs). Results The neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89-4.65), independent of sex, 1-min Apgar score, and five maternal factors. Discussion The risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil.
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Affiliation(s)
- Tulio Konstantyner
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Kelsy Catherina Nema Areco
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Departamento de Informática em Saúde, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Paulo Bandiera-Paiva
- Departamento de Informática em Saúde, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Mandira Daripa Kawakami
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Rita de Cássia Xavier Balda
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Milton Harumi Miyoshi
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Adriana Sanudo
- Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Daniela Testoni Costa-Nobre
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Rosa Maria Vieira de Freitas
- Diretoria Adjunta de Produção e Análise de Dados, Fundação Sistema Estadual de Análise de Dados, São Paulo, São Paulo, Brazil
| | - Liliam Cristina Correia Morais
- Diretoria Adjunta de Produção e Análise de Dados, Fundação Sistema Estadual de Análise de Dados, São Paulo, São Paulo, Brazil
| | - Monica La Porte Teixeira
- Diretoria Adjunta de Produção e Análise de Dados, Fundação Sistema Estadual de Análise de Dados, São Paulo, São Paulo, Brazil
| | - Bernadette Cunha Waldvogel
- Diretoria Adjunta de Produção e Análise de Dados, Fundação Sistema Estadual de Análise de Dados, São Paulo, São Paulo, Brazil
| | - Carlos Roberto Veiga Kiffer
- Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Ruth Guinsburg
- Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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de Almeida MFB, Sanudo A, Areco KN, Balda RDCX, Costa-Nobre DT, Kawakami MD, Konstantyner T, Marinonio ASS, Miyoshi MH, Bandiera-Paiva P, Freitas RMV, Morais LCC, Teixeira MLP, Waldvogel B, Kiffer CRV, Guinsburg R. Temporal Trend, Causes, and Timing of Neonatal Mortality of Moderate and Late Preterm Infants in São Paulo State, Brazil: A Population-Based Study. Children 2023; 10:children10030536. [PMID: 36980094 PMCID: PMC10047302 DOI: 10.3390/children10030536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Moderate and late preterm newborns comprise around 85% of live births < 37 weeks gestation. Data on their neonatal mortality in middle-income countries is limited. This study aims to analyze the temporal trend, causes and timing of neonatal mortality of infants with 320/7–366/7 weeks gestation without congenital anomalies from 2004–2015 in the population of São Paulo State, Brazil. A database was built by deterministic linkage of birth and death certificates. Causes of death were classified by ICD-10 codes. Among 7,317,611 live births in the period, there were 545,606 infants with 320/7–366/7 weeks gestation without congenital anomalies, and 5782 of them died between 0 and 27 days. The neonatal mortality rate decreased from 16.4 in 2004 to 7.6 per thousand live births in 2015 (7.47% annual decrease by Prais–Winsten model). Perinatal asphyxia, respiratory disorders and infections were responsible, respectively, for 14%, 27% and 44% of the 5782 deaths. Median time to death was 24, 53 and 168 h, respectively, for perinatal asphyxia, respiratory disorders, and infections. Bottlenecks in perinatal health care are probably associated with the results that indicate the need for policies to reduce preventable neonatal deaths of moderate and late preterm infants in the most developed state of Brazil.
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Affiliation(s)
| | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Kelsy N. Areco
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Rita de Cássia X. Balda
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Daniela T. Costa-Nobre
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Mandira D. Kawakami
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Ana Sílvia S. Marinonio
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Milton H. Miyoshi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
| | - Rosa M. V. Freitas
- Fundação Sistema Estadual de Análise de Dados, São Paulo 05508-000, SP, Brazil
| | - Liliam C. C. Morais
- Fundação Sistema Estadual de Análise de Dados, São Paulo 05508-000, SP, Brazil
| | | | | | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo 04023-062, SP, Brazil
- Correspondence:
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Scavacini Marinonio AS, Harumi Miyoshi M, Testoni Costa-Nobre D, Sanudo A, Nema Areco KC, Daripa Kawakami M, Xavier Balda RDC, Konstantyner T, Bandiera-Paiva P, Vieira de Freitas RM, Correia Morais LC, La Porte Teixeira M, Cunha Waldvogel B, Veiga Kiffer CR, Branco de Almeida MF, Guinsburg R. Congenital diaphragmatic hernia in a middle-income country: Persistent high lethality during a 12-year period. PLoS One 2023; 18:e0281723. [PMID: 36763629 PMCID: PMC9916629 DOI: 10.1371/journal.pone.0281723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND In high- and middle-income countries, mortality associated to congenital diaphragmatic hernia (CDH) is high and variable. In Brazil, data is scarce regarding the prevalence, mortality, and lethality of CDH. This study aimed to analyze, in São Paulo state of Brazil, the temporal trends of prevalence, neonatal mortality and lethality of CDH and identify the time to CDH-associated neonatal death. METHODS Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥400g, from mothers residing in São Paulo State, Brazil, during 2004-2015. CDH definition and its subgroups classification were based on ICD-10 codes reported in the death and/or live birth certificates. CDH-associated neonatal death was defined as death up to 27 days after birth of infants with CDH. CDH prevalence, neonatal mortality and lethality were calculated and their annual percent change (APC) with 95% confidence intervals (95%CI) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that CDH-associated neonatal death occurred. RESULTS CDH prevalence was 1.67 per 10,000 live births, with a significant increase throughout the period (APC 2.55; 95%CI 1.30 to 3.83). CDH neonatal mortality also increased over the time (APC 2.09; 95%CI 0.27 to 3.94), while the lethality was 78.78% and remained stationary. For isolated CDH, CDH associated to non-chromosomal anomalies and CDH associated to chromosomal anomalies the lethality was, respectively, 72.25%, 91.06% and 97.96%, during the study period. For CDH as a whole and for all subgroups, 50% of deaths occurred within the first day after birth. CONCLUSIONS During a 12-year period in São Paulo State, Brazil, CDH prevalence and neonatal mortality showed a significant increase, while lethality remained stable, yet very high, compared to rates reported in high income countries.
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Affiliation(s)
| | - Milton Harumi Miyoshi
- Escola Paulista de Medicina – Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | | | - Adriana Sanudo
- Escola Paulista de Medicina – Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | | | - Mandira Daripa Kawakami
- Escola Paulista de Medicina – Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | | | - Tulio Konstantyner
- Escola Paulista de Medicina – Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina – Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Ruth Guinsburg
- Escola Paulista de Medicina – Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil
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19
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar J, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Pediatrics 2023; 151:189896. [PMID: 36325925 DOI: 10.1542/peds.2022-060463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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20
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Foglia EE, Davis PG, Guinsburg R, Kapadia V, Liley HG, Rüdiger M, Schmölzer GM, Strand ML, Wyckoff MH, Wyllie J, Weiner GM. Recommended Guideline for Uniform Reporting of Neonatal Resuscitation: The Neonatal Utstein Style. Pediatrics 2023; 151:190463. [PMID: 36632729 DOI: 10.1542/peds.2022-059631] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 01/13/2023] Open
Abstract
Clinical research on neonatal resuscitation has accelerated over recent decades. However, an important methodologic limitation is that there are no standardized definitions or reporting guidelines for neonatal resuscitation clinical studies. To address this, the International Liaison Committee on Resuscitation Neonatal Life Support Task Force established a working group to develop the first Utstein-style reporting guideline for neonatal resuscitation. The working group modeled this approach on previous Utstein-style guidelines for other populations. This reporting guideline focuses on resuscitation of newborns immediately after birth for respiratory failure, bradycardia, severe bradycardia, or cardiac arrest. We identified 7 relevant domains: setting, patient, antepartum, birth/preresuscitation, resuscitation process, postresuscitation process, and outcomes. Within each domain, relevant data elements were identified as core versus supplemental. Core data elements should be collected and reported for all neonatal resuscitation studies, while supplemental data elements may be collected and reported using standard definitions when possible. The Neonatal Utstein template includes both core and supplemental elements across the 7 domains, and the associated Data Table provides detailed information and reporting standards for each data element. The Neonatal Utstein reporting guideline is anticipated to assist investigators engaged in neonatal resuscitation research by standardizing data definitions. The guideline will facilitate data pooling in meta-analyses, enhancing the strength of neonatal resuscitation treatment recommendations and subsequent guidelines.
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Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter G Davis
- Newborn Research Center, the Royal Women's Hospital and the University of Melbourne, Victoria, Australia
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Mario Rüdiger
- Saxony Center for Fetal-Neonatal Health.,Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Medizinische Fakultät TU Dresden, Dresden, Germany
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Marya L Strand
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan Wyllie
- Department of Paediatrics and Neonatology, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Gary M Weiner
- Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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21
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Tomo CK, Balogun OO, Davidson J, Guinsburg R, Almeida MFBD, Lopes JMDA, Barros MCDM, Takehara K, Mikami M, Isayama T, Hoshino A, Mori R, Mizuguchi M. Comparison of mortality and survival without major morbidities of very preterm infants with very low birth weight from Japan and Brazil. Rev paul pediatr 2023; 41:e2021389. [PMID: 36102406 PMCID: PMC9462411 DOI: 10.1590/1984-0462/2023/41/2021389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/13/2022] [Indexed: 11/22/2022]
Abstract
Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30–11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32–0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26–15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38–7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25–10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.
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Affiliation(s)
- Caroline Kaori Tomo
- University of Tokyo, Japan; National Center for Child Health and Development, Japan
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22
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Chung SP, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Ong YKG, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM, Cartledge S, Dawson JA, Elgohary MM, Ersdal HL, Finan E, Flaatten HI, Flores GE, Fuerch J, Garg R, Gately C, Goh M, Halamek LP, Handley AJ, Hatanaka T, Hoover A, Issa M, Johnson S, Kamlin CO, Ko YC, Kule A, Leone TA, MacKenzie E, Macneil F, Montgomery W, O’Dochartaigh D, Ohshimo S, Palazzo FS, Picard C, Quek BH, Raitt J, Ramaswamy VV, Scapigliati A, Shah BA, Stewart C, Strand ML, Szyld E, Thio M, Topjian AA, Udaeta E, Vaillancourt C, Wetsch WA, Wigginton J, Yamada NK, Yao S, Zace D, Zelop CM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2022; 146:e483-e557. [PMID: 36325905 DOI: 10.1161/cir.0000000000001095] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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23
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Lyra JC, Guinsburg R, de Almeida MFB, Variane GFT, Souza Rugolo LMSD. Use of laryngeal mask for neonatal resuscitation in Brazil: A national survey. Resusc Plus 2022; 13:100336. [PMID: 36582476 PMCID: PMC9792880 DOI: 10.1016/j.resplu.2022.100336] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/06/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background The International Liaison Committee on Resuscitation suggests using the laryngeal mask airway (LMA) as an alternative to the face mask for performing positive pressure ventilation (PPV) in the delivery room in newborns ≥34 weeks. Because not much is known about the health professionals' familiarity in using LMA in Brazil, this study aimed to describe the health professionals' knowledge and practice of using LMA, who provide neonatal care in the country. Methods An online questionnaire containing 29 questions was sent to multi-healthcare professionals from different regions in the country through email and social media groups (WhatsApp®, Instagram®, Facebook®, and LinkedIn®). The participants anonymously answered the questions regarding their knowledge and expertise in using LMA to ventilate newborns in the delivery room. Results We obtained 749 responses from all the regions in Brazil, with 80% from health professionals working in public hospitals. Most respondents were neonatologists (73%) having > 15 years of clinical practice. Among the respondents, 92% recognized the usefulness of LMA for performing PPV in newborns, 59% did not have specific training in LMA insertion, and only 8% reported that they have already used LMA in the delivery room. In 90% of the hospitals, no written protocol was available to use LMA; and in 68% of the hospitals, LMA was not available for immediate use. Conclusion This nationwide survey showed that most professionals recognize the usefulness of LMA. However, the device is scarcely available and underused in the routine of ventilatory assistance for newborns in delivery rooms in Brazil.
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Affiliation(s)
- João Cesar Lyra
- Department of Pediatrics, UNESP – Univ Estadual Paulista, Sao Paulo State, Brazil,Corresponding author at: Department of Pediatrics, UNESP – Univ Estadual Paulista, Sao Paulo State, Distrito de Rubiao Junior – Av. Prof, Mario Rubens Guimaraes Montenegro s/n; Botucatu, Sao Paulo 18618-687, Brazil.
| | - Ruth Guinsburg
- Division of Neonatal Medicine - Escola Paulista de Medicina - Universidade Federal de São Paulo, Brazil
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24
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Wyckoff MH, Greif R, Morley PT, Ng KC, Olasveengen TM, Singletary EM, Soar J, Cheng A, Drennan IR, Liley HG, Scholefield BR, Smyth MA, Welsford M, Zideman DA, Acworth J, Aickin R, Andersen LW, Atkins D, Berry DC, Bhanji F, Bierens J, Borra V, Böttiger BW, Bradley RN, Bray JE, Breckwoldt J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Phil Chung S, Considine J, Costa-Nobre DT, Couper K, Couto TB, Dainty KN, Davis PG, de Almeida MF, de Caen AR, Deakin CD, Djärv T, Donnino MW, Douma MJ, Duff JP, Dunne CL, Eastwood K, El-Naggar W, Fabres JG, Fawke J, Finn J, Foglia EE, Folke F, Gilfoyle E, Goolsby CA, Granfeldt A, Guerguerian AM, Guinsburg R, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hsu CH, Ikeyama T, Isayama T, Johnson NJ, Kapadia VS, Kawakami MD, Kim HS, Kleinman M, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lee HC, Lin YJ, Lockey AS, Maconochie IK, Madar RJ, Malta Hansen C, Masterson S, Matsuyama T, McKinlay CJD, Meyran D, Morgan P, Morrison LJ, Nadkarni V, Nakwa FL, Nation KJ, Nehme Z, Nemeth M, Neumar RW, Nicholson T, Nikolaou N, Nishiyama C, Norii T, Nuthall GA, O'Neill BJ, Gene Ong YK, Orkin AM, Paiva EF, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reis AG, Reynolds JC, Ristagno G, Rodriguez-Nunez A, Roehr CC, Rüdiger M, Sakamoto T, Sandroni C, Sawyer TL, Schexnayder SM, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Sugiura T, Tijssen JA, Trevisanuto D, Van de Voorde P, Wang TL, Weiner GM, Wyllie JP, Yang CW, Yeung J, Nolan JP, Berg KM, Cartledge S, Dawson JA, Elgohary MM, Ersdal HL, Finan E, Flaatten HI, Flores GE, Fuerch J, Garg R, Gately C, Goh M, Halamek LP, Handley AJ, Hatanaka T, Hoover A, Issa M, Johnson S, Kamlin CO, Ko YC, Kule A, Leone TA, MacKenzie E, Macneil F, Montgomery W, O’Dochartaigh D, Ohshimo S, Stefano Palazzo F, Picard C, Quek BH, Raitt J, Ramaswamy VV, Scapigliati A, Shah BA, Stewart C, Strand ML, Szyld E, Thio M, Topjian AA, Udaeta E, Vaillancourt C, Wetsch WA, Wigginton J, Yamada NK, Yao S, Zace D, Zelop CM. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Resuscitation 2022; 181:208-288. [PMID: 36336195 DOI: 10.1016/j.resuscitation.2022.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.
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25
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Shukla VV, Carlo WA, Niermeyer S, Guinsburg R. Neonatal resuscitation from a global perspective. Semin Perinatol 2022; 46:151630. [PMID: 35725655 DOI: 10.1016/j.semperi.2022.151630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The majority of perinatal and neonatal mortality occurs in low-resource settings in low- and middle-income countries. Access and quality of care at delivery are major determinants of the health and survival of newborn infants. Availability of basic neonatal resuscitation care at birth has improved, but basic neonatal resuscitation at birth or high-quality care continues to be inaccessible in some settings, leading to persistently high perinatal and neonatal mortality. Low-resource settings of high-income countries and socially disadvantaged communities also suffer from inadequate access to quality perinatal healthcare. Quality improvement, implementation research, and innovation should focus on improving the quality of perinatal healthcare and perinatal and neonatal outcomes in low-resource settings. The current review presents an update on issues confronting universal availability of optimal resuscitation care at birth and provides an update on ongoing efforts to address them.
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Affiliation(s)
- Vivek V Shukla
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Waldemar A Carlo
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Susan Niermeyer
- University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Ruth Guinsburg
- Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, SP, Brazil.
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26
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Marinonio ASS, Costa-Nobre DT, Sanudo A, Miyoshi MH, Areco KCN, Kawakami MD, Xavier RDC, Konstantyner T, Bandiera-Paiva P, Freitas RMVD, Morais LCC, Teixeira MLP, Waldvogel BC, Kiffer CRV, Almeida MFBD, Guinsburg R. Temporal Trend and Risk Factors for Respiratory Distress Syndrome-Associated Neonatal Mortality in Preterm Infants: A Population-Based Study in a Middle-Income Country. Am J Perinatol 2022. [PMID: 35973740 DOI: 10.1055/s-0042-1754410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This article aimed to report a temporal series of respiratory distress syndrome (RDS)-associated neonatal mortality rates in preterm live births in São Paulo state, Brazil, and to identify social, maternal, and neonatal characteristics associated with these deaths. STUDY DESIGN This is a population-based study of all live births with gestational age (GA) between 22 and 36 weeks, birth weight ≥400 g, without congenital anomalies from mothers living in São Paulo state during 2004 to 2015. RDS-associated neonatal mortality was defined as death up to 27 days after birth with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality rate (annual percent change [APC] with 95% confidence intervals [95% CIs]) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that the RDS-associated neonatal death occurred. Poisson's regression model compared social maternal and neonatal characteristics between preterm live births that survived the neonatal period and those with RDS-associated neonatal deaths, with results expressed in incidence rate ratio and 95% CI. RESULTS A total of 645,276 preterm live births were included in the study, of which 612,110 survived and 11,078 had RDS-associated neonatal deaths. RDS-associated neonatal mortality rate was 17.17 per thousand preterm live births, with a decreasing annual trend (APC: -6.50%; 95% CI: -9.11 to -3.82%). The median time of these deaths was 48 hours after birth. The following risk factors for RDS-associated neonatal death were identified: maternal schooling ≤7 years (1.18; 1.09-1.29), zero to three prenatal care visits (1.25; 1.18-1.32), multiple pregnancy (1.24; 1.16-1.33), vaginal delivery (1.29; 1.22-1.36), GA 22 to 27 weeks (106.35; 98.36-114.98), GA 28 to 31 weeks (20.12; 18.62-21.73), male sex (1.16; 1.10-1.22), and 5-minute Apgar scores of 0 to 3 (6.74; 6.08-7.47) and 4 to 6 (3.97; 3.72-4.23). CONCLUSION During the study period, RDS-associated neonatal mortality rates showed significant reduction. The relationship between RDS-associated neonatal deaths and social, maternal, and neonatal factors suggests the need for perinatal strategies to reduce prematurity and to improve the initial management of preterm infants. KEY POINTS · RDS is associated with preterm live births.. · Impact of RDS-associated neonatal mortality in middle-income countries is scarce.. · Qualified perinatal care can reduce RDS-associated neonatal mortality..
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Affiliation(s)
| | - Daniela Testoni Costa-Nobre
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Milton Harumi Miyoshi
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Kelsy Catherina Nema Areco
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Mandira Daripa Kawakami
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Rita de Cassia Xavier
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | | | | | | | | | - Carlos Roberto Veiga Kiffer
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Vila Clementino, São Paulo, Brazil
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Rugolo LMSDS, Bentlin MR, Almeida MFBD, Guinsburg R, Carvalho WBD, Marba STM, Almeida JHCLD, Luz JH, Procianoy RS, Duarte JLMB, Anchieta LM, Ferreira DMDLM, Alves Júnior JMS, Diniz EMDA, Santos JPFD, Gimenes CB, Silva NMDME, Ferrari LL, Silva RPGVCD, Meneses J, Gonçalves-Ferri WA, Vale MSD, Brine H, Weiner GM. Risk Perception and Decision Making about Early-Onset Sepsis among Neonatologists: A National Survey. Am J Perinatol 2022; 39:1117-1123. [PMID: 33341925 DOI: 10.1055/s-0040-1721691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Many newborns are investigated and empirically treated for suspected early-onset sepsis (EOS). This study aimed to describe neonatologists' self-identified risk thresholds for investigating and treating EOS and assess the consistency of these thresholds with clinical decisions. STUDY DESIGN Voluntary online survey, available in two randomized versions, sent to neonatologists from 20 centers of the Brazilian Network on Neonatal Research. The surveys included questions about thresholds for investigating and treating EOS and presented four clinical scenarios with varying calculated risks. In survey version A, only the scenarios were presented, and participants were asked if they would order a blood test or start antibiotics. Survey version B presented the same scenarios and the risk of sepsis. Clinical decisions were compared between survey versions using chi-square tests and agreement between thresholds and clinical decisions were investigated using Kappa coefficients. RESULTS In total, 293 surveys were completed (145 survey version A and 148 survey version B). The median risk thresholds for blood test and antibiotic treatment were 1:100 and 1:25, respectively. In the high-risk scenario, there was no difference in the proportion choosing antibiotic therapy between the groups. In the moderate-risk scenarios, both tests and antibiotics were chosen more frequently when the calculated risks were included (survey version B). In the low-risk scenario, there was no difference between survey versions. There was poor agreement between the self-described thresholds and clinical decisions. CONCLUSION Neonatologists overestimate the risk of EOS and underestimate their risk thresholds. Knowledge of calculated risk may increase laboratory investigation and antibiotic use in infants at moderate risk for EOS. KEY POINTS · Neonatologists overestimate the risk of EOS.. · There is wide variation in diagnostic/treatment thresholds for EOS.. · Clinical decision on EOS is not consistent with risk thresholds.. · Knowledge of risk may increase investigation and treatment of EOS..
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Affiliation(s)
| | - Maria Regina Bentlin
- Division of Neonatology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista-UNESP, Botucatu, Brazil
| | | | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Jorge Hecker Luz
- Department of Pediatrics, Hospital São Lucas-Faculdade de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato Soibelmann Procianoy
- Division of Neonatology, Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre -HCPA, Porto Alegre, Brazil
| | - José Luiz Muniz Bandeira Duarte
- Department of Pediatrics, Hospital Universitário Pedro Ernesto-Universidade do Estado de Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leni Márcia Anchieta
- Division of Neonatology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Edna Maria de Albuquerque Diniz
- Division of Neonatology, University of São Paulo, Brazil da Universidade de São Paulo, Hospital Universitário, São Paulo, Brazil
| | | | | | | | - Lígia Lopes Ferrari
- Department of Pediatrics, Hospital Universitário-Universidade Estadual de Londrina, Londrina, Brazil
| | | | - Jucille Meneses
- Department of Pediatrics, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Walusa Assad Gonçalves-Ferri
- Department of Pediatrics, Faculdade de Medicina de Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Holly Brine
- Departent of Pediatrics, Promedica Toledo Children's Hospital, University of Toledo, Ohio
| | - Gary M Weiner
- Department of Pediatrics, Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, Michigan
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Soares JDCA, Barros MCDM, da Silva GVT, Carlini LP, Heiderich TM, Orsi RN, Balda RDCX, Silva PASO, Thomaz CE, Guinsburg R. Looking at neonatal facial features of pain: do health and non-health professionals differ? J Pediatr (Rio J) 2022; 98:406-412. [PMID: 34914897 PMCID: PMC9432145 DOI: 10.1016/j.jped.2021.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze the regions that trigger the attention of adults' gaze when assessing pain in newborn infants' pictures and to verify if there are differences between health and non-health professionals. METHOD Experimental study with 84 health professionals and 59 non-health professionals, who evaluated two images of 10 neonates, one at rest and the other during a painful procedure. Each image was shown for 7 seconds on a computer screen, while eye movements were tracked by the Tobii TX300 EyeTracker. After evaluating each image, participants gave a score from 0 (absent pain) to 10 (maximum pain), according to their perception of neonatal pain. For each image, the number and total time of gaze fixations in the forehead, eyes, nasolabial furrow, and mouth were studied. Comparisons between both groups of adults were made by an intraclass correlation coefficient, Student's t-test, and Bland Altman graphic. RESULTS Health professionals (93% female; 34 ± 9 years old), compared to non-health professionals (64% female; 35 ± 11 years old), gave lower scores for images at rest (0.81 ± 0.50 vs. 1.59 ± 0.76; p = 0.010), with no difference for those obtained during the painful procedure (6.98 ± 1.08 vs. 6.73 ± 0.82). There was a strong or almost perfect correlation for the number of fixations in the mouth, eyes, forehead, and for the total fixation time in the eyes and forehead. CONCLUSIONS Adults, irrespective of their profession, showed a homogeneous gaze pattern when evaluating pictures of neonates at rest or during a painful procedures.
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Affiliation(s)
- Juliana do Carmo Azevedo Soares
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Pediatrics, Division of Neonatal Medicine, São Paulo, SP, Brazil
| | - Marina Carvalho de Moraes Barros
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Pediatrics, Division of Neonatal Medicine, São Paulo, SP, Brazil.
| | - Giselle Valério Teixeira da Silva
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Pediatrics, Division of Neonatal Medicine, São Paulo, SP, Brazil
| | - Lucas Pereira Carlini
- Centro Universitario FEI, Department of Electrical Engineering, Image Processing Laboratory, São Bernardo do Campo, SP, Brazil
| | - Tatiany Marcondes Heiderich
- Centro Universitario FEI, Department of Electrical Engineering, Image Processing Laboratory, São Bernardo do Campo, SP, Brazil
| | - Rafael Nobre Orsi
- Centro Universitario FEI, Department of Electrical Engineering, Image Processing Laboratory, São Bernardo do Campo, SP, Brazil
| | - Rita de Cássia Xavier Balda
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Pediatrics, Division of Neonatal Medicine, São Paulo, SP, Brazil
| | | | - Carlos Eduardo Thomaz
- Centro Universitario FEI, Department of Electrical Engineering, Image Processing Laboratory, São Bernardo do Campo, SP, Brazil
| | - Ruth Guinsburg
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Pediatrics, Division of Neonatal Medicine, São Paulo, SP, Brazil
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Marinonio ASS, Costa-Nobre DT, Miyoshi MH, Balda RDCX, Areco KCN, Konstantyner T, Kawakami MD, Sanudo A, Bandiera-Paiva P, de Freitas RMV, Morais LCC, La Porte Teixeira M, Waldvogel BC, de Almeida MFB, Guinsburg R, Kiffer CRV. Clusters of preterm live births and respiratory distress syndrome-associated neonatal deaths: spatial distribution and cooccurrence patterns. BMC Public Health 2022; 22:1226. [PMID: 35725459 PMCID: PMC9210662 DOI: 10.1186/s12889-022-13629-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Prematurity and respiratory distress syndrome (RDS) are strongly associated. RDS continues to be an important contributor to neonatal mortality in low- and middle-income countries. This study aimed to identify clusters of preterm live births and RDS-associated neonatal deaths, and their cooccurrence pattern in São Paulo State, Brazil, between 2004 and 2015. Methods Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥ 400 g, without congenital anomalies from mothers living in São Paulo State, Brazil, during 2004–2015. RDS-associated neonatal mortality was defined as deaths < 28 days with ICD-10 codes P22.0 or P28.0. RDS-associated neonatal mortality and preterm live births rates per municipality were submitted to first- and second-order spatial analysis before and after smoothing using local Bayes estimates. Spearman test was applied to identify the correlation pattern between both rates. Results Six hundred forty-five thousand two hundred seventy-six preterm live births and 11,078 RDS-associated neonatal deaths in São Paulo State, Brazil, during the study period were analyzed. After smoothing, a non-random spatial distribution of preterm live births rate (I = 0.78; p = 0.001) and RDS-associated neonatal mortality rate (I = 0.73; p = 0.001) was identified. LISA maps confirmed clusters for both, with a negative correlation (r = -0.24; p = 0.0000). Clusters of high RDS-associated neonatal mortality rates overlapping with clusters of low preterm live births rates were detected. Conclusions Asymmetric cluster distribution of preterm live births and RDS-associated neonatal deaths may be helpful to indicate areas for perinatal healthcare improvement. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13629-4.
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Affiliation(s)
- Ana Sílvia Scavacini Marinonio
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil.
| | - Daniela Testoni Costa-Nobre
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Milton Harumi Miyoshi
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Rita de Cassia Xavier Balda
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Kelsy Catherina Nema Areco
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Tulio Konstantyner
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Mandira Daripa Kawakami
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Adriana Sanudo
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Paulo Bandiera-Paiva
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Rosa Maria Vieira de Freitas
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Lilian Cristina Correia Morais
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Mônica La Porte Teixeira
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Bernadette Cunha Waldvogel
- Fundação Sistema Estadual de Análise de Dados (SEADE Foundation), Avenida Professor Lineu Prestes, 913 - Cidade Universitária, São Paulo, 05508-000, Brazil
| | - Maria Fernanda Branco de Almeida
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Ruth Guinsburg
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
| | - Carlos Roberto Veiga Kiffer
- Departamento de Pediatria, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), Rua Marselhesa 630, São Paulo, Vila Clementino, 04020-060, Brazil
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de Almeida MFB, Guinsburg R, Weiner GM, Penido MG, Ferreira DMLM, Alves JMS, Embrizi LF, Gimenes CB, Mello E Silva NM, Ferrari LL, Venzon PS, Gomez DB, do Vale MS, Bentlin MR, Sadeck LR, Diniz EMA, Fiori HH, Caldas JPS, de Almeida JHCL, Duarte JLMB, Gonçalves-Ferri WA, Procianoy RS, Lopes JMA. Translating Neonatal Resuscitation Guidelines Into Practice in Brazil. Pediatrics 2022; 149:186998. [PMID: 35510495 DOI: 10.1542/peds.2021-055469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Brazilian Neonatal Resuscitation Program releases guidelines based on local interpretation of international consensus on science and treatment recommendations. We aimed to analyze whether guidelines for preterm newborns were applied to practice in the 20 Brazilian Network on Neonatal Research centers of this middle-income country. METHODS Prospectively collected data from 2014 to 2020 were analyzed for 8514 infants born at 230/7 to 316/7 weeks' gestation. The frequency of procedures was evaluated by gestational age (GA) category, including use of a thermal care bundle, positive pressure ventilation (PPV), PPV with a T-piece resuscitator, maximum fraction of inspired oxygen (Fio2) concentration during PPV, tracheal intubation, chest compressions and medications, and use of continuous positive airway pressure in the delivery room. Logistic regression, adjusted by center and year, was used to estimate the probability of receiving recommended treatment. RESULTS For 3644 infants 23 to 27 weeks' GA and 4870 infants 28 to 31 weeks' GA, respectively, the probability of receiving care consistent with guidelines per year increased, including thermal care (odds ratio [OR], 1.52 [95% confidence interval (CI) 1.44-1.61] and 1.45 [1.38-1.52]) and PPV with a T-piece (OR, 1.45 [95% CI 1.37-1.55] and 1.41 [1.32-1.51]). The probability of receiving PPV with Fio2 1.00 decreased equally in both GA groups (OR, 0.89; 95% CI, 0.86-0.93). CONCLUSIONS Between 2014 and 2020, the resuscitation guidelines for newborns <32 weeks' GA on thermal care, PPV with a T-piece resuscitator, and decreased use of Fio2 1.00 were translated into clinical practice.
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Affiliation(s)
| | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Marcia G Penido
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - José Mariano S Alves
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | | | | - Dafne B Gomez
- Instituto de Medicina Integral Prof Fernando Figueira, Recife, Pernambuco, Brazil
| | | | - Maria Regina Bentlin
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Lilian R Sadeck
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Edna M A Diniz
- Hospital Universitário da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Humberto H Fiori
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jamil P S Caldas
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - João Henrique C L de Almeida
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Luis M B Duarte
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Walusa A Gonçalves-Ferri
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Renato S Procianoy
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - José Maria A Lopes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, Rio de Janeiro, Brazil
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Guerreiro MDM, Ogata JFM, Sanudo A, Prestes ACY, Conzi MF, Kawakami MD, Miyoshi MH, Almeida MFBD, Guinsburg R. Acquisition of Behavioral Skills after Manikin-Based Simulation of Neonatal Resuscitation by Fellows in Neonatology. Am J Perinatol 2022. [PMID: 35272385 DOI: 10.1055/a-1793-8024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Behavioral performance of health professionals is essential for adequate patient care. This study aimed to assess the behavioral skills of fellows in neonatology before and after a simulation training program on neonatal resuscitation. STUDY DESIGN From March 2019 to February 2020, a prospective cohort with 12 second-year fellows in neonatology were evaluated during three training cycles (16 hours each) in manikin-based simulation of neonatal resuscitation with standardized scenarios. Each cycle lasted 1 month, followed by a 3-month interval. One video-recorded scenario of approximately 10 minutes was performed for each fellow at the beginning and at the end of each training cycle. Therefore, each fellow was recorded six times, before and after each one of three training cycles. Anxiety of the fellows was assessed by the Beck Anxiety Inventory applied before the first training cycle. The videos were independently analyzed in a random order by three trained facilitators using the Behavioral Assessment Tool. The behavioral performance was evaluated by repeated measures of analysis of variance adjusted for anxiety and for previous experience in neonatal resuscitation. RESULTS Fellows' overall behavioral performance improved comparing the moment before the first training and after the second training. The specific skills, such as communication with the team, delegation of tasks, allocation of attention, use of information, use of resources, and professional posture, showed a significant improvement after the second month of training. No further gains were noted with the third training cycle. Anxiety was observed in 42% of the fellows and its presence worsened their behavioral performance. CONCLUSION An improvement in behavioral performance was observed, comparing the moment before the first training and after the second training, without further gains after the third training. It is worth noting the important role of anxiety as a modulator of acquisition and retention of behavioral skills in health professionals in training. KEY POINTS · Simulation training should improve technical and behavioral skills of providers. · Behavioral skills improve after a first cycle of training, but not after a repeat cycle. · Anxiety modulates trainees' behavioral performance.
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Affiliation(s)
- Maiana D M Guerreiro
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Joice F M Ogata
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Adriana Sanudo
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Ana Claudia Y Prestes
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Maria F Conzi
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Mandira D Kawakami
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Milton H Miyoshi
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Maria Fernanda B de Almeida
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo
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Guinsburg R, de Almeida MFB, Finan E, Perlman JM, Wyllie J, Liley HG, Wyckoff MH, Isayama T. Tactile Stimulation in Newborn Infants With Inadequate Respiration at Birth: A Systematic Review. Pediatrics 2022; 149:185380. [PMID: 35257181 DOI: 10.1542/peds.2021-055067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT For many years the International Liaison Committee on Resuscitation has recommended the use of tactile stimulation for initial management of infants born with inadequate respiratory effort at birth without systematically examining its effectiveness. OBJECTIVE Systematic review to compare the effectiveness of tactile stimulation with routine handling in newly born term and preterm infants. DATA SOURCES Medline, Embase, Cochrane CENTRAL, along with clinical trial registries. STUDY SELECTION Randomized and non-randomized studies were included based on predetermined criteria. DATA EXTRACTION Data were extracted independently by authors. Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) was used to assess risk of bias in non-randomized studies. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to assess the certainty of evidence. RESULTS Among 2455 unique articles identified, 2 observational studies were eligible and qualitatively summarized. Because one of the studies was at critical risk of bias, only the other study including 243 preterm infants on continuous positive airway pressure with clinical indications for tactile stimulation was analyzed. It showed a reduction in tracheal intubation in infants receiving tactile stimulation compared with no tactile stimulation (12 of 164 vs 14 of 79, risk ratio of 0.41 [95% confidence interval 0.20 to 0.85]); however, the certainty of evidence was very low. LIMITATIONS The available data were limited and only from observational studies. CONCLUSIONS A potential benefit of tactile stimulation was identified but was limited by the very low certainty of evidence. More research is suggested to evaluate the effectiveness as well as the optimal type and duration of tactile stimulation.
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Affiliation(s)
- Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria Fernanda B de Almeida
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Emer Finan
- Department of Paediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Jeffrey M Perlman
- Weill Cornell Medicine and New York-Presbyterian Komansky Children's Hospital, New York, New York
| | - Jonathan Wyllie
- Department of Paediatrics and Neonatology, James Cook University Hospital, South Tees National Health Services Foundation Trust, Middlesbrough, United Kingdom
| | - Helen G Liley
- Mater Research Institute and Mater Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
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Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, El-Naggar W, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami MD, Kim HS, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang TL, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group. Circulation 2021; 145:e645-e721. [PMID: 34813356 DOI: 10.1161/cir.0000000000001017] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami M, Kim HS, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang TL, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2021; 169:229-311. [PMID: 34933747 PMCID: PMC8581280 DOI: 10.1016/j.resuscitation.2021.10.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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Wright NJ, Leather AJ, Ade-Ajayi N, Sevdalis N, Davies J, Poenaru D, Ameh E, Ademuyiwa A, Lakhoo K, Smith ER, Douiri A, Elstad M, Sim M, Riboni C, Martinez-Leo B, Akhbari M, Tabiri S, Mitul A, Aziz DAA, Fachin C, Niyukuri A, Arshad M, Ibrahim F, Moitt N, Doheim MF, Thompson H, Ubhi H, Williams I, Hashim S, Philipo GS, Herrera L, Yunus A, Vervoort D, Parker S, Benaskeur YI, Alser OH, Adofo-Ansong N, Alhamid A, Salem HK, Saleh M, Elrais SA, Abukhalaf S, Shinondo P, Nour I, Aydin E, Vaitkiene A, Naranjo K, Dube AM, Ngwenya S, Yacoub MA, Kwasau H, Hyman G, Elghazaly SM, Al-Slaibi I, Hisham I, Franco H, Arbab H, Samad L, Soomro A, Chaudhry MA, Karim S, Khattak MAK, Nah SA, Dimatatac DM, Choo CSC, Maistry N, Mitul AR, Hasan S, Karim S, Yousuf H, Qureshi T, Nour IR, Al-Taher RN, Sarhan OAK, Garcia-Aparicio L, Prat J, Blazquez-Gomez E, Tarrado X, Iriondo M, Bragagnini P, Rite S, Hagander L, Svensson E, Owusu S, Abdul-Mumin A, Bagbio D, Ismavel VA, Miriam A, T S, Anaya Dominguez M, Ivanov M, Serban AM, Derbew M, Elfiky M, Olivos Perez M, Abrunhosa Matias M, Arnaud AP, Negida A, King S, Fazli MR, Hamidi N, Touabti S, Chipalavela RF, Lobos P, Jones B, Ljuhar D, Singer G, Hasan S, Cordonnier A, Jáuregui L, Zvizdic Z, Wong J, St-Louis E, Shu Q, Lui Y, Correa C, Pos L, Alcántara E, Féliz E, Zea-Salazar LE, Ali L, Peycelon M, Anatole NK, Jallow CS, Lindert J, Ghosh D, Adhiwidjaja CF, Tabari AK, Lotfollahzadeh S, Mussein HM, Vatta F, Pasqua N, Kihiko D, Gohil H, Nour IR, Elhadi M, Almada SA, Verkauskas G, Risteski T, Peñarrieta Daher A, Outani O, Hamill J, Lawal T, Mulu J, Yapo B, Saldaña L, Espineda B, Toczewski K, Tuyishime E, Ndayishimiye I, Raboe E, Hammond P, Walker G, Djordjevic I, Chitnis M, Son J, Lee S, Hussien M, Malik S, Ismail EM, Boonthai A, Dahman NBH, Hall N, Castedo Camacho FR, Sobrero H, Butler M, Makhmud A, Novotny N, Hammouri AG, Al-Rayyes M, Bvulani B, Muraveji Q, Murzaie MY, Sherzad A, Haidari SA, Monawar AB, Samadi DAZ, Thiessen J, Venant N, Hospital SI, Jérémie N, Mbonicura JC, Vianney BJM, Tadesse A, Negash S, Roberts CA, Jabang JN, Bah A, Camamra K, Correa A, Sowe B, Gai A, Jaiteh M, Raymond KJ, Mvukiyehe JP, Itangishaka I, Kayibanda E, Manirambona E, Lule J, Costas-Chavarri A, Shyaka Gashugi I, Ndata A, Gasana G, Nezerwa YC, Simeon T, Muragijimana JDD, Rashid S, Msuya D, Elisante J, Solanki M, Manjira E, Lodhia J, Jusabani M, Tarmohamed M, Koipapi S, Souhem T, Sara N, Sihem B, Dania B, Toufik IA, Mounira BNEI, Habiba A, Aragão L, Gonçalves V, Lino Urquizo MM, Varela MF, Mercado P, Horacio B, Damiani A, Mac C, Putruele D, Liljesthrom K, Bernaus M, Jauri C, Cripovich A, Bianchin E, Puig MG, Andreussi L, Iracelay S, Marcos D, Herrera C, Palacios N, Avile R, Serezo B, Montoya D, Cepeda R, Vaquila J, Veronica S, Pardo L, Valeria P, Julio L, Martin AD, Lucio P, Gabriel C, Marianella D, Calderón Arancibia JA, Huespe E, Losa GN, Arancibia Gutiérrez E, Scherl H, Gonzalez DE, Baistrocchi V, Silva Y, Galdeano M, Medard P, Sueiras I, Romero Manteola E, Defago VH, Mieres C, Alberto C, Cornelli F, Molina M, Ravetta P, Patiño Gonzalez CC, Dallegre MB, Szklarz MT, Leyba MF, Rivarola NI, Charras MD, Morales A, Caseb P, Toselli L, Millán C, Junes MDC, Di Siervi O, Gilardi J, Simon S, Contreras CS, Rojas N, Arnoletto LB, Blain OE, Bravo MN, Sanchez N, Herrera Pesara LM, Moreno ME, Sferco CA, Huq U, Ferdousi T, Al-Mamun A, Sultana S, Mahmud R, Mahmud K, Sayeed F, Svirsky A, Sempertegui D, Negrete A, Teran A, Sadagurschi M, Popovic N, Karavdic K, Milisic E, Jonuzi A, Mesic A, Terzic S, Dendusic N, Biber E, Sehic A, Zvizdic N, Letic E, Saracevic A, Hamidovic A, Selak N, Horozic D, Hukic L, Muhic A, Vanis N, Sokolovic E, Sabic A, Becker K, Novochadlo Klüppel E, dos Santos Dias AIB, Agulham MA, Bischoff C, Sabbatini S, Fernandes de Souza R, Souza Machado AB, Werneck Raposo J, da Silva Augusto ML, Martins BM, de Souza Santos Ferreira M, Fernandes de Oliveira D, Silva dos Santos C, Ribeiro de Fernández y Alcázar F, Alves Dutra da Silva É, Furtado M, Tamada H, Silva Ferreira dos Santos M, Lopes de Almeida T, Oliveira de Andrade S, Gurgel do Amaral AC, Sartori Giovanoni L, de Deus Passos Leles K, Corrêa Costa E, Feldens L, Ferraz Schopf L, Soares de Fraga JC, Colombo de Holanda F, Brolin Santis Isolan PM, Loyola Ferreira J, Bruxel CL, Lopes Teixeira Ferdinando D, Zottis Barcelos F, Baseggio N, Knorr Brenner N, Trindade Deyl R, Dure C, Nunes Kist I, Bueno Mazzuca R, Bueno Motter S, Ramos Y, Suzana Trein C, Rezende Rosa B, de Assis Silva M, Menin FA, Semensato Carloni IC, Norberto da Silva JA, Gomes AL, Girão Tauffer M, Bassan Gonçalves PC, Nogueira Marques GM, Moriya E, Labonia C, Carrasco AL, Furtado Meyer K, Farion-Aguiar L, Amado F, Antunes A, Silva E, Telles L, Almeida G, Belmino Gadelha AA, de Azevedo Belesa F, Gonçalves da Cunha, Jr A, Souza Barros B, Zanellato JB, Guimarães P, Silva KID, Ribas B, Reuter C, Casado FT, Correa Leite MT, Testoni D, Guinsburg R, de Campos Vieira Abib S, Khodor Cury E, Dornellas do Nascimento S, Almeida Aguiar A, Melo Gallindo R, Gonçalves Borges C, Liu Y, Duote C, Wang J, Gao Z, Liang L, Luo W, Zhao X, Chen R, Wang P, Han Y, Huang T, Donglai H, Xiaodong G, Junjie C, Zhu L, Wu G, Bao X, Li H, Lv J, Li Z, Yong F, Gao ZC, Bai Q, Tang W, Xie H, Motee J, Zhu J, Wen G, Ruan W, Li S, Chen L, Huang S, Lv Z, Lu J, Huang L, Yu M, Dajia W, Bai YZ, Rincon LC, Mancera J, Alzate Gallego E, Torres-Canchala L, Silva Beltrán N, Osorio Fory G, Castaño Avila D, Forero Ladino AM, Gomez J, Jaramillo M, Morales O, Sanchez B, Tinoco Guzmán NJ, Castañeda Espinosa S, Prieto Vargas O, Pardo LM, Toral E, Cáceres Aucatoma F, Hinostroza D, Valencia S, Salinas V, Landivar Cino E, Ponce Fajardo GY, Astudillo M, Garcia V, Muñoz G, Verduga L, Verduga I, Murillo E, Bucaram E, Guayelema M, Marmol M, Sanchez J, Vergara C, Mena A, Velaña J, Salazar K, Lara S, Chiriboga E, Silva J, Gad D, Samy D, Elsadek MA, Mohammed HM, Abouheba M, Ali KO, Rashwan H, Fawzy OM, Kamel TM, Nemer R, Hassan MA, Falah EH, Abdelhady DS, Zain M, Ibrahim EAA, Elsiraffy OO, Aboelela A, Farag EM, Oshiba AM, Emam OS, Attia AM, Laymouna MA, Ghorab IA, Mohammed MM, Soliman NA, Ghaly KAE, Sadek K, Elsherbiny M, Saleh A, Sheir H, Wafa T, Elmenam MA, Abdelmaksoud S, Reda A, Mansour I, Elzohiri M, Waseem B, Elewaily M, El-Ghazaly M, Elhattab A, Shalaby A, Elsaied A, Adawy A, Sadek M, Ahmed MA, Herdan MO, Elassall GMH, Mohammed AA, Takrouney MH, Essa TM, Mahmoud AM, Saad AM, Fouly MAN, Ibrahim MA, Nageh M, Saad MM, Badr H, Fouda MF, Nofal AH, Almohamady H, Arafa MA, Amad M, Mansour MA, O'Connor J, O'Connor Z, Anatole N, Nkunzimana E, Machemedze S, Dieudonné L, Appeadu-Mensah W, Anyomih TTK, Alhassan P, Abantanga FA, Michael V, Mary Koshy R, Raj A, Kumar V, PT S, Prabhu PS, Vosoughi A, Al-Mayoof AF, Fadhle MJ, Joda AE, Algabri HNO, Al-Taher RN, Abdelhamid SS, Al-Momani HM, Amarin M, Zaghlol LY, Alsaadi NN, Qwaider YZ, Qutishat H, Aliwisat AH, Arabiat E, Bsisu I, Murshidi RM, Jabaiti MS, Bataineh ZA, Abuhayyeh HA, Quran TMA, Za'nouneh FJA, Alebbini MM, Qudah HA, Hussein OG, Murad AM, Amarin JZ, Suradi HH, Alzraikat SH, Omari RY, Matour BM, Al-Halbouni L, Zurikat RO, Yanis AH, Hussein SA, Shoubaki A, Ghanem WH, David K, Chitiavi SW, Mose M, Mugo R, Ndungu J, Mwai T, Shahbal S, Malik J, Chauhan N, Syovata F, Ochieng K, Omendo Liyenzero P, Hussain SR, Mugambi S, Ochieng R, Elkhazmi EOA, Khaled A, Albozidi A, Enbaya MB, Elgammudi M, Soula E, Khalel WIA, Elhajjaji YA, Alwaggaa NA, Ghayth S, Zreeg DA.S, Tantush SA, Bibas F, Layas T, Sharif RAM, Aljadidi WOFS, Tarek A, Ahmed H, Essamilghi KAM, Alfoghi M, Abuhlega MA, Arrmali S, Abduljawad FM, Alosta HM, Abuajaila A, Abdelmutalib F, Bashir F, Almengar I, Annajjar MH, Deyab A, Elzowawi F, Krayem Y, Drah W, Meftah A, Mohammed A, Arrmalli LA, Aljaboo H, Elayeb A, Altomi M, Altaweel A, Tumi M, Bazozi HM, Shaklawoon A, Alglaib MM, Elkaloush AA, Trainba S, Swessi H, Alnaeri A, Shnishah AE, Mustufa H, Gargum SA, Tarniba SA, Shalluf HA, Shokri HA, Sarkaz TL, Tababa O, Elhadi A, Naunova VC, Jovcheski L, Kamilovski M, Gavrilovska-Brzanov A, Latiff ZA, Pauzi SFM, Osman M, Lim F, Bakar AHA, Zaman ASK, Ishak S, Teo R, Qi DTTH, Othman MYB, Zahari DDZB, Hassan ZBM, Shan CH, Lechmiannandan A, Tamaddun HFB, Adanan MFSBM, Abdullah MYB, Junyi W, Nor MTM, Noor WR, Hassan MRB, Dalek NFRA, Hashim HHB, Zarwawi AZB, Vellusamy VMM, Yuen QS, Kannessan HA, Ramli NB, Bujarimin ASB, Anntinea J, Dass A, Khalid HM, Hanifah NABM, Jyun KWY, Razak RBA, Naim NABM, Hamzah SNABH, Vidal CRZ, Bracho Blanchet E, Dávila Perez R, Fernandez Portilla E, Villegas Silva R, Ibarra D, Calderon Moore A, Carrasco-Ortega C, Noguez Castillo M, Herappe Mellado D, Yanowsky Reyes G, Gonzalez Cortez LF, Santana Ortiz R, Orozco Perez J, Corona C.Rivera JR, Cardenas Ruiz Velasco JJ, Quiles Corona M, Peña Padilla C, Bobadilla Morales L, Corona Rivera A, Rios Flores IM, Aranda Sánchez CI, Ambriz-González G, Martínez Hernández Magro N, León Frutos FJ, Cárdenas Barón JDJ, González Ojeda A, Yarza Fernández J, Porras JD, Aguirre-Lopez P, Sánchez Paredes V, Montalvo Marin A, Diaz Gomez JM, Caamal LJ, Bulnes Mendizabal D, Sanchez Valladares P, Garcia Martinez H, Adesanya O, Olanrewaju M, Adegboyega R, Abdulraheem N, Aremo A, Dedeke F, Chukwuemeka ALJ, Mohammad MA, Lawalbarau A, Collins N, Ibukunolu O, Shonubi A, Ladipo-Ajayi O, Elebute OA, Seyi-Olajide J, Alakaloko F, Ihediwa G, Olayade K, Bode C, Ogundoyin O, Olulana DI, Egbuchulem IK, Kumolalo FO, Ulasi I, Ezomike UO, Ekenze SO, Nwankwo EP, Nwangwu EI, Chukwu I, Amah CC, Obianyo NE, Williams O, Osuoji RI, Faboya OM, Ajai OT, Abdulsalam MA, Agboola TH, Temilade BB, Osazuwa M, Salawu MM, Ejinkeonye EC, Yola MM, Mairami AB, Otuneye AT, Igoche M, Tanimola AG, Ajao EA, Agelebe E, Olori S, Mshelbwala PM, Osagie O, Oyinloye A, Abubakar AM, Oyebanji L, Shehu I, Cletus C, Bamanga A, Suleiman F, Adamu S, C.Nwosu D, S.Alkali Y, Jalo I, Rasaki A, T.Sambo Y, A.Mohammed K, M.Ballah A, Modekwe V, Ekwunife OH, Ezidiegwu US, Osuigwe AN, Ugwu JO, Ugwunne CA, Akhter N, Gondal MF, Raza R, Chaudary AR, Ali H, Nisar MU, Jamal MU, Pandit GS, Mumtaz U, Amjad MB, Talat N, Rehman WU, Saleem M, Mirza MB, Hashim I, Haider N, Hameed S, Saleem A, Dogar S, Sharif M, Bashir MK, Naumeri F, Rani Z, Baniowda MA, Ba'baa' B, Hassan MYM, Darwish A, Sehwiel AS, Shehada M, Balousha AG, Ajrami Y, Alzamari AAM, Yaghi B, Al-saleem HSHA, Farha MSA, Abdelhafez MOM, Anaya F, Qadomi AB, Odi AANB, Assi MAF, Sharabati F, Abueideh A, Beshtawi DMS, Arafat H, Khatatba LZA, Abatli SJ, Al-Tammam H, Jaber D, Kayed YIO, Abumunshar AA, Misk RA, Alzeer AMS, Sharabati M, Ghazzawi I, Darras OM, M.Qabaja M, Hajajreh MS, Samarah YA, Yaghi DH, Qunaibi MAF, Mayaleh AA, Joubeh S, Ebeido A, Adawi S, Adawi I, Alqor MOI, Arar AS, Awad H, Abu-Nejmah F, Shabana OS, Alqarajeh F, Alzughayyar TZ, Madieh J, Sbaih MF, Alkareem RMA, Lahlooh RA, Halabi YA, Baker W, Almusleh TFH, Tahyneh AAA, Atatri YYM, Jamie NA, Massry NAA, Lubbad W, A.Nemer A, Alser M, Salha AAS, Alnahhal K, Elmzyyen AM, Ghabayen ATS, Alamrain AAA, Al-Shwaikh SH, Elshaer OA, Shaheen N, Fares J, Dalloul H, Qawwash A, Jayyab MA, Ashour DA, Shaheen AA, Naim SRR, Shiha EA, Dammagh NMA, Almadhoun W, Al-Salhi AA, Hammato AY, Salim JM, Hasanain DK, Alwadia SMS, Nassar I, Al-Attar HM, Alshaikhkhalil HAA, Jamie YMKA, Ashour YS, Alijla SS, Tallaa MAE, Abuattaya AA, Wishah BD, ALDIRAWI MOHAMMEDA, Darwish AS, Alzerei ST, Wishah N, Alijla S, Garcia I, Diaz Echegaray M, Cañapataña Sahuanay VR, Trigoso Mori F, Alvarado Zelada J, Salinas Barreto JJ, Rivera Altamirano P, Torres Miranda C, Anicama Elias R, Rivera Alvarez J, Vasquez Matos JP, Ayque Rosas F, Ledesma Peraza J, Gutarra Palomino A, Vega Centen S, Casquero V, Ortiz Argomedo MR, Lapouble F, Llap Unchón G, Delgado Malaga FP, Ortega Sotelo L, Gamboa Kcomt S, Villalba Villalba A, Mendoza Leon NR, Cardenas Alva LR, Loo Neyra MS, Alanguia Chipana CL, Torres Picón CMDJ, Huaytalla Quiroz N, Dominguez D, Segura Calle C, Arauco J, Ormeño Calderón L, Ghilardi Silva X, Fernandez Wilson MD, Gutierrez Maldonado JE, Diaz Leon C, Berrocal Anaya W, Chavez Galvez P, Aguilar Gargurevich PP, Diaz Castañeda FDM, Guisse C, Ramos Paredes E, Apaza Leon JL, Aguilar Aguilar F, Ramirez De La Cruz R, Flores Carbajal L, Mendoza Chiroque C, Sulca Cruzado GJ, Tovar Gutierrez N, Sotelo Sanchez J, Paz Soldan C, Hernández Córdova K, Delgado Quinteros EF, Brito Quevedo LM, Mendoza Oviedo JJ, Samanez Obeso A, Paredes Espinoza P, de Guzman J, Yu R, Cosoreanu V, Ionescu S, Mironescu A, Vida L, Papa A, Verdeata R, Gavrila B, Muntean L, Lukac M, Stojanovic M, Toplicic D, Slavkovic M, Slavkovi A, Zivanovic D, Kostic A, Raicevic M, Nkuliza D, Sidler D, Vos CD, Merwe EV, Tasker D, Khamag O, Rengura C, Siyotula T, Jooma U, Delft DV, Arnold M, Mangray H, Harilal S, Madziba S, Wijekoon N, Gamage T, Bright BP, Abdulrahman A, Mohammed OAA, Salah M, Ajwa AEA, Morjan M, Batal MM, Faks V, Mouti MB, Assi A, Al-Mouakeh A, Tarabishi AS, Aljarad Z, Alhamid A, Khorana J, Poocharoen W, Liukitithara S, Sriniworn A, Nuntasunti W, Ngerncham M, Phannua R, Thaiwatcharamas K, Tanming P, Sahnoun L, Kchiche N, Abdelmoumen R, Eroğlu E, Ozen MA, Cömert HSY, İmamoğlu M, Sarıhan H, Kader Ş, Mutlu M, Aslan Y, Beşir A, Geze Ş, Çekiç B, Yalcinkaya A, Sönmez K, Karabulut R, Türkyılmaz Z, Şeref K, Altın M, Aykut M, Akan M, Erdem M, Ergenekon E, Türkyılmaz C, Keleş E, Canözer A, Yeniay AÖ, Eren E, Cesur İB, Özçelik Z, Kurt G, Mert MK, Kaya H, Çelik M, Karakus SC, Erturk N, Suzen A, Hakan N, Akova F, Pasaoglu M, Eshkabilov S, Yuldashev RZ, Abdunomonovich DA, Muslimovich AM, Patel A, Kapihya C, Ensar N, Nataraja RM, Sivasubramaniam M, Jones M, Teague W, Tanny ST, Thomas G, Roberts K, Venkatraman SS, Till H, Pigeolet M, Dassonville M, Shikha A, Win WSP, Ahmad ZAH, Meloche-Dumas L, Caouette-Laberge L, St-Vil D, Aspirot A, Piché N, Joharifard S, Safa N, Laberge JM, Emil S, Puligandla P, Shaw K, Wissanji H, Duggan E, Guadagno E, Puentes MC, Leal PO, Mendez Benavente C, Rygl M, Trojanová B, Berková K, Racková T, Planka L, Škvařil J, Štichhauer R, Sabti S, Macdonald A, Bouhadiba N, Kufeji D, Pardy C, Mccluney S, Keshtgar A, Roberts R, Rhodes H, Burns K, Garrett-Cox R, Ford K, Cornwall H, Ravi K, Arthur F, Losty P, Lander T, Jester I, Arul S, Gee O, Soccorso G, Singh M, Pachl M, Martin B, Alzubair A, Kelay A, Sutcliffe J, Middleton T, Thomas AH, Kurian M, Cameron F, Sivaraj J, Thomas MC, Rex D, Jones C, Bradshaw K, Bonnard A, Delforge X, Duchesne C, Gall CL, Defert C, Laraqui Hossini S, Guerin F, Hery G, Fouquet-Languillat V, Kohaut J, Broch A, Blanc T, Harper L, Delefortrie T, Ballouhey Q, Fourcade L, Grosos C, Parmentier B, Levard G, Grella MG, Renaux Petel M, Grynberg L, Abbo O, Mouttalib S, Juricic M, Scalabre A, Haraux E, Rissmann A, Krause H, Goebel P, Patzer L, Rolle U, Schmedding A, Antunez-Mora A, Tillig B, Bismarck SV, Barbosa PR, Knorr C, Stark D, Brunero M, Avolio L, Manni F, Molinelli M, Guazzotti M, Raffaele A, Romano PG, Cavaiuolo S, Parigi GB, Juhasz L, Rieth A, Strumila A, Dagilytė R, Liubsys A, Gurskas P, Malcius D, Mikneviciute A, Vinskaite A, Barauskas V, Vierboom L, Hall T, Beasley S, Goddard L, Stringer M, Weeratunga N, Adams S, Cama J, Wong M, Jayaratnam S, Kukkady A, Samarakkody U, Gerus S, Patkowski D, Wolny A, Koszutski T, Tobor S, Osowicka M, Czauderna P, Wyrzykowski D, Garnier H, Anzelewicz S, Marta O, Knurowska A, Weiszewsk A, Grabowski A, Korlacki W, Pasierbek M, Wolak P, Piotrowska A, Roszkiewicz A, Kalicińsk P, Trypens A, Kowalewsk G, Sigalet D, Alsaied A, Ali M, Alsaggaf A, Ghallab A, Owiwi Y, Zeinelabdeen A, Fayez M, Atta A, Zidan M, Radwan AS, Shalaby H, Abdelbaqi R, Alattas K, Kano Y, Sindi O, Alshehri A, Altokhais T, Alturki F, Almosaibli M, Krisanova D, Abbas W, Yang HB, Kim HY, Youn JK, Chung JH, Cho SH, Hwang IJ, Lee JY, Song ES, Arboleda J, Ruiz de Temiño Bravo M, Siles Hinojosa A, García M, Casal Beloy I, Oliu San Miguel D, Molina Vazquez ME, Alonso V, Sanchez A, Gomez O, Carrillo I, Wester T, Mesas Burgos C, Hagander L, Salö M, Omling E, Rudolfson N, Granéli C, Arnadóttir H, Grottling E, Abrahamsson K, Gatzinsky V, Dellenmark Blom M, Borbonet D, Puglia P, Jimenez Morejon V, Acuna G, Moraes M, Chan J, Brahmamdam P, Tom A, Sherer K, Gonzales B, Cunningham A, Krishnaswami S, Baertschiger R, Leech M, Williams R, Camp L, Gosain A, Mora M, Lyttle BD, Chang J, McColl Makepeace L, Fowler KL, Mansfield S, Hodgman E, Amaechi C, Beres A, Pernik MN, Dosselman LJ, Almasri M, Jain S, Modi V, Fernandez Ferrer M, Coon J, Gonzalez J, Honhar M, Ruzgar N, Coghill G, Ullrich S, Cheung M, Løfberg K, Greenberg J, Davenport K, Gadepalli S, Fox S, Johnson S, Pilkington M, Hamilton A, Lin N, Sola J, Yao Y, Davis JK, Langer M, Vacek J, Abdullah F, Khlevner J, Middlesworth W, Levitt M, Ahmad H, Siddiqui SM, Bowder A, Derks T, Amoabin AA, Pinar B, Owusu-Sekyere F, Saousen B, Naidoo R, Karamustafic A, Oliveira DPD, Motter SB, Andrade J, Šafus A, Langley J, Wilke A, Deya C, Murtadi HM, Berzanskis M, Calistus N, Ajiboye OS, Felix M, Olabisi OO, Erçin S, Muradi T, Burks SS, Lerma S, Jacobson J, Calancea C, Valerio-Vazquez R, Sikwete G, Sekyere O, Mbonisweni A, Syed S, Hyeon CS, Pajouhandeh F, Kunfah SMP. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study. Lancet 2021; 398:325-339. [PMID: 34270932 PMCID: PMC8314066 DOI: 10.1016/s0140-6736(21)00767-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/10/2021] [Accepted: 03/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. METHODS We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. FINDINGS We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36-39) and median bodyweight at presentation was 2·8 kg (2·3-3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88-4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59-2·79], p<0·0001), sepsis at presentation (1·20 [1·04-1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4-5 vs ASA 1-2, 1·82 [1·40-2·35], p<0·0001; ASA 3 vs ASA 1-2, 1·58, [1·30-1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02-1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41-2·71], p=0·0001; parenteral nutrition 1·35, [1·05-1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47-0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50-0·86], p=0·0024) or percutaneous central line (0·69 [0·48-1·00], p=0·049) were associated with lower mortality. INTERPRETATION Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030. FUNDING Wellcome Trust.
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Silva GVTD, Barros MCDM, Soares JDCA, Carlini LP, Heiderich TM, Orsi RN, Balda RDCX, Thomaz CE, Guinsburg R. What Facial Features Does the Pediatrician Look to Decide That a Newborn Is Feeling Pain? Am J Perinatol 2021; 40:851-857. [PMID: 34192767 DOI: 10.1055/s-0041-1731453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study aimed to analyze the gaze fixation of pediatricians during the decision process regarding the presence/absence of pain in pictures of newborn infants. STUDY DESIGN Experimental study, involving 38 pediatricians (92% females, 34.6 ± 9.0 years, 22 neonatologists) who evaluated 20 pictures (two pictures of each newborn: one at rest and one during a painful procedure), presented in random order for each participant. The Tobii-TX300 equipment tracked eye movements in four areas of interest of each picture (AOI): mouth, eyes, forehead, and nasolabial furrow. Pediatricians evaluated the intensity of pain with a verbal analogue score from 0 to 10 (0 = no pain; 10 = maximum pain). The number of pictures in which pediatricians fixed their gaze, the number of gaze fixations, and the total and average time of gaze fixations were compared among the AOI by analysis of variance (ANOVA). The visual-tracking parameters of the pictures' evaluations were also compared by ANOVA according to the pediatricians' perception of pain presence: moderate/severe (score = 6-10), mild (score = 3-5), and absent (score = 0-2). The association between the total time of gaze fixations in the AOI and pain perception was assessed by logistic regression. RESULTS In the 20 newborn pictures, the mean number of gaze fixations was greater in the mouth, eyes, and forehead than in the nasolabial furrow. Also, the average total time of gaze fixations was greater in the mouth and forehead than in the nasolabial furrow. Controlling for the time of gaze fixation in the AOI, each additional second in the time of gaze fixation in the mouth (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.08-1.46) and forehead (OR: 1.16; 95% CI: 1.02-1.33) was associated with an increase in the chance of moderate/severe pain presence in the neonatal facial picture. CONCLUSION When challenged to say whether pain is present in pictures of newborn infants' faces, pediatricians fix their gaze preferably in the mouth. The longer duration of gaze fixation in the mouth and forehead is associated with an increase perception that moderate/severe pain is present. KEY POINTS · Neonatal pain assessment is intrinsically subjective.. · Visual tracking identifies the focus of attention of individuals.. · Adults' gaze in neonates' mouth and forehead is associated with pain perception..
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Affiliation(s)
- Giselle Valério Teixeira da Silva
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marina Carvalho de Moraes Barros
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Juliana do Carmo Azevedo Soares
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucas Pereira Carlini
- Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, São Bernardo do Campo, São Paulo, Brazil
| | - Tatiany Marcondes Heiderich
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rafael Nobre Orsi
- Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, São Bernardo do Campo, São Paulo, Brazil
| | - Rita de Cássia Xavier Balda
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carlos Eduardo Thomaz
- Image Processing Laboratory, Department of Electrical Engineering, Centro Universitario FEI, São Bernardo do Campo, São Paulo, Brazil
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Department of Pediatrics at Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Areco KN, Konstantyner T, Bandiera-Paiva P, Balda RCX, Costa-Nobre DT, Sanudo A, Kiffer CRV, Kawakami MD, Miyoshi MH, Marinonio ASS, Freitas RMV, Morais LCC, Teixeira MLP, Waldvogel B, Almeida MFB, Guinsburg R. Operational Challenges in the Use of Structured Secondary Data for Health Research. Front Public Health 2021; 9:642163. [PMID: 34211950 PMCID: PMC8239175 DOI: 10.3389/fpubh.2021.642163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background: In Brazil, secondary data for epidemiology are largely available. However, they are insufficiently prepared for use in research, even when it comes to structured data since they were often designed for other purposes. To date, few publications focus on the process of preparing secondary data. The present findings can help in orienting future research projects that are based on secondary data. Objective: Describe the steps in the process of ensuring the adequacy of a secondary data set for a specific use and to identify the challenges of this process. Methods: The present study is qualitative and reports methodological issues about secondary data use. The study material was comprised of 6,059,454 live births and 73,735 infant death records from 2004 to 2013 of children whose mothers resided in the State of São Paulo - Brazil. The challenges and description of the procedures to ensure data adequacy were undertaken in 6 steps: (1) problem understanding, (2) resource planning, (3) data understanding, (4) data preparation, (5) data validation and (6) data distribution. For each step, procedures, and challenges encountered, and the actions to cope with them and partial results were described. To identify the most labor-intensive tasks in this process, the steps were assessed by adding the number of procedures, challenges, and coping actions. The highest values were assumed to indicate the most critical steps. Results: In total, 22 procedures and 23 actions were needed to deal with the 27 challenges encountered along the process of ensuring the adequacy of the study material for the intended use. The final product was an organized database for a historical cohort study suitable for the intended use. Data understanding and data preparation were identified as the most critical steps, accounting for about 70% of the challenges observed for data using. Conclusion: Significant challenges were encountered in the process of ensuring the adequacy of secondary health data for research use, mainly in the data understanding and data preparation steps. The use of the described steps to approach structured secondary data and the knowledge of the potential challenges along the process may contribute to planning health research.
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Affiliation(s)
- Kelsy N Areco
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rita C X Balda
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Mandira D Kawakami
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Milton H Miyoshi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Rosa M V Freitas
- Fundação Sistema Estadual de Análise de Dados, São Paulo, Brazil
| | | | | | | | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Dainty KN, Atkins DL, Breckwoldt J, Maconochie I, Schexnayder SM, Skrifvars MB, Tijssen J, Wyllie J, Furuta M, Aickin R, Acworth J, Atkins D, Couto TB, Guerguerian AM, Kleinman M, Kloeck D, Nadkarni V, Ng KC, Nuthall G, Ong YKG, Reis A, Rodriguez-Nunez A, Schexnayder S, Scholefield B, Tijssen J, Voorde PVD, Wyckoff M, Liley H, El-Naggar W, Fabres J, Fawke J, Foglia E, Guinsburg R, Hosono S, Isayama T, Kawakami M, Kapadia V, Kim HS, McKinlay C, Roehr C, Schmolzer G, Sugiura T, Trevisanuto D, Weiner G, Greif R, Bhanji F, Bray J, Breckwoldt J, Cheng A, Duff J, Eastwood K, Gilfoyle E, Hsieh MJ, Lauridsen K, Lockey A, Matsuyama T, Patocka C, Pellegrino J, Sawyer T, Schnaubel S, Yeung J. Family presence during resuscitation in paediatric and neonatal cardiac arrest: A systematic review. Resuscitation 2021; 162:20-34. [PMID: 33577966 DOI: 10.1016/j.resuscitation.2021.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Parent/family presence at pediatric resuscitations has been slow to become consistent practice in hospital settings and has not been universally implemented. A systematic review of the literature on family presence during pediatric and neonatal resuscitation has not been previously conducted. OBJECTIVE To conduct a systematic review of the published evidence related to family presence during pediatric and neonatal resuscitation. DATA SOURCES Six major bibliographic databases was undertaken with defined search terms and including literature up to June 14, 2020. STUDY SELECTION 3200 titles were retrieved in the initial search; 36 ultimately included for review. DATA EXTRACTION Data was double extracted independently by two reviewers and confirmed with the review team. All eligible studies were either survey or interview-based and as such we turned to narrative systematic review methodology. RESULTS The authors identified two key sets of findings: first, parents/family members want to be offered the option to be present for their child's resuscitation. Secondly, health care provider attitudes varied widely (ranging from 15% to >85%), however, support for family presence increased with previous experience and level of seniority. LIMITATIONS English language only; lack of randomized control trials; quality of the publications. CONCLUSIONS Parents wish to be offered the opportunity to be present but opinions and perspectives on the family presence vary greatly among health care providers. This topic urgently needs high quality, comparative research to measure the actual impact of family presence on patient, family and staff outcomes. PROSPERO REGISTRATION NUMBER CRD42020140363.
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Affiliation(s)
- Katie N Dainty
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada.
| | - Dianne L Atkins
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jan Breckwoldt
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Ian Maconochie
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Steve M Schexnayder
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Markus B Skrifvars
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Janice Tijssen
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jonathan Wyllie
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Marie Furuta
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Richard Aickin
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jason Acworth
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Dianne Atkins
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Thomaz Bittencourt Couto
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Anne-Marie Guerguerian
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Monica Kleinman
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - David Kloeck
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Vinay Nadkarni
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Kee-Chong Ng
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Gabrielle Nuthall
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Yong-Kwang Gene Ong
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Amelia Reis
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Antonio Rodriguez-Nunez
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Steve Schexnayder
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Barney Scholefield
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Janice Tijssen
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Patrick van de Voorde
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Myra Wyckoff
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Helen Liley
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Walid El-Naggar
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jorge Fabres
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Joe Fawke
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Elizabeth Foglia
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Ruth Guinsburg
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Shigeharu Hosono
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Tetsuya Isayama
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Mandira Kawakami
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Vishal Kapadia
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Han-Suk Kim
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Chris McKinlay
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Charles Roehr
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Georg Schmolzer
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Takahiro Sugiura
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Daniele Trevisanuto
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Gary Weiner
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Robert Greif
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Farhan Bhanji
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Janet Bray
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jan Breckwoldt
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Adam Cheng
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jonathan Duff
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Kathryn Eastwood
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Elaine Gilfoyle
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Ming-Ju Hsieh
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Kasper Lauridsen
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Andrew Lockey
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Tasuku Matsuyama
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Catherine Patocka
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Jeffrey Pellegrino
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Taylor Sawyer
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Sebastian Schnaubel
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
| | - Joyce Yeung
- North York General Hospital, Li Ka Shing Knowledge Institute, 4001 Leslie Street, Toronto, Ontario M3K 3E1, Canada
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Kawakami MD, Sanudo A, Teixeira MLP, Andreoni S, de Castro JQX, Waldvogel B, Guinsburg R, de Almeida MF. Neonatal mortality associated with perinatal asphyxia: a population-based study in a middle-income country. BMC Pregnancy Childbirth 2021; 21:169. [PMID: 33639885 PMCID: PMC7913394 DOI: 10.1186/s12884-021-03652-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/18/2021] [Indexed: 01/21/2023] Open
Abstract
Background It is challenging to decrease neonatal mortality in middle-income countries, where perinatal asphyxia is an important cause of death. This study aims to analyze the annual trend of neonatal mortality with perinatal asphyxia according to gestational age in São Paulo State, Brazil, during a 10-year period and to verify demographic, maternal and neonatal characteristics associated with these deaths. Methods Population-based study of neonatal deaths associated with perinatal asphyxia from 0 to 27 days in São Paulo State, Brazil, from 2004 to 2013. Perinatal asphyxia was considered as associated to death if intrauterine hypoxia, birth asphyxia or neonatal aspiration of meconium were noted in any line of the Death Certificate according to ICD-10. Poisson Regression was applied to analyze the annual trend of neonatal mortality rate according to gestational age. Kaplan-Meier curve was used to assess age at death during the 10-year study period. Hazard ratio of death during the neonatal period according to gestational age was analyzed by Cox regression adjusted by year of birth and selected epidemiological factors. Results Among 74,002 infant deaths in São Paulo State, 6648 (9%) neonatal deaths with perinatal asphyxia were studied. Neonatal mortality rate with perinatal asphyxia fell from 1.38‰ in 2004 to 0.95‰ in 2013 (p = 0.002). Reduction started in 2008 for neonates with 32–41 weeks, in 2009 for 28–31 weeks, and in 2011 for 22–27 weeks. Median time until 50% of deaths occurred was 25.3 h (95%CI: 24.0; 27.2). Variables independently associated with higher risk of death were < 7 prenatal visits, 1st minute Apgar score 0–3, and death at the same place of birth. Cesarean delivery compared to vaginal was protective against death with perinatal asphyxia for infants at 28–36 weeks. Conclusions There was an expressive reduction in neonatal mortality rates associated with perinatal asphyxia during this 10-year period in São Paulo State, Brazil. Variables associated with these deaths highlight the need of public health policies to improve quality of regionalized perinatal care.
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Affiliation(s)
- Mandira D Kawakami
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil
| | - Adriana Sanudo
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil
| | | | - Solange Andreoni
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil
| | - Josiane Q X de Castro
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil
| | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil
| | - Maria Fernanda de Almeida
- Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Los Angeles, 40, São Paulo, CEP 04564-030, Brazil.
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40
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Guinsburg R, Sanudo A, Kiffer CRV, Marinonio ASS, Costa-Nobre DT, Areco KN, Kawakami MD, Miyoshi MH, Bandiera-Paiva P, Balda RDCX, Konstantyner T, Morais LC, Freitas RM, Teixeira ML, Waldvogel B, Almeida MFB. Annual trend of neonatal mortality and its underlying causes: population-based study - São Paulo State, Brazil, 2004-2013. BMC Pediatr 2021; 21:54. [PMID: 33499817 PMCID: PMC7836582 DOI: 10.1186/s12887-021-02511-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/19/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Population-based studies analyzing neonatal deaths in middle-income countries may contribute to design interventions to achieve the Sustainable Development Goals, established by United Nations. This study goal is to analyze the annual trend of neonatal mortality in São Paulo State, Brazil, over a 10-year period and its underlying causes and to identify maternal and neonatal characteristics at birth associated with neonatal mortality. METHOD A population-based study of births and deaths from 0 to 27 days between 2004 and 2013 in São Paulo State, Brazil, was performed. The annual trend of neonatal mortality rate according to gestational age was analyzed by Poisson or by Negative Binomial Regression models. Basic causes of neonatal death were classified according to ICD-10. Association of maternal demographic variables (block 1), prenatal and delivery care variables (block 2), and neonatal characteristics at birth (block 3) with neonatal mortality was evaluated by Poisson regression analysis adjusted by year of birth. RESULTS Among 6,056,883 live births in São Paulo State during the study period, 48,309 died from 0 to 27 days (neonatal mortality rate: 8.0/1,000 live births). For the whole group and for infants with gestational age 22-27, 28-31, 32-36, 37-41 and ≥ 42 weeks, reduction of neonatal mortality rate was, respectively, 18 %, 15 %, 38 %, 53 %, 31 %, and 58 %. Median time until 50 % of deaths occurred was 3 days. Main basic causes of death were respiratory disorders (25 %), malformations (20 %), infections (17 %), and perinatal asphyxia (7 %). Variables independently associated with neonatal deaths were maternal schooling, prenatal care, parity, newborn sex, 1st minute Apgar, and malformations. Cesarean delivery, compared to vaginal, was protective against neonatal mortality for infants at 22-31 weeks, but it was a risk factor for those with 32-41 weeks. CONCLUSIONS Despite the significant decrease in neonatal mortality rate over the 10-year period in São Paulo State, improved access to qualified health care is needed in order to avoid preventable neonatal deaths and increase survival of infants that need more complex levels of assistance.
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Affiliation(s)
- Ruth Guinsburg
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil.
| | - Adriana Sanudo
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Carlos Roberto V Kiffer
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Ana Sílvia S Marinonio
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Daniela T Costa-Nobre
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Kelsy N Areco
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Mandira D Kawakami
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Milton H Miyoshi
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Rita de Cássia X Balda
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Liliam Cc Morais
- Fundação Sistema Estadual de Análise de Dados, São Paulo, Brazil
| | - Rosa Mv Freitas
- Fundação Sistema Estadual de Análise de Dados, São Paulo, Brazil
| | | | | | - Maria Fernanda B Almeida
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
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Wallau CAK, Costa-Nobre DT, Leslie ATFS, Guinsburg R. Impact of bundle implementation on the incidence of peri/intraventricular hemorrhage among preterm infants: a pre-post interventional study. SAO PAULO MED J 2021; 139:251-258. [PMID: 33978129 PMCID: PMC9625011 DOI: 10.1590/1516-3180.2020.0412.r1.28012021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Peri/intraventricular hemorrhage (PIVH) is a frequent cause of death and morbidity among preterm infants. Few studies have addressed the use of bundles for preventing PIVH. OBJECTIVE To evaluate the efficacy of a bundle of interventions designed to decrease the incidence of intraventricular hemorrhage at hospital discharge among preterm infants. DESIGN AND SETTING Pre-post interventional study with retrospective and prospective data collection performed before and after bundle implementation in the neonatal intensive care unit of a university hospital. METHODS Infants with gestational age < 32 weeks without malformations, who survived > 6 days were included. The bundle consisted of the following actions during the first 72 hours of life: maintenance of head in neutral position with the body in supine position, minimal handling, including delay of lumbar puncture until after 72 hours and absence of respiratory therapy maneuvers. Cranial ultrasound was performed on days 3, 7 and 28, or later if needed. The effect of the bundle was analyzed through logistic regression and results were adjusted for confounding variables. RESULTS 167 infants met the inclusion criteria; 146 (87%) were analyzed. Bundle implementation was associated with decreased chances of PIVH at hospital discharge (odds ratio 0.29; 95% confidence interval 0.13-0.65). Cerebrospinal fluid collection within the first 72 hours increased the odds of PIVH of any grade during the hospital stay fourfold, after adjustment for all variables included in the model. CONCLUSION Implementation of a bundle of interventions to avoid intraventricular hemorrhage was effective for decreasing the incidence of all grades of PIVH in preterm infants.
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Affiliation(s)
- Cristiane Akemi Koyama Wallau
- MSc. Postgraduate Student. Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| | - Daniela Testoni Costa-Nobre
- MD, PhD. Adjunct Professor, Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| | - Ana Teresa Figueiredo Stochero Leslie
- MD, MSc, PhD. Adjunct Professor, Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
| | - Ruth Guinsburg
- MD, PhD. Full Professor, Neonatal Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo (SP), Brazil
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Wyckoff MH, Wyllie J, Aziz K, de Almeida MF, Fabres J, Fawke J, Guinsburg R, Hosono S, Isayama T, Kapadia VS, Kim HS, Liley HG, McKinlay CJD, Mildenhall L, Perlman JM, Rabi Y, Roehr CC, Schmölzer GM, Szyld E, Trevisanuto D, Velaphi S, Weiner GM. Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S185-S221. [PMID: 33084392 DOI: 10.1161/cir.0000000000000895] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for neonatal life support includes evidence from 7 systematic reviews, 3 scoping reviews, and 12 evidence updates. The Neonatal Life Support Task Force generally determined by consensus the type of evidence evaluation to perform; the topics for the evidence updates followed consultation with International Liaison Committee on Resuscitation member resuscitation councils. The 2020 CoSTRs for neonatal life support are published either as new statements or, if appropriate, reiterations of existing statements when the task force found they remained valid. Evidence review topics of particular interest include the use of suction in the presence of both clear and meconium-stained amniotic fluid, sustained inflations for initiation of positive-pressure ventilation, initial oxygen concentrations for initiation of resuscitation in both preterm and term infants, use of epinephrine (adrenaline) when ventilation and compressions fail to stabilize the newborn infant, appropriate routes of drug delivery during resuscitation, and consideration of when it is appropriate to redirect resuscitation efforts after significant efforts have failed. All sections of the Neonatal Resuscitation Algorithm are addressed, from preparation through to postresuscitation care. This document now forms the basis for ongoing evidence evaluation and reevaluation, which will be triggered as further evidence is published. Over 140 million babies are born annually worldwide (https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100). If up to 5% receive positive-pressure ventilation, this evidence evaluation is relevant to more than 7 million newborn infants every year. However, in terms of early care of the newborn infant, some of the topics addressed are relevant to every single baby born.
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Foglia EE, Weiner G, de Almeida MFB, Wyllie J, Wyckoff MH, Rabi Y, Guinsburg R. Duration of Resuscitation at Birth, Mortality, and Neurodevelopment: A Systematic Review. Pediatrics 2020; 146:peds.2020-1449. [PMID: 32788267 DOI: 10.1542/peds.2020-1449] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The International Liaison Committee on Resuscitation Neonatal Life Support Task Force reviewed evidence for the duration of cardiopulmonary resuscitation (CPR) for newborns immediately after birth. OBJECTIVE To summarize evidence for ongoing CPR on the outcomes of survival, neurodevelopment, and the composite of survival without moderate or severe neurodevelopmental impairment (NDI). DATA SOURCES Medline, Embase, Evidence-Based Medicine Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scientific Electronic Library Online were searched between inception and February 29, 2020. STUDY SELECTION Two independent reviewers selected studies of newborns with at least 10 minutes of asystole, bradycardia, or pulseless electrical activity for which CPR is indicated. DATA EXTRACTION Two independent reviewers extracted data and appraised the risk of bias. RESULTS In 16 eligible studies, researchers reported outcomes of 579 newborns born between 1982 and 2017. Within individual studies, 2% to 100% of infants survived to last follow-up (hospital discharge through 12 years). Summarized across studies, 237 of 579 (40.9%) newborns survived to last follow-up. In 13 studies, researchers reported neurodevelopmental outcomes of 277 newborns. Of these, 30 of 277 (10.8%) survived without moderate or severe impairment, and 240 of 277 (87%) met the composite outcome of death or NDI (191 died and 49 survived with moderate or severe impairment). LIMITATIONS There was very low certainty of evidence because of risk of bias and inconsistency. CONCLUSIONS Infants with ongoing CPR at 10 minutes after birth are at high risk for mortality and neurodisability, but survival without moderate or severe NDI is possible. One specified duration of CPR is unlikely to uniformly predict survival or survival without neuroimpairment.
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Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
| | - Gary Weiner
- Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan
| | - Maria Fernanda B de Almeida
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jonathan Wyllie
- Departments of Paediatrics and Neonatology, The James Cook University Hospital, South Tees Hospitals National Health Services Foundation Trust, Middlesbrough, United Kingdom
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Yacov Rabi
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Castro JSD, Leslie ATFS, Guinsburg R. Perinatal factors associated with amplitude-integrated electroencephalography abnormalities in preterm infants on the first day of life. J Pediatr (Rio J) 2020; 96:644-651. [PMID: 31325413 PMCID: PMC9432229 DOI: 10.1016/j.jped.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/07/2019] [Accepted: 06/18/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Evaluate the association between perinatal factors and amplitude-integrated electroencephalogram abnormalities in preterm infants on the first day of life. METHODS This was a cross-sectional study of 60 infants with gestational age between 23 and 32 weeks, without malformations. Infants were continuously monitored by amplitude-integrated electroencephalogram on the first day of life, for at least 3h. The tracings were recorded and analyzed in each column for the following: burst-suppression pattern, sleep-wake cycle, and amplitude of the lower margin (<3μV or <5μV). The association of maternal complications, mode of delivery, birth weight, gestational age, neonatal sex, resuscitation procedures, hypothermia on admission, and the Score for Neonatal Acute Physiology, Perinatal Extension, Version II [SNAPPE-II]) with amplitude-integrated electroencephalogram alterations was assessed by multiple logistic regression. RESULTS A discontinuous pattern occurred in 65% of infants, and a continuous pattern occurred in 23%. The burst-suppression pattern was associated with vaginal delivery (OR: 7.6; 95% CI: 1.1-53.1) and SNAPPE-II≥40 (OR: 13.1; 95% CI: 1.8-95.1). A lower margin of the amplitude-integrated electroencephalogram of <3μV was also associated with SNAPPE-II≥40 (OR: 10.6, 95% CI: 2.3-49.2), while a value <5μV was associated with lower GA (OR: 0.51, 95% CI: 0.34-0.76). There were no associations between the perinatal variables and the absence of a sleep-wake cycle in amplitude-integrated electroencephalogram recordings on the first day of life. CONCLUSION Biological variables and clinical severity are associated with electroencephalographic characteristics of preterm infants on the first day of life and should be considered in clinical practice when amplitude-integrated electroencephalogram is performed.
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Affiliation(s)
- Junia Sampel de Castro
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Divisão de Medicina Neonatal, São Paulo, SP, Brazil
| | | | - Ruth Guinsburg
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Divisão de Medicina Neonatal, São Paulo, SP, Brazil.
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Castro JSD, Leslie ATFS, Guinsburg R. Perinatal factors associated with amplitude‐integrated electroencephalography abnormalities in preterm infants on the first day of life. Jornal de Pediatria (Versão em Português) 2020. [DOI: 10.1016/j.jpedp.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Malheiros JM, Andreeta MB, Polli RS, Paiva FF, Tannús A, Guinsburg R, Covolan L. Adult brain activation in response to pain is changed by neonatal painful stimulation according to sex: A manganese-enhanced MRI study. Eur J Neurosci 2020; 53:571-587. [PMID: 32852090 DOI: 10.1111/ejn.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 07/27/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
Although it is known that nociceptive stimulation in the first postnatal week in rats is useful to model preterm pain, resulting in activation of specific brain areas, as assessed in vivo using manganese-enhanced magnetic resonance imaging (MEMRI), little is known about its long-term effects and sex specificity. Here we aimed to investigate whether inflammatory pain induced in male and female adult rats modify the pattern of brain activation between animals subjected or not to neonatal pain. For this, Complete Freund's adjuvant (CFA) was injected into the left hind paw of rat pups on postnatal day 1 (P1) or P8 to induce inflammatory response. During adulthood, CFA-treated and control animals were injected with CFA 1 hr prior MRI. MEMRI has the ability to enhance the contrast of selective brain structures in response to a specific stimulus, as the pain. MEMRI responses were consistent with activation of nociceptive pathways and these responses were reduced in animals treated with CFA on P1, but increased in animals treated on P8, mainly in the female group. In agreement, P8 female group showed exacerbated responses in the thermal nociceptive test. Using MEMRI, we conclude that the natural ability of adult rats to recognize and react to pain exposition is modified by neonatal painful exposition, mainly among females.
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Affiliation(s)
| | - Mariane B Andreeta
- Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos, Brazil
| | - Roberson S Polli
- Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo, São José dos Campos, Brazil
| | - Fernando F Paiva
- Centro de Imagens e Espectroscopia in vivo por Ressonância Magnética (CIERMag), Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos, Brazil
| | - Alberto Tannús
- Centro de Imagens e Espectroscopia in vivo por Ressonância Magnética (CIERMag), Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos, Brazil
| | - Ruth Guinsburg
- Disciplina de Pediatria Neonatal, Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luciene Covolan
- Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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Santana DS, Cecatti JG, Surita FG, Tedesco RP, Passini R, Souza RT, Lajos GJ, Dias TZ, Nomura ML, Rehder PM, Sousa MH, Costa ML, Pacagnella RC, Marba ST, Guinsburg R, Martinez FE, Zotarelli V, Gurgel LT, Feitosa FE, Chaves GN, Porto AM, Coutinho IC, Barbosa Lima AC, Melo EF, Leite DF, Amorim MM, Melo ASO, Melo FO, Martins MG, Nunes MV, Paiva CS, Lima MD, Freire DM, Tristão EG, Nascimento DJ, Menezes CA, Aquino M, Vettorazzi J, Senger CE, Assumpção AMB, Guedes MAF, Moreira MEL, Borges VT, Maia Filho NL, Mathias JP, Souza E, Zamarian ACP, Quintana SM, Melli PPS, Lotufo FA, Uzilin K, Zanette EA, Andreucci CB, Oliveira TA, Oliveira LR, Santos MAN, Sass N, Silveira MRF, Coutinho PR, Siqueira L. Maternal and perinatal outcomes and factors associated with twin pregnancies among preterm births: Evidence from the Brazilian Multicenter Study on Preterm Birth (
EMIP
). Int J Gynaecol Obstet 2020; 149:184-191. [DOI: 10.1002/ijgo.13107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/02/2019] [Accepted: 01/31/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Danielly S. Santana
- Department of Obstetrics and Gynecology Campinas University School of Medicine Campinas Brazil
| | - Jose G. Cecatti
- Department of Obstetrics and Gynecology Campinas University School of Medicine Campinas Brazil
| | - Fernanda G. Surita
- Department of Obstetrics and Gynecology Campinas University School of Medicine Campinas Brazil
| | - Ricardo P. Tedesco
- Department of Obstetrics and Gynecology Jundiai Medical School Jundiaí Brazil
| | - Renato Passini
- Department of Obstetrics and Gynecology Campinas University School of Medicine Campinas Brazil
| | - Renato T. Souza
- Department of Obstetrics and Gynecology Campinas University School of Medicine Campinas Brazil
| | - Giuliane J. Lajos
- Department of Obstetrics and Gynecology Campinas University School of Medicine Campinas Brazil
| | - Tabata Z. Dias
- Department of Obstetrics and Gynecology Campinas University School of Medicine Campinas Brazil
| | - Marcelo L. Nomura
- Department of Obstetrics and Gynecology Campinas University School of Medicine Campinas Brazil
| | - Patricia M. Rehder
- Department of Obstetrics and Gynecology Campinas University School of Medicine Campinas Brazil
| | - Maria H. Sousa
- Department of Obstetrics and Gynecology Jundiai Medical School Jundiaí Brazil
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Li G, Bielicki JA, Ahmed ASMNU, Islam MS, Berezin EN, Gallacci CB, Guinsburg R, da Silva Figueiredo CE, Santarone Vieira R, Silva AR, Teixeira C, Turner P, Nhan L, Orrego J, Pérez PM, Qi L, Papaevangelou V, Triantafyllidou P, Iosifidis E, Roilides E, Sarafidis K, Jinka DR, Nayakanti RR, Kumar P, Gautam V, Prakash V, Seeralar A, Murki S, Kandraju H, Singh S, Kumar A, Lewis L, Pukayastha J, Nangia S, K N Y, Chaurasia S, Chellani H, Obaro S, Dramowski A, Bekker A, Whitelaw A, Thomas R, Velaphi SC, Ballot DE, Nana T, Reubenson G, Fredericks J, Anugulruengkitt S, Sirisub A, Wong P, Lochindarat S, Boonkasidecha S, Preedisripipat K, Cressey TR, Paopongsawan P, Lumbiganon P, Pongpanut D, Sukrakanchana PO, Musoke P, Olson L, Larsson M, Heath PT, Sharland M. Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network. Arch Dis Child 2020; 105:26-31. [PMID: 31446393 PMCID: PMC6951234 DOI: 10.1136/archdischild-2019-316816] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middle-income country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR). DESIGN A web-based survey using a REDCap database was circulated to NNUs participating in the Neonatal AMR research network. The survey included questions about NNU funding structure, size, admission rates, access to supportive therapies, empirical antimicrobial guidelines and period prevalence of neonatal blood culture isolates and their resistance patterns. SETTING 39 NNUs from 12 countries. PATIENTS Any neonate admitted to one of the participating NNUs. INTERVENTIONS This was an observational cohort study. RESULTS The number of live births per unit ranged from 513 to 27 700 over the 12-month study period, with the number of neonatal cots ranging from 12 to 110. The proportion of preterm admissions <32 weeks ranged from 0% to 19%, and the majority of units (26/39, 66%) use Essential Medicines List 'Access' antimicrobials as their first-line treatment in neonatal sepsis. Cephalosporin resistance rates in Gram-negative isolates ranged from 26% to 84%, and carbapenem resistance rates ranged from 0% to 81%. Glycopeptide resistance rates among Gram-positive isolates ranged from 0% to 45%. CONCLUSION AMR is already a significant issue in NNUs worldwide. The apparent burden of AMR in a given NNU in the LMIC setting can be influenced by a range of factors which will vary substantially between NNUs. These variations must be considered when designing interventions to improve neonatal mortality globally.
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Affiliation(s)
- Grace Li
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Julia Anna Bielicki
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK,Paediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital, Basel, Switzerland
| | | | | | | | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Paul Turner
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
| | - Ladin Nhan
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Jaime Orrego
- Fundación Valle del Lili, Santiago de Cali, Colombia
| | | | - Lifeng Qi
- Shenzhen Children’s Hospital, Shenzhen, China
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Elias Iosifidis
- School of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Emmanuel Roilides
- School of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Kosmas Sarafidis
- School of Health Sciences, Aristotle University, Thessaloniki, Greece
| | | | | | - Praveen Kumar
- Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gautam
- Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinayagam Prakash
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Chennai, India
| | - Arasar Seeralar
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Chennai, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | | | | | - Anil Kumar
- Amrita Institute of Medical Sciences, Kochi, India
| | | | | | | | - Yogesha K N
- Lady Hardinge Medical College, New Delhi, India
| | | | - Harish Chellani
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Stephen Obaro
- International Foundation Against Infectious Disease in Nigeria, Omaha, Nebraska, USA
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Andrew Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Reenu Thomas
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Trusha Nana
- University of the Witwatersrand, Johannesburg, South Africa
| | - Gary Reubenson
- University of the Witwatersrand, Johannesburg, South Africa
| | - Joy Fredericks
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Pimol Wong
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | - Tim R Cressey
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | | | | | | | | | - Philippa Musoke
- Paediatrics and Child Health, Makerere University, Kampala, Kampala, Uganda,Mulago Hospital, Kampala, Uganda
| | - Linus Olson
- Karolinska Institute in collaboration with Vietnam National Children's Hospital within Training and Research Academic Collaboration (TRAC) Sweden – Vietnam, Hanoi, Vietnam
| | - Mattias Larsson
- Karolinska Institute in collaboration with Vietnam National Children's Hospital within Training and Research Academic Collaboration (TRAC) Sweden – Vietnam, Hanoi, Vietnam
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Michael Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK
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Soar J, Maconochie I, Wyckoff MH, Olasveengen TM, Singletary EM, Greif R, Aickin R, Bhanji F, Donnino MW, Mancini ME, Wyllie JP, Zideman D, Andersen LW, Atkins DL, Aziz K, Bendall J, Berg KM, Berry DC, Bigham BL, Bingham R, Couto TB, Böttiger BW, Borra V, Bray JE, Breckwoldt J, Brooks SC, Buick J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Couper K, Dainty KN, Dawson JA, de Almeida MF, de Caen AR, Deakin CD, Drennan IR, Duff JP, Epstein JL, Escalante R, Gazmuri RJ, Gilfoyle E, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Holmberg MJ, Hood N, Hosono S, Hsieh MJ, Isayama T, Iwami T, Jensen JL, Kapadia V, Kim HS, Kleinman ME, Kudenchuk PJ, Lang E, Lavonas E, Liley H, Lim SH, Lockey A, Lofgren B, Ma MHM, Markenson D, Meaney PA, Meyran D, Mildenhall L, Monsieurs KG, Montgomery W, Morley PT, Morrison LJ, Nadkarni VM, Nation K, Neumar RW, Ng KC, Nicholson T, Nikolaou N, Nishiyama C, Nuthall G, Ohshimo S, Okamoto D, O’Neil B, Yong-Kwang Ong G, Paiva EF, Parr M, Pellegrino JL, Perkins GD, Perlman J, Rabi Y, Reis A, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Skrifvars MB, Smyth MA, Stanton D, Swain J, Szyld E, Tijssen J, Travers A, Trevisanuto D, Vaillancourt C, Van de Voorde P, Velaphi S, Wang TL, Weiner G, Welsford M, Woodin JA, Yeung J, Nolan JP, Fran Hazinski M. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2019; 140:e826-e880. [DOI: 10.1161/cir.0000000000000734] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
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Bueno GGG, Barros MCDM, Guinsburg R. Preterm infants with peri/intraventricular hemorrhage have poorer habituation responses to external stimuli. Jornal de Pediatria (Versão em Português) 2019. [DOI: 10.1016/j.jpedp.2018.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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