Use of Suctioning during Newborn Resuscitation and Its Effects on Heart Rate in a Low-Resource Setting, Tanzania
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Subjects
2.3. Development of the Annotation Protocol
2.4. Video Annotations
2.5. Suction Annotations
2.6. Heart Rate and Ventilation Extraction
2.7. Statistical Analyses
3. Results
3.1. Suction Events and Heart Rate Changes
3.2. Probability of Suction-Related HR Changes in Relation to Newborn Characteristics and Other Factors
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total n = 76 | Deaths n = 30 | Survivors n = 46 | p 1 | p 2 |
---|---|---|---|---|---|
Birth weight (grams) | 3060 ± 560 | 2841 ± 491 | 3203 ± 561 | 0.004 | 0.009 |
Gestational age (weeks) | 38.1 ± 1.6 n = 72 | 37.9 ± 1.4 n = 27 | 38.2 ± 1.6 n = 45 | 0.35 | 0.47 |
Female | 26 (34%) | 13 (43%) | 13 (28%) | 0.18 | 0.26 |
Abnormal FHR on admission | 2 (3%) n = 66 | 1 (4%) n = 24 | 1 (2%) n = 42 | 0.69 | 0.56 |
Cervical dilatation on admission (cm) | 6.3 ± 2.4 n = 64 | 6.2 ± 2.6 n = 22 | 6.4 ± 2.3 n = 42 | 0.84 | 0.96 |
Fetal presentation | 0.60 | 0.49 | |||
Cephalic | 67 (88%) | 26 (87%) | 41 (89%) | ||
Breech | 6 (8%) | 2 (7%) | 4 (9%) | ||
Others (transverse, prolapse) | 3 (4%) | 2 (7%) | 1 (2%) | ||
Abnormal FHR during labor | 9 (15%) n = 62 | 7 (30%) n = 23 | 2 (5%) n = 39 | 0.007 | 0.010 |
Amniotic fluid 5 | (n = 75) | (n = 45) | 0.22 | 0.37 | |
Clear | 39 (52%) | 12 (40%) | 27 (60%) | ||
Slight meconium | 11 (15%) | 6 (20%) | 5 (11%) | ||
Thick meconium | 24 (32%) | 12 (40%) | 12 (27%) | ||
Blood stained | 1 (1%) | 0 (0%) | 1 (2%) | ||
Abnormal final FHR before delivery | 9 (14%) n = 64 | 7 (29%) n = 24 | 2 (5%) n = 40 | 0.008 | 0.010 |
Multiples (twins) | 3 (4%) | 1 (3%) | 2 (4%) | 0.82 | 0.60 |
Labor complications 6 | 6 (8%) | 2 (7%) | 4 (9%) | 0.75 | 0.93 |
Mode of delivery | 0.53 | 0.85 | |||
Spontaneous vaginal delivery | 41 (54%) | 14 (47%) | 27 (59%) | ||
Cesarean section | 32 (42%) | 15 (50%) | 17 (37%) | ||
Assisted breech delivery | 3 (4%) | 1 (3%) | 2 (4%) | ||
Apgar score assigned by attending midwife | |||||
1 min | 7 (4, 7) | 4 (3, 5) | 7 (7, 8) | <0.001 3 | <0.001 3 |
5 min | 10 (8, 10) | 9 (6, 10) | 10 (10, 10) | <0.001 3 | <0.001 3 |
First newborn HR (bpm) | 77 (55, 139) | 66 (52, 94) | 94 (59, 154) | 0.098 4 |
Characteristics | Total n = 76 | Deaths n = 30 | Survivors n = 46 | p 1 | p 2 |
---|---|---|---|---|---|
General | |||||
Duration of resuscitation | 388 (223, 602) | 609 (336, 1218) | 288 (182, 438) | 0.003 3 | 0.013 3 |
Time from birth to cord clamping (sec) | 33 (15, 57) n = 74 | 19 (14, 50) n = 29 | 35 (12, 58) n = 45 | 0.10 3 | 0.69 3 |
Time from birth to placement of ECG sensor (sec) | 107 (71, 142) n = 72 | 115 (71, 131) n = 28 | 103 (71, 166) n = 44 | 0.50 3 | 0.42 3 |
Time from birth to start ventilation (sec) | 108 (76, 158) n = 74 | 125 (81, 146) n = 29 | 104 (73, 176) n = 45 | 0.32 3 | 0.63 3 |
Duration from first to final ventilation (sec) | 174 (104, 344) n = 72 | 557 (208, 700) n = 28 | 122 (77, 192) n = 44 | <0.001 3 | <0.001 3 |
HR at start of first ventilation (bpm) | 82 (61, 133) n = 58 | 61 (54, 79) n = 22 | 121 (69, 160) n = 36 | 0.002 3 | 0.81 3 |
HR at cessation of ventilation (bpm) | 150 (129, 167) n = 70 | 142 (123, 155) n = 25 | 156 (140, 171) n = 45 | 0.096 3 | 0.31 3 |
HR increase from first to final ventilation (bpm) | 27 (2, 82) n = 52 | 63 (9, 92) n = 17 | 25 (1, 74) n = 35 | 0.085 3 | 0.40 3 |
Ventilation Parameters | |||||
Inflated volume (ml) 4 | 39 (25, 49) | 36 (25, 46) | 41 (25, 51) | 0.48 3 | 0.47 3 |
Mask leakage (%) 4 | 50 ± 21 | 47 ± 22 | 52 ± 20 | 0.39 | 0.50 |
Expired volume (ml) 4 | 14 (8, 25) | 16 (7, 25) | 13 (8, 26) | 0.35 3 | 0.37 3 |
Expired volume (ml/kg) 4 | 6.2 (3.7, 10.1) | 9.7 (3.8, 11.9) | 4.8 (3.3, 8.2) | 0.001 3 | 0.001 3 |
Ventilation frequency (per minute) 4 | 52 (41, 68) | 51 (41, 67) | 54 (40, 68) | 0.64 3 | 0.84 3 |
Peak inflation pressure (mBar) 4 | 34 ± 8 | 33 ± 7 | 34 ± 8 | 0.43 | 0.56 |
Expired CO2 (%) 4 | 3.2 (1.8, 4.2) | 3.1 (1.3, 3.8) | 3.5 (2.1, 4.4) | 0.57 3 | 0.57 3 |
Suctioning during Resuscitation | |||||
Resuscitation period analyzed for suctioning (sec) | 391 (245, 420) | 420 (360, 471) | 312 (213, 416) | ||
Babies with at least one SE | 69 (91%) | 27 (90%) | 42 (91%) | 0.85 | 0.86 |
Number of SEs per baby | 2 (1, 4) | 2 (1, 4) | 2 (1, 4) | ||
Total duration of suctioning (sec) | 32 (15, 64) | 32 (18, 67) | 32 (13, 61) | ||
Proportion of time spent suctioning (%) | 10 (5, 19) | 10 (4, 17) | 11 (6, 20) | ||
Infants receiving at least one catheter suction (vs. only bulb suction or no suction) | 17 (22%) | 8 (27%) | 9 (20%) | 0.47 | 0.67 |
Number of suction insertions per baby | 9 (5, 16) | 9 (6, 15) | 11 (5, 18) | ||
Number of mouth suction insertions | 6 (3, 9) | 5 (3, 8) | 6 (3, 11) | ||
Number of nose suction insertions | 4 (2, 7) | 4 (2, 7) | 4 (2, 7) | ||
Number of suction insertions/SE 5 | 3.6 (3.0, 5.4) n = 68 | 3.4 (2.4, 6.0) n = 26 | 3.9 (3.0, 5.1) n = 42 | ||
Number of mouth suction/SE | 2.0 (1.5, 3.0) | 1.8 (1.3, 3.1) | 1.3 (1.0, 2.0) | ||
Number of nose suctions/SE | 1.5 (0.8, 2.1) | 1.6 (0.6, 2.6) | 1.3 (1.0, 2.0) |
Predictors | Suction-Related Change in HR (n = 17) | No Suction-Related Change in HR (n = 118) | OR 1 (95% CI) | p 2 | pNL 4 |
---|---|---|---|---|---|
Categorical | |||||
Female | 6 (35%) | 26 (22%) | 1.93 (0.51–7.33) | 0.33 | |
Amniotic fluid | (n = 115) | 0.10 | |||
Clear | 6 (35%) | 61 (53%) | 1 (ref) | ||
Slight | 2 (12%) | 14 (12%) | 1.45 (0.26–8.15) | 0.67 | |
Thick/Blood | 9 (53%) | 40 (35%) | 2.29 (0.69–7.53) | 0.17 | |
Catheter (vs. bulb) | 3 (18%) | 32 (27%) | 0.58 (0.16–2.02) | 0.39 | |
Ventilation prior to SE | 8 (47%) | 60 (51%) | 0.86 (0.28–2.66) | 0.79 | |
Stimulation prior to SE | 13 (76%) | 75 (64%) | 1.86 (0.56–6.16) | 0.31 | |
Continuous | |||||
Gestational Age (weeks) | 39 (38, 39) n = 15 | 38 (36, 39) n = 114 | 1.37 (0.98–1.93) | 0.066 | 0.095 |
Birthweight (g) | 2780 (2530, 3320) | 3100 (2730, 3350) | 0.080 3 | 0.043 | |
First observed HR (bpm) | 74 (58, 123) | 72 (52, 131) | 0.96 (0.85–1.07) | 0.45 | 0.089 |
Time post delivery to initiation of SE (sec) | 113 (64, 160) | 103 (54, 183) | 0.12 3 | 0.047 | |
HR prior to SE (bpm) | 144 (129, 155) | 137 (89, 170) | 0.003 3 | 0.001 | |
Duration of SE (sec) | 18 (10, 23) | 14 (7, 23) | 1.02 (0.99–1.04) | 0.14 | 0.98 |
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Purington, C.; Eilevstjønn, J.; Dalen, I.; Yeconia, A.; Blacy, L.; Mduma, E.; Haug, I.; Holte, K.; Chang, C.; Perlman, J.; et al. Use of Suctioning during Newborn Resuscitation and Its Effects on Heart Rate in a Low-Resource Setting, Tanzania. Children 2023, 10, 1540. https://doi.org/10.3390/children10091540
Purington C, Eilevstjønn J, Dalen I, Yeconia A, Blacy L, Mduma E, Haug I, Holte K, Chang C, Perlman J, et al. Use of Suctioning during Newborn Resuscitation and Its Effects on Heart Rate in a Low-Resource Setting, Tanzania. Children. 2023; 10(9):1540. https://doi.org/10.3390/children10091540
Chicago/Turabian StylePurington, Carolyn, Joar Eilevstjønn, Ingvild Dalen, Anita Yeconia, Ladislaus Blacy, Estomih Mduma, Ingunn Haug, Kari Holte, Catherine Chang, Jeffrey Perlman, and et al. 2023. "Use of Suctioning during Newborn Resuscitation and Its Effects on Heart Rate in a Low-Resource Setting, Tanzania" Children 10, no. 9: 1540. https://doi.org/10.3390/children10091540