Neonatology

Evaluation of a new out-of-hospital newborn life support (OH-NLS) course in the UK South West region: a mixed-methods survey study (2024)

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Type of publication:

Journal article

Author(s):

Bradfield, Michael; Goodwin, Laura; Bates, Sarah; Tinnion, Robert; Hedge, Sally; Kerslake, Dawn; Madar, John; Murcott, Lucy; *Tyler, Wendy; Yates, James; Powell, Anna; Hall, Louise.

Citation:

British Paramedic Journal. 9(3):44-52, 2024 Dec 01.

Abstract:

Introduction: Unplanned out-of-hospital births (UOHBs) are associated with poorer outcomes for babies, especially those born prematurely. The current Newborn Life Support (NLS) course offered by Resuscitation Council UK (RCUK) is not designed to address the challenges associated with birth out of hospital. A new course was developed to address these challenges. This study aimed to evaluate the impact of this course on attendees' knowledge and confidence in supporting transition, resuscitation, stabilisation and onward transfer of newborns in an out-of-hospital setting.

Methods: A convergent mixed-methods approach was used consisting of pre-, post- and follow-up surveys and a post-course multiple-choice questionnaire (MCQ). The surveys asked participants to rate their confidence, on a five-point Likert scale (from 'Underconfident/fearful' to 'Very confident') across seven domains of NLS, as well as making an individual assessment of provider confidence before and after the course. Free-text comments were collected and analysed using thematic analysis.

Results: Attendees comprised multidisciplinary staff from the South West of England. The pre-course survey was completed by 32 of the 33 participants, the post-course survey by 31 and the MCQ by all 33. A total of 18 participants completed the follow-up survey. Analysis showed a significant, positive change in confidence across NLS domains between the pre- and post-course surveys (p <0.0001). The follow-up survey data showed self-reported increases in knowledge and largely sustained confidence. The qualitative analysis revealed themes relating to the participants' feelings about managing babies born out of hospital.

Conclusion: The proof-of-concept OH-NLS course appears to address the learning needs of the target professional group, and the results suggest improved knowledge and confidence in the immediate management of babies born out of hospital. Further evaluation is required to determine whether such training has a long-term impact and translates into improved outcomes across a larger group of participants.

Healthcare professionals' views to inform revision of the BAPM newborn early warning trigger and track system (2023)

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Type of publication:Journal article

Author(s):Ojha S.; MacAllister K.; Abdula S.; Madar J.; Rackham O.; *Tyler W.

Citation:Archives of Disease in Childhood: Fetal and Neonatal Edition. 108(1) (pp F92-F93), 2023. Date of Publication: January 2023.

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Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study (2022)

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Type of publication:Journal article

Author(s):Mullins E; Perry A; Banerjee J; Townson J; Grozeva D; Milton R; Kirby N; Playle R; Bourne T; Lees C; PAN-COVID Investigators (including *Millward, H.)

Citation:European Journal of Obstetrics, Gynecology, and Reproductive Biology, 2022 Sep; Vol. 276, pp. 161-167.

Abstract:Objective: To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection.Methods: Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant.Results: Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3-1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2.Conclusions: Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians' threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection. The proportion affected by pre-eclampsia amongst participants was not higher than would be expected, although we report a higher than expected proportion affected by eclampsia. There appears to be no effect on birthweight or congenital malformations in women affected by SARS-CoV-2 infection in pregnancy and neonatal infection is uncommon. This study reflects a population with a range of infection severity for SARS-COV-2 in pregnancy, generalisable to whole obstetric populations.

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Neonate with persisting respiratory distress after resolution of pneumothorax (2021)

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Type of publication:
Journal article

Author(s):
*Ray S.

Citation:
Archives of disease in childhood. Education and practice edition; Jun 2021; vol. 106 (no. 3); p. 152-154

Abstract:
A preterm baby boy was born in good condition at 31+5 weeks gestation with a birth weight of 1956 g, following a precipitous labour with no prolonged rupture of membranes and no opportunity for  dministration of antenatal steroids to mother. Following admission to the neonatal unit, he developed respiratory distress and was commenced on nasal continuous positive airway pressure (CPAP) of 6 cm of water. At 24 hours of age, he developed a left-sided tension pneumothorax (figure 1), requiring endotracheal intubation and insertion of a chest drain. He received two doses of surfactant and was extubated onto CPAP on day 3. There was reaccumulation of the pneumothorax on day 4, which was subsequently drained. He remained self-ventilating in air in the second week of life. From day 15 to day 30, he required humidified high flow nasal cannula oxygen (fractional inspired oxygen up to 0.4), in view of marked subcostal and intercostal recession, intolerance to handling and a compensated respiratory acidosis on capillary blood gases.Figure 2is the chest radiograph undertaken in the third week of life. Figure 1 Chest radiograph (supine anteroposterior) on day 1. Figure 2 Chest radiograph (supine  anteroposterior) in week 3. Questions: What is the most likely diagnosis in this case?
Congenital pulmonary airway malformation (CPAM) Respiratory distress syndrome Pulmonary interstitial
emphysema (PIE) Pneumatocoele Congenital diaphragmatic hernia Which of the following is not an effective option for treatment of this condition? Corticosteroid therapy Lateral decubitus with affected side down High frequency oscillatory ventilation (HFOV) Selective main bronchial intubation of contralateral lung (which is not affected) Chest physiotherapy Which of the following statements is false about this condition? Complications can include other air leak syndromes Most neonates presenting with this condition have been mechanically ventilated Diagnosis is usually made on a chest radiograph Surfactant therapy has been associated with an increase in this condition Air embolism can be a fatal complication Answers can be found on page 2.

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Midwifery Identification, Stabilisation and Transfer of the Sick Newborn (MIST) (2019)

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Type of publication:
E-learning package

Author(s):
*Wendy Tyler, Alan Fenton, Scott Mountifield, Leanne Hargreaves, Claire Beattie

Citation:
e-Learning for Healthcare

Abstract:
This e-learning programme is aimed at midwifery and ambulance personnel to support the treatment plan for newborn babies who are, or have the potential to become, unwell following delivery in a community setting. The resources are designed to equip maternity and emergency teams with the knowledge required to extend care beyond the first minutes after birth, up to and including handover to the neonatal team.

The programme consists of four e-learning sessions and covers several clinical scenarios from normal variation to significant illness.

It is expected that by completing all four sessions within this programme, you will be able to:

  • Recognise normal and abnormal infant colour (anaemia and cyanosis)
  • Recognise normal and abnormal feeding patterns and abdominal signs
  • Support an infant born unexpectedly preterm
  • Support a baby born in an unexpectedly poor condition

Each session will cover identification, management including stabilisation and communication, and transfer to a neonatal unit.

This programme is the result of a collaboration between Health Education England’s e-Learning for Healthcare, The Shrewsbury and Telford Hospital NHS Trust and The Newcastle upon Tyne Hospitals NHS Foundation Trust. It was also made possible through the support of Shrewsbury and Telford Hospital NHS Trust, as part of a successful bid from HEE.

All the resources for this programme have been written by subject specialists and experts in this field.

Link to full-text [registration required to use package]