Neonatal Life Support

Octubre - 2020

 

 

Neonatal Life Support


 

I.- ANTICIPATION AND PREPARATION


The keys to successful neonatal resuscitation include assessment of perinatal risk and a system to rapidly assemble team members with skills that are appropriate
to the anticipated need for resuscitation on the basis of that risk. Other critical components of successful resuscitation include an organized resuscitation
area that ensures immediate access to all needed supplies and equipment and the standardization of behavioral skills that foster optimal teamwork and
communication.


1.- Prediction of Need of Respiratory Support in the Delivery Room (NLS 611: EvUp)


One important aspect of anticipating risk (determining if operative delivery conferred increased risk of need for intubation) was reviewed by the NLS Task Force most recently in 2010.12–14 In 2020, The NLS Task Force undertook an EvUp to identify additional evidence published after 2010 that warranted consideration of a
new SysRev.
An EvUp (see Supplement Appendix C-1) did not identify any evidence that would suggest the need for a new SysRev or a change in the 2010 treatment recommendation. 12–14  Most of the new studies confirmed previously identified risk factors for the need for PPV in the delivery room.
 

Population, Prognostic Factors, Outcome

  • Population: Newborn infants who are to be delivered

    • Prognostic factors: Maternal, perinatal, or delivery risk factors beyond age of gestation

    • Outcome: Prediction of need for PPV in the delivery room/operating suite

Treatment Recommendation


These treatment recommendations (below) are unchanged from 2010.12–14
When an infant without antenatally identified risk factors is delivered at term by cesarean delivery under regional anesthesia, a provider capable of performing
assisted ventilation should be present at the delivery. It is not necessary for a provider skilled in neonatal intubation to be present at that delivery.

 

2.- Effect of Briefing/Debriefing Following Neonatal Resuscitation (NLS 1562:ScopRev)


Rationale for Review


Although a prior review examined the utility of debriefing after simulation training, the NLS Task Force chose this topic for ScopRev because there is emerging evidence in many fields that briefing before and debriefing after clinical events may lead to improvement in practice and outcomes. There was no previous NLS Task Force treatment recommendation on this application of briefing and debriefing.
 

Population, Intervention, Comparator, Outcome, Study Design, and Time Frame

  • Population: Among healthcare professionals involved in the resuscitation or simulated resuscitation of a neonate

  • Intervention: Does briefing/debriefing

  • Comparator: In comparison with no briefing/debriefing

  • Outcome: Improve outcomes for infants, families, or clinicians

  • Study design: RCTs and nonrandomized studies (non-RCTs, interrupted time series, controlled before-and-after studies, cohort studies) were eligible for inclusion. Manikin studies were eligible for inclusion; animal studies were excluded.  Conference abstracts were included; unpublished studies (eg, trial protocols) were excluded.

  • Time frame: All years and all languages were included if there was an English abstract.


Summary of Evidence


The ScopRev14a identified 1 RCT15 and 3 observational studies of preintervention and postintervention design.16–18 One study considered video debriefing,
16 1 considered the use of a checklist combined with video debriefing,18 and 1 considered the use of a checklist with a team prebrief/debrief as the key element
in a quality improvement bundle.17 The RCT determined whether there was benefit to rapid cycle deliberate practice compared with standard simulation
debriefing.15 This entire ScopRev14a can be found in Supplement Appendix B-1.


Task Force Insights


Because this is a new PICOST question for the NLS Task Force, the task force elected to perform a ScopRev to assess the extent and type of available studies. Although briefing and debriefing in resuscitation has been previously reviewed by the NLS Task Force12–14 and the Education, Implementation, and Teams Task Force,19,20 clinical outcomes specific to neonates or neonatal resuscitation were not included in those recommendations.

 

The evidence identified in this ScopRev is primarily from quality-improvement studies with preintervention and postintervention comparisons. There were no RCTs comparing briefing or debriefing with no briefing or no debriefing. In addition, many investigators studied briefing or debriefing in the context of bundles of interventions; these studies were not included in this evidence review because it was not possible to isolate the effects of briefing or debriefing alone on outcomes.


A small number of studies were identified that included adjuncts to briefing and debriefing (eg, the review of video recordings to assist debriefing, the use of checklists); these studies compared the use of adjuncts with no briefing or no debriefing. There is limited evidence that use of video-assisted debriefing may improve the process of care and adherence to resuscitation guidelines, but none of the included studies evaluated the effect on clinical outcomes.
The use of checklists during briefings and debriefings may help improve team communication and process, but the evidence did not report changes in clinical
outcomes, and the reported effects on the delivery of care were inconsistent.


We identified limited evidence that rapid-cycle deliberate practice may improve short term performance in a resuscitation simulation but not provider confidence
in or retention of skills. These findings were similar to a recent SysRev completed by the ILCOR Education, Implementation, and Teams Task Force (see “Education, Implementation, and Teams: Spaced Versus Massed Learning,” in this supplement [EIT 601: SysRev]), which included neonatal studies and also identified limited evidence that rapid-cycle deliberate practice may improve short-term performance in a resuscitation simulation but not provider confidence in or retention of skills.


We conclude that briefing or debriefing may improve short-term clinical and performance outcomes for infants and staff. The effects of briefing or debriefing on long-term clinical and performance outcomes are uncertain. This scoping review did not identify sufficient evidence to prompt a SysRev.
 

Treatment Recommendation

  • There was no previous treatment recommendation on the topic.