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Safety and Ergonomic Challenges of Ventilating a Premature Infant During Delayed Cord Clamping

1
Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
2
Department of Pediatrics, Stanford University, Palo Alto, CA 94304, USA
3
Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA 94304, USA
4
California Perinatal Quality Care Collaborative, Palo Alto, CA 94305, USA
*
Author to whom correspondence should be addressed.
Children 2019, 6(4), 59; https://doi.org/10.3390/children6040059
Received: 1 March 2019 / Revised: 3 April 2019 / Accepted: 9 April 2019 / Published: 13 April 2019
(This article belongs to the Special Issue Emerging Concepts in Neonatal Resuscitation)
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Abstract

Delayed cord clamping (DCC) is endorsed by multiple professional organizations for both term and preterm infants. In preterm infants, DCC has been shown to reduce intraventricular hemorrhage, lower incidence of necrotizing enterocolitis, and reduce the need for transfusions. Furthermore, in preterm animal models, ventilation during DCC leads to improved hemodynamics. While providing ventilation and continuous positive airway pressure (CPAP) during DCC may benefit infants, the logistics of performing such a maneuver can be complicated. In this simulation-based study, we sought to explore attitudes of providers along with the safety and ergonomic challenges involved with safely resuscitating a newborn infant while attached to the placenta. Multidisciplinary workshops were held simulating vaginal and Caesarean deliveries, during which providers started positive pressure ventilation and transitioned to holding CPAP on a preterm manikin. Review of videos identified 5 themes of concerns: sterility, equipment, mobility, space and workflow, and communication. In this study, simulation was a key methodology for safe identification of various safety and ergonomic issues related to implementation of ventilation during DCC. Centers interested in implementing DCC with ventilation are encouraged to form multidisciplinary work groups and utilize simulations prior to performing care on infants. View Full-Text
Keywords: neonatology; resuscitation; delivery room; delayed cord clamping; premature infants; simulation neonatology; resuscitation; delivery room; delayed cord clamping; premature infants; simulation
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Lapcharoensap, W.; Cong, A.; Sherman, J.; Schwandt, D.; Crowe, S.; Daniels, K.; Lee, H.C. Safety and Ergonomic Challenges of Ventilating a Premature Infant During Delayed Cord Clamping. Children 2019, 6, 59.

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