During a delivery when and where should a person with intubation

1. Hamilton BE, Martin JA, Osterman MJ. Births: preliminary data for 2015. Natl Vital Stat Rep. 2016;65(3):1–15. [PubMed] [Google Scholar]

2. Perlman JM, Risser R. Cardiopulmonary resuscitation in the delivery room: associated clinical events. Arch Pediatr Adolesc Med. 1995;149(1):20–25. [PubMed] [Google Scholar]

3. Barber CA, Wyckoff MH. Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room. Pediatrics. 2006;118(3):1028–1034. [PubMed] [Google Scholar]

4. Halamek LP. Educational perspectives: the genesis, adaptation, and evolution of the neonatal resuscitation program. NeoReviews. 2008;9(4):e142–e149. [Google Scholar]

5. Perlman JM, Wyllie J, Kattwinkel J, et al.Neonatal Resuscitation Chapter Collaborators Part 7: Neonatal Resuscitation: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(16 Suppl 1):S204–S241. [PubMed] [Google Scholar]

6. Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:S543–S560. [PubMed] [Google Scholar]

7. Weiner GM, Zaichkin J, Kattwinkel J, editors. Textbook of Neonatal Resuscitation. 7th ed. Elk Grove Village, IL: American Academy of Pediatrics and American Heart Association; 2016. [Google Scholar]

8. Sawyer T, White M, Zaveri P, et al. Learn, see, practice, prove, do, maintain: an evidence-based pedagogical framework for procedural skill training in medicine. Acad Med. 2015;90(8):1025–1033. [PubMed] [Google Scholar]

9. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79(10 Suppl):S70–S81. [PubMed] [Google Scholar]

10. Sawyer T, Ades A, Ernst K, Colby C. Simulation and the neonatal resuscitation program 7th edition curriculum. NeoReviews. 2016;17(8):e447–e453. [Google Scholar]

11. Schön DA. The Reflective Practitioner: How Professionals Think In Action. New York: Basic Books; 1983. [Google Scholar]

12. Kolb DA. Experiential Learning: Experience as The Source Of Learning and Development. Englewood Cliffs, NJ: Prentice Hall; 1984. [Google Scholar]

13. Sawyer T, Eppich W, Brett-Fleegler M, Grant V, Cheng A. More than one way to debrief: a critical review of healthcare simulation debriefing methods. Simul Healthc. 2016;11(3):209–217. [PubMed] [Google Scholar]

14. Phrampus P, O’Donnell J. Debriefing using a structured and supported approach. In: Levine A, Demaria S, Schwarz A, editors. The Comprehensive Textbook of Healthcare Simulation. 1st ed. New York, NY: Springer; 2013. pp. 73–84. [Google Scholar]

15. Sawyer T, Loren D, Halamek LP. Post-event debriefings during neonatal care: why are we not doing them, and how can we start? J Perinatol. 2016;36(6):415–419. [PubMed] [Google Scholar]

16. Brimacombe J, Gandini D. Airway rescue and drug delivery in an 800 g neonate with the laryngeal mask airway. Paediatr Anaesth. 1999;9(2):178. [PubMed] [Google Scholar]

17. Velankar P, Joshi M, Sahu P. Use of laryngeal mask airway in premature infant. Indian J Anaesth. 2013;57(6):634–635. [PMC free article] [PubMed] [Google Scholar]

18. Trevisanuto D, Cavallin F, Nguyen LN, et al. Supreme laryngeal mask airway versus face mask during neonatal resuscitation: a randomized controlled trial. J Pediatr. 2015;167(2):286–291. [PubMed] [Google Scholar]

19. Kapadia V, Wyckoff MH. Chest compressions for bradycardia or asystole in neonates. Clin Perinatol. 2012;39(4):833–842. [PubMed] [Google Scholar]

20. Papile LA, Polin RA, Carlo WA, et al.Committee on Fetus and Newborn. American Academy of Pediatrics Respiratory support in preterm infants at birth. Pediatrics. 2014;133(1):171–174. [PubMed] [Google Scholar]

21. Kattwinkel J, Perlman JM, Aziz K, et al. Part 15: Neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 Suppl 3):S909–S919. [PubMed] [Google Scholar]

Page 2

Advances in the Neonatal Resuscitation Program (NRP) educational curriculum from the 6th to the 7th edition

Objective: To evaluate the significance and predictive value of each of the Neonatal Resuscitation Program (NRP)-listed ante- and intrapartum risk factors for the need of neonatal intubation at birth.

Study design: In this population-based study, perinatal data of all infants born at ≥ 35 weeks gestation in the province of Nova Scotia between 1994 and 2014, were identified and reviewed from the Nova Scotia Atlee Database. The frequency of occurrence of risk factors, incidence of neonatal intubation at birth, and its relationship with the different NRP-listed risk factors, were examined. Variables that were significant (P < .05) in univariate analyses were entered into the regression model.

Results: During the 20-year study period, 176,365 infants ≥ 35 weeks gestation were born. In presence of any of the listed risk factors, 0.3% of infants received intubation at birth compared with 0.08% in absence of any risk factor (P < .001). On logistic regression analysis, only 16 of the NRP-listed risk factors had a significant relationship with intubation at birth (P < .001). Delivery in a tertiary care center did not have an impact.

Conclusions: The presence of an intubation-skilled person at birth may not be indicated in all the NRP-listed ante- and intrapartum risk factors. Stratification of the relative significance of different risk factors may be of importance for the less-resourced health care units providing maternal and newborn care.