Pregnancy, Childbirth and the Puerperium, Resuscitation
Conditions
Keywords
Suctioning, Wiping, Neonate, Resuscitation
Brief summary
Until recently, bulb or catheter oronasopharyngeal suctioning (ONPS) of all the infants, including vigorous infants in the delivery room, has been featured as a standard of newborn care. The 5th edition of the Newborn Resuscitation Program (NRP) has minimized the recommendation for routine suctioning of infants following delivery, provided they are not depressed or in need of immediate resuscitation. However, this new alternative recommendation was based on a small randomized trial and other lower level evidence rather than evidence from larger trials. The NRP Textbook cautions against vigorous suctioning because of the resultant apnea or bradycardia. Furthermore, suctioning may delay other more important steps of resuscitation. Thus, it is necessary to compare the alternative recommended practice, i.e. simple wiping of the mouth, to determine if it has equivalent efficacy and a favorable side effect profile compared to suctioning.
Interventions
PROCEDUREBulb Suctioning
Bulb suctioning of the mouth then the nose immediately following delivery
PROCEDUREWiping
Gentle wiping of mouth then nose with a soft cloth immediately following delivery
Sponsors
University of Alabama at Birmingham
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
1 Minutes to 1 Minutes
Healthy volunteers
No
Inclusion criteria
* Inborn neonates at the UAB hospital with gestational age greater than or equal to 35 weeks.
Exclusion criteria
* Major birth anomalies or where a decision to institute comfort care only has been made antenatally * Significant resuscitation efforts are anticipated prior to delivery * Nonvigorous infants with meconium stained amniotic fluid
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean respiratory rate over the first 24 hours of life | 24 hours after birth | Respiratory rates measured every 8 hours during the first 24 hours after birth |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of newborns with tachypnea | 24 hours | Number of newborns with tachypnea as defined by respiratory rate greater than 60 breaths per minute |
| Need for delivery room resuscitation | 1 hour after birth | Need for delivery room resuscitation including suctioning, intubation, positive pressure ventilation, chest compressions, and/or medication |
| Apgar Scores at one minute of age | 1 minute of age | Independent assignment of Apgar Scores at one minute of age |
| Oxygen saturations prior to discharge from hospital | 5 days of age | Measurements of oxygen saturations in the well baby nursery prior to discharge home |
| Apgar score at 5 minutes of age | 5 minutes of age | Independent assignment of Apgar score at 5 minutes of age |
| Admission to the Neonatal Intensive Care Unit | 1 hour after birth | Needing admission to the Neonatal Intensive Care Unit |
Countries
United States
Outcome results
None listed