Knowledge and skills of neonatal resuscitation of health professionals at a university teaching hospital of Northwest Ethiopia

BACKGROUND:Competency in neonatal resuscitation is critical in the delivery rooms,neonatology units and pediatrics intensive care units to ensure the safety and health of neonates. Each year,millions of babies do not breathe immediately at birth,and among them the majority require basic neonatal resuscitation. Perinatal asphyxia is a major contributor to neonatal deaths worldwide in resource-limited settings. Neonatal resuscitation is effective only when health professionals have sufficient knowledge and skills. But malpractices by health professionals are frequent in the resuscitation of neonates. The present study was to assess the knowledge and skills of health professionals about neonatal resuscitation.METHODS:An institution based cross-sectional study was conducted in our hospital from February15 to April 30,2014. All nurses,midwives and residents from obstetrics-gynecology(obsgyn),midwifery and pediatric departments were included. The mean scores of knowledge and skills were compared for sex,age,type of profession,qualification,year of service and previous place of work of the participants by using Student's t test and ANOVA with Scheffe's test. A P value <0.05 was considered statistically significant.RESULTS:One hundred and thirty-five of 150 participants were included in this study with a response rate of 90.0%. The overall mean scores of knowledge and skills of midwives,nurses and residents were 19.9(SD=3.1) and 6.8(SD=3.9) respectively. The mean knowledge scores of midwives,nurses,pediatric residents and obs-gyn residents were 19.7(SD=3.03),20.2(SD=2.94),19.7(SD=4.4) and 19.6(SD=3.3) respectively. Whereas the mean scores of skills of midwives,nurses,pediatric residents and obs-gyn residents were 7.1(SD=4.17),6.7(SD=3.75),5.7(SD=4.17) and 6.6(SD=3.97) respectively.CONCLUSIONS:The knowledge and skills of midwives,nurses and residents about neonatal resuscitation were substandardized. Training of neonatal resuscitation for midwives,nurses and residents should be emphasized.

Short-Term Outcomes of Neonatal Resuscitation

Introduction: Neonatal resuscitation is a means to restore life to a baby from the state of asphyxia. It can end in either survival or death. Survivors may develop short-term complications in the immediate postnatal period. Objective: Determine the short-term outcomes following neonatal resuscitation. Materials and Methods: A retrospective cross-sectional study was conducted for seven months running from November 2021 to June 2022 in two hospitals in Yaounde. Admission files of newborns who benefited from neonatal resuscitation at birth from the year 2019 to 2022 were included. We recorded the clinical characteristics of newborns (gestational age, gender, and birth weight), the frequency of transfers, the duration of admission, the rate and types of complications in an operating sheet The results were analysed using IBM SPSS 23.0 software and the data expressed as frequencies, percentages, and means. The threshold of significance was set at 5%. Results: A total of 245 files of newborns who benefited from neonatal resuscitation were included. The mean gestational age at delivery was 36.7 ± 3.6 weeks with a minimum and maximum of 25 weeks and 46 weeks respectively. 61.6% of newborns were born at term and were of the male sex (55.5%, sex ratio of 1.25). The average birth weight was 2748.4 ± 794.3 g (range: 800 - 5600 g) with 62.4% of newborns weighing between 2500 and 4000 g. 97.1% of the newborns were transferred to the neonatology unit with a median length of hospitalization of 5 days. The frequency of short-term complications during the study was 26.9% and hypoxic-ischemic encephalopathy was the most common (97%). Newborns resuscitated for more than 5 minutes were more likely to develop a short-term complication. Conclusion: Hypoxic-ischaemic encephalopathy was the most frequent complication post-resuscitation and a prolonged duration of resuscitation favoured the development of short-term complications.

Evaluation of participants' feedback after a simulation-based training in neonatal resuscitation using a realistic delivery room

BACKGROUND: Low-frequency and high-risk situations, such as neonatal resuscitation, are the ideal targets for simulation-based learning. The aim of this paper is to present the structure of our internal neonatal resuscitation training program, using a realistic, simulated delivery room, and to present the participants' opinions about teamwork, emotional stress, and their subjective ability to face a resuscitation. METHODS: We administered a training course to 24 doctors and midwives. One of the simulation classrooms was modified to appear similar to a real delivery room. Four scenarios were conducted using a previously designed checklist of primary and secondary goals. Upon completion, all students participated in a debriefing session with the help of a video review. RESULTS: Students rated the achievement of their previously defined goals on a scale of 1 to 5. Grouping together the percentages of the highest ratings (Categories 4 and 5), 83.4% (20/24) of the students considered the course useful for acquiring clinical skills. For 87.5% (21/24) of the students, the scenarios simulated real clinical situations, the room properly simulated a real delivery room, and the course improved the students' ability to work in a team. For 66.6% (16/24) of the students, the course improved their stress in confronting neonatal resuscitation. Initially, only 33.3% (8/24) of the students considered themselves very capable or fully able to cope with a resuscitation. After the course, that percentage rose to 62.5% (15/24). CONCLUSIONS: The incorporation of simulation-based learning into neonatal resuscitation teaching programs, using realistic scenarios, is useful and offers the possibility of acquiring technical skills, but it also allows for the improvement of teamwork and the adoption of different roles and positive attitudes towards emotional stress.

Epidemic to Different Strains of SERRATIA: Experience of Neonatal Intensive Care Unit: About 30 Cases

Serratia is an opportunistic pathogenic bacterium of the Enterobacteriaceae family, occasionally responsible for epidemics of nosocomial infections in critical departments;in particular in neonatal intensive care units Enterobacteriaceae form a large family of Gram-negative bacteria, which cause diseases of highly variable severity, due to distinct pathogenic mechanisms. This family is heterogeneous as it consists of about 30 genera of bacteria and more than 100 species. However, all these germs have in common their preferential location in the digestive system, some being part of the normal flora although they are also present in the environment. Several metabolic processes characterize this bacterial family. These include the ability to reduce nitrate to nitrite (for energy generation), ferment glucose, lack cytochrome oxidase, be aerobic or anaerobic, motile or immobile, … Enterobacteriaceae constitute more than 80% of the germs isolated in the laboratory: Escherichia, Salmonella, Shigella, Klebsiella, Enterobacter, Serratia, Proteus, Morganella and Yersinia are the rods most often found. Regarding nosocomial infection to Serratia, this bacterium colonizes the respiratory, digestive and urinary systems of patients, mainly responsible for bacteremia, infections of the lower respiratory tract, urinary and skin infections. Through our work, we report the epidemic experienced in the neonatal intensive care unit MOHAMMED VI university hospital, mother-child hospital MARRAKECH MOROCCO for three months from December at February 2023 interesting 30 newborns whose clinical presentation was different, the positive diagnosis was based on blood and geographical samples taken by the bacteriology department to isolate the offending germs, the therapeutic management of our patients consisted essentially of various hygiene measures in association with dual antibiotic therapy based on meropenem and amikacin. The evolution was marked by the death of 21 patients (70%) and the recovery of 9 patients (30%). The prognosis of infection by serratia remains bleak with high morbidity interest in prevention by respecting the rules of hygiene, which begins with hand disinfection.

Pantoea SPP: A New Nosocomial Infection in the Neonatal Intensive Care Unit

Pantoea SPP is a gram-negative bacillus, which usually colonizes plants, soil and water. This pathogen very rarely causes neonatal sepsis. The most common infections caused by Pantoea SPP are septic arthritis or synovitis, meningitis frequently complicated by brain abscess, upper respiratory infections, and peritonitis. We present the case of a premature infant who presented neonatal respiratory distress and whose evolution was complicated by the occurrence of a nosocomial infection for which a blood culture was performed isolating the germ Pantoea SPP. The patient’s management was initially centered on non-invasive ventilation with antibiotherapy based on carbapenem and aminoglycoside. Due to the clinical and biological worsening, the neonate was intubated and sedated and put on colymicin. The evolution was unfavorable marked by a death at 16th days of life. Considering the high pathogenicity of this germ and its multi-resistance to antibiotics, it is crucial to know the clinical spectrum of Panteoa SPP infections in neonatal intensive care units, in order to palliate the fulminant evolution of multifocal attacks due to this germ.

Nosocomial Klebsiella variicola Infection in Neonatal Intensive Care: A New Emerging Pathogen

Klebsiella variicola is a human pathogen that has been misidentified as K. pneumoniae. This misidentification has led to a lack of understanding of important clinical and biological aspects of this bacterial species. It is responsible for serious and potentially fatal infections, with a prevalence of multi-resistance to routine antibiotics. We present through three clinical observations, the case of three newborns having been hospitalized in the neonatal intensive care unit and whose evolution was complicated by the occurrence of a nosocomial infection in front of which a blood culture was done on blood agar, with a manual antibiogram on antibiotic disks, isolated the germ Klebsiella variicola. The management of the newborns was initially centered on non-invasive ventilation with a bi-antibiotic therapy based on carbapenem and amikacin for two newborns and switched to colymicin for the third case. Newborn follow-up was based on assessment of general condition, clinical signs of infection, as well as a biological control made of a blood count, a c-reactive protein, a complete ionogram, and a blood culture, every four days or if signs of clinical call. The evolution was favorable for two cases with good clinical and biological improvement, and complicated by death due to alveolar hemorrhage in the third case. Given the high pathogenicity of this germ, and the frequency of misidentification, it is crucial to know the clinical spectrum of Klebsiella variicola infections in neonatal intensive care units, in order to adapt the antibiotic therapy and to mitigate the fulminant evolution of this germ.

Delivery room resuscitation intensity and associated neonatal outcomes of 24^(+0)-31^(+6) weeks'preterm infants in China:a retrospective cross-sectional study

Background The aim of this study was to review current delivery room(DR)resuscitation intensity in Chinese tertiary neonatal intensive care units and to investigate the association between DR resuscitation intensity and short-term outcomes in preterm infants born at 24+0_31+6 weeks gestation age(GA).Methods This was a retrospective cross-sectional study.The source population was infants born at 24+0_31+6 weeks'GA who were enrolled in the Chinese Neonatal Network 2019 cohort.Eligible infants were categorized into five groups:(1)regular care;(2)oxygen supplementation and/or continuous positive airway pressure(O2/CPAP);(3)mask ventilation;(4)endotracheal intubation;and(5)cardiopulmonary resuscitation(CPR).The association between DR resuscitation and shortterm outcomes was evaluated by inverse propensity score-weighted logistic regression.Results Of 7939 infants included in this cohort,2419(30.5%)received regular care,1994(25.1%)received O,/CPAP,1436(18.1%)received mask ventilation,1769(22.3%)received endotracheal intubation,and 321(4.0%)received CPR in the DR.Advanced maternal age and maternal hypertension correlated with a higher need for resuscitation,and antenatal steroid use tended to be associated with a lower need for resuscitation(P<0.001).Severe brain impairment increased significantly with increasing amounts of resuscitation in DR after adjusting for perinatal factors.Resuscitation strategies vary widely between centers,with over 50%of preterm infants in eight centers requiring higher intensity resuscitation.Conclusions Increased intensity of DR interventions was associated with increased mortality and morbidities in very preterm infants in China.There is wide variation in resuscitative approaches across delivery centers,and ongoing quality improvement to standardize resuscitation practices is needed.