Foglia Research Group

We designed and implemented an individualized airway bundle and demonstrated a sustained reduction in severe adverse events during neonatal intubation.

Pediatrics

An Individualized Airway Bundle to Improve Intubation Safety

Difficult intubations are common in the NICU and are associated with adverse event and severe oxygen desaturation. Difficult intubations occur more commonly in small preterm infants. The occurrence of a difficult intubation in other neonates is hard to predict due to the lack of sensitivity of bedside screening tests

Arch Dis Child Fetal Neonatal Ed

Difficult intubation prediction for neonatal intubation

Adverse TIAEs and severe oxygen desaturation events are common in the NICU setting. Modifiable risk factors associated with TIAEs identified include intubator training level and use of paralytic medications.

Neonatology

Adverse Events During Tracheal Intubation

In this multi-center study of 92 fellows from 8 hospitals participating in the NEAR4NEOS registry, we assessed the impact of ongoing training on intubation competence and defined procedural learning curves for neonatal intubation.

Pediatrics

Neonatal Intubation Competence for Neonatal Fellows

We implemented a novel multisite neonatal intubation registry and identified potentially modifiable factors associated with adverse events.

Pediatrics

Neonatal Intubation Practice and Outcomes

In this analysis of 3,145 neonatal intubation encounters, there were important differences in the characteristics and outcomes between intubations that occurred in the delivery room versus neonatal intensive care unit setting.

Neonatology

Neonatal intubation: delivery room vs NICU

In this single site retrospective cohort study, video laryngoscopy was independently associated with decreased risk for adverse events during neonatal intubation.

Journal of Pediatrics

Video Laryngoscope and Adverse Intubation Events

This Clinical Decisions piece explores universal vs selective neonatal resuscitation at 22 weeks' gestation

New England Journal of Medicine

Neonatal Resuscitation in 22-Week Pregnancies

In this multicenter cohort of infants receiving chest compressions following delivery, recognizable pre-birth risk factors as well as resuscitation interventions associated with increased and decreased odds of achieving return of spontaneous circulation (ROSC) were identified.

Resuscitation

Neonatal delivery room CPR: An analysis of the Get with the Guidelines®-Resuscitation Registry

This inaugural report of over 1,000 delivery room cardiopulmonary resuscitation events in the multi-site American Heart Association Get with the Guidelines-Resuscitation Registry contributes to defining gestational-age specific survival outcomes.

Resuscitation

Survival after delivery room resuscitation: A national registry study.

In this article, we review the current evidence for interventions applied during neonatal transition (delivery room and first postnatal hours of life) to prevent BPD in extremely preterm infants: continuous positive airway pressure (CPAP), sustained lung inflation, supplemental oxygen use during neonatal resuscitation, and surfactant therapy including less-invasive surfactant administration

Journal of Perinatology

Delivery room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants

We analyzed respiratory function monitor (RFM) and vital sign measurements for infants who received sustained inflation and intermittent positive pressure ventilation (IPPV) in the Sustained Aeration of Infant Lungs (SAIL) trial.

Journal of Pediatrics

Sustained Inflation Versus Intermittent Positive Pressure Ventilation for Preterm Infants at Birth: Respiratory Function and Vital Sign Measurements

This is an updated ILCOR systematic review of 16 studies including 579 infants with ongoing CPR at 10 minutes after birth. These infants are at high risk for mortality and neurodisability, but survival without moderate or severe neuroimpairment is possible. One specified duration of CPR is unlikely to uniformly predict survival or survival without neuroimpairment.

Pediatrics

Duration of Resuscitation at Birth, Mortality, and Neurodevelopment: A Systematic Review

In this pilot trial, we demonstrated that intubation and ventilation prior to umbilical cord clamping is safe and feasible among infants with congenital diaphragmatic hernia and may result in short-term physiologic benefit

Arch Dis Child Fetal Neonatal Ed

Initiating resuscitation before umbilical cord clamping in infants with congenital diaphragmatic hernia: a pilot feasibility trial

Effective ventilation is the cornerstone of neonatal resuscitation. In this article, we review the physiology of cardiopulmonary transition at birth, with particular attention to factors the caregiver should consider when providing ventilation.

Seminars in Fetal and Neonatal Medicine

Effective ventilation: The most critical intervention for successful delivery room resuscitation.

We studied of 3,521 infants who received CPR in the NICU or PICU in the AHA GWTG-Resuscitation registry. Factors most strongly independently associated with death after CPR were vasoactive agent before CPR, initial pulseless condition or development of pulselessness, and NICU location compared with PICU.

Resuscitation

Epidemiology and outcomes of infants after cardiopulmonary resuscitation in the neonatal or pediatric intensive care unit from a national registry

In this meta-analysis, sustained inflation was associated with similar risks of in-hospital mortality compared with standard therapy. Sustained inflation was associated with increased risk of mortality in the first 2 days compared with standard therapy, and there were no differences in the risk of any other secondary outcomes.

JAMA Pediatrics

Sustained inflation versus standard resuscitation of preterm infants: A systematic review and meta-analysis.

In this randomized clinical trial involving 426 infants that was stopped early due to suggestion of harm in the sustained inflation group, there was no significant difference in the rate of bronchopulmonary dysplasia or death at 36 weeks’ postmenstrual age for infants treated with sustained inflation vs standard resuscitation (63.7% vs 59.2%).

JAMA

Effect of Sustained Inflations vs Intermittent Positive Pressure Ventilation on Bronchopulmonary Dysplasia or Death Among Extremely Preterm Infants

We defined SpO2 trajectories after birth and delivery room respiratory interventions for 200 infants with three distinct phenotypes of cyanotic congenital heart disease. These results inform delivery room management of these high-risk populations.

Journal of Perinatology

Delivery room oxygen physiology and respiratory interventions for newborns with cyanotic congenital heart disease

We used eye tracking glasses to assess where team leaders focus their visual attention during neonatal resuscitation. We found systematic differences in eye tracking patterns between neonatologists and neonatal fellows

Resuscitation

Visual attention patterns of team leaders during delivery room resuscitation

We assessed the accuracy of real-time delivery room resuscitation documentation. Real-time documentation correctly reflects interventions performed during delivery room resuscitation but is less accurate for early vital sign
assessments.

Arch Dis Child Fetal Neonatal Ed

Accuracy of real-time delivery room resuscitation documentation

We adapted a novel tool to measure the impact of Flow Disruptions on practice measures and clinical outcomes during delivery room resuscitation.

Resuscitation

Impact of flow disruptions in the delivery room

Wearable eye-tracking technology is feasible to identify gaze fixation on the respiratory function monitor (RFM) display and is well accepted by providers. Neonatal providers look at exhaled tidal volume more than any other RFM parameter.

Arch Dis Child Fetal Neonatal Ed

Visual attention on a respiratory function monitor during simulated neonatal resuscitation: an eye-tracking study

Smartphone-integrated consumer baby monitors that measure vital signs are popular among parents but are not regulated by the FDA. This study measured the accuracy of pulse oximetry-based consumer baby monitors using an FDA-cleared oximeter as a reference.

JAMA

Accuracy of Pulse Oximetry-Based Home Baby Monitors

We studied the impact of "MROPSA" corrective steps on heart rate and tidal volumes during delivery room PPV for preterm infants. Ventilation corrective steps improved tidal volume delivery in some cases but worsened exhaled tidal volumes in others. Mask leak and airway obstruction were induced by some ventilation corrective maneuvers

Archives Disease Childhood Fetal Neonatal Edition

Corrective steps to enhance ventilation in the delivery room

PEA may be observed during resuscitation of critically ill newborns, as described in this report. Incor- poration of discrepant physical examination findings and nonpulsatile pulse oximetry waveforms with electronic heart rate monitoring may improve providers’ ability to rapidly recognize PEA.

Neonatology

Pulseless Electrical Activity Complicating Neonatal Resuscitation.

We compared pulse oximetry measurement bias between infants with hypoxemia with either dark skin or light skin with Masimo Radical 7 and Nellcor Oximax. There was no significant difference in systematic bias based on skin pigment for either oximeter

Journal of Pediatrics

The Effect of Skin Pigmentation on the Accuracy of Pulse Oximetry in Infants with Hypoxemia

In this national study of US obstetrical hospitals from 2010-2018, we found marked variation in birth volume, geographic distribution, proximity, and urban adjacency of obstetrical hospitals.

JAMA Network Open

Birth Volume and Geographic Distribution of US Hospitals With Obstetric Services From 2010 to 2018

This qualitative study of providers’ perceptions of deferred consent for DR studies suggests that a deferred consent approach is acceptable but implementation of this approach can be improved

Arch Dis Child Fetal Neonatal Ed

Deferred consent for delivery room studies: the providers’ perspective

We sought to understand the views of international neonatal resuscitation scientists regarding optimal methods of obtaining informed consent for delivery room research

Arch Dis Child Fetal Neonatal Ed

Obtaining informed consent for delivery room research: the investigators’ perspective