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BackgroundAn umbilical venous catheter (UVC) is the preferred route of epinephrine administration during neonatal resuscitation but requires specialized equipment, expertise, and time.HypothesisDirect injection of epinephrine into the umbilical vein (UV) followed by milking a ~20 cm segment of cut umbilical cord to flush the epinephrine (DUV + UCM) will lead to a quicker administration and earlier return of spontaneous circulation (ROSC) compared with epinephrine given through a UVC.DesignEighteen near-term asphyxiated lambs were randomized to receive a low-UVC or DUV + UCM of epinephrine at 0.02 or 0.03 mg/kg doses.Outcome measuresA total of 16/18 lambs achieved ROSC with a similar mean (±SEM) time to ROSC [DUV + UCM vs. low-UVC (4.67 ± 0.67 vs. 3.99 ± 0.58 min); p = 0.46]. Two out of ten lambs in the DUV + UCM group required UVC placement for additional epinephrine. The administration of the first dose of epinephrine was similar (DUV + UCM-2.97 ± 0.48 vs. UVC-4.23 ± 0.58 min; p = 0.12). Both methods yielded similar epinephrine concentrations (peak concentrations of 253 ± 63 and 328 ± 80 ng/mL for DUV + UCM and UVC EPI, respectively).ConclusionsDUV + UCM resulted in a ROSC success of 78% following the first epinephrine dose and showed similar epinephrine concentrations to UVC. Clinical studies evaluating DUV + UCM as an alternate route for epinephrine while intravenous access is being established are warranted.

Aim Methods Results Conclusion To assess the feasibility, safety and efficacy of using a high‐flow nasal cannula (HFNC) for stabilising very preterm infants after birth.A prospective observational study included preterm infants born at 28 + 0 to 31 + 6 weeks' gestation between February 2021 and December 2022 at the General University Hospital in Prague. Following delayed cord clamping, HFNC was administered at a flow rate of 8 L/min through the infants' nostrils. Criteria for switching to continuous positive airway pressure (CPAP) or positive pressure ventilation (PPV) included persistent bradycardia in the first few minutes or low saturation of oxygen (SpO2) after 5 min, respectively.Of the 65 infants enrolled in the study, 56 (86%) were successfully stabilised exclusively using HFNC while 7 (11%) required PPV. Additionally, 52 (80%) infants achieved SpO2 > 80% at 5 min, and 54 (83%) infants were successfully treated with HFNC within the first 3 h of life.The primary use of HFNC seems to be an appropriate alternative to CPAP for the stabilisation of very premature infants after birth and subsequent transfer to the NICU. A randomised trial comparing HFNC and CPAP in the delivery room will enable to answer the questions raised in this study. [ABSTRACT FROM AUTHOR]

Objective Patients and Methods Results Conclusions This study sought to compare the risks and outcomes associated with category I cesarean section procedures performed in the delivery room versus those performed in the operating room.The analysis included 126 singleton pregnant women who underwent inpatient delivery at the Second People's Hospital of Nanning between January 2021 and May 2024. Following propensity score matching, 21 cases were in the delivery room group, and 105 cases were in the operating room group. Parameters under investigation encompassed decision‐to‐delivery interval, incision‐to‐delivery interval, surgical duration, intraoperative blood loss, postoperative antibiotic duration, postoperative hospital stay length, postoperative fever incidence, adverse neonatal outcomes, and blood routine parameters.The decision‐to‐delivery interval was significantly shorter in the delivery room group than in the operating room group. Conversely, the delivery room group exhibited longer surgical durations, higher blood loss, prolonged postoperative antibiotic usage, extended hospital stays, and elevated white blood cell counts with statistical significance (p < 0.05). Nevertheless, no notable variations were observed between the groups in maternal and neonatal outcome indicators, such as adverse neonatal outcomes and postoperative fever rates.The outcomes suggest that the delivery room group showed increased risks compared with the operating room group, potentially indicating heightened vulnerabilities to bleeding and infection. Hence, it is advisable for patients to undergo surgery in the operating room unless the delivery room is equipped with sterile surgical facilities or in cases of urgent necessity. [ABSTRACT FROM AUTHOR]

Background. Recent studies have reported that using a stylet does not provide any advantages during intubation within a diverse infant population. Our research focuses on the issue, specifically in premature infants who undergo elective or rescue intubation (EI or RI) in the delivery room (DR). Methods. We conducted a single-center retrospective observational study comparing the number of intubation attempts, the duration of intubation procedure until successful, and the rate of associated desaturations exceeding 20%. We derived outcomes from video recordings and performed statistical analyses. Results. We have analyzed 104 intubation attempts in 70 infants with a mean gestational age and birth weight of 25±1.9 weeks and 736±221 grams, respectively; 39 of these attempts involved stylet use, and 65 did not. 75% of infants requiring intubation were less than 26 weeks of gestational age. The use of a stylet increased the rate of successful initial attempts [OR (95% CI) 4.3 (1.3-14.8), P=0.019], reduced the duration of the intubation procedure [median (IQR) seconds: 43 (30-72) vs 140 (62-296), P

Aim: Respiratory distress due to transition delay in term and late preterm newborns is an important cause of neonatal intensive care unit (NICU) admissions. In our study, we aimed to assess the impact of the intermediate neonatal care unit structure on the occurrence of NICU admission and pneumothorax resulting from transient tachypnea of neonate (TTN) and transition delay. Materiasl and Methods: On April 1, 2021, an intermediate neonatal care unit with 4 beds was established in the delivery room of our hospital in order to reduce shortterm hospitalizations in the NICU. The unit is staffed by two senior pediatric residents and two neonatal nurses. In accordance with the ILCOR 2020 recommendations, newborns born ≥ 34 weeks who require nasal continuous positive airway pressure (nCPAP) due to respiratory distress, before (January 2020--March 2021=Period 1) and after (April 2021--December 2022=Period 2) the intermediate care unit were evaluated retrospectively in terms of perinatal, postnatal and NICU hospitalization characteristics. Results: Demographic characteristics of infants in Period 1 and Period 2 were similar (p>0.05). At least one symptom of respiratory distress was observed in 89% of neonates receiving nCPAP in the NICU throughout period 1. In period 2, there was an increase in the number of infants who received nCPAP because O2 saturation targets could not be reached after the 10th minute. Hospitalization rates declined significantly in the Period 2 (p<0.01). Invasive mechanical ventilation requirement was higher (p=0.01) and total ventilation time was longer (p=0.035) in patients hospitalized in the NICU in period 2. Duration of hospital stay and pneumothorax rates were similar in both periods (p=0.489 and p=0.720). Conclusion: It has been shown that an intermediate neonatal care unit structured in the delivery room provides a reduction in NICU hospitalizations of term and late preterm newborns without causing air leakage with the nCPAP treatment. The appropriate use of resources is expected to minimize the anxiety that will arise in the family and the separation of mother and infant during hospitalization. [ABSTRACT FROM AUTHOR]

Background: Newborn resuscitation algorithms have since the turn of the century been more evidence-based. In this review, we discuss the development of American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR)'s algorithm for newborn resuscitation from 1992–2024. We have also aimed to identify the remaining gaps in non-evidenced practice. Summary: Of the 22 procedures reviewed in the 2020 ILCOR recommendations, the evidence was either low, very low, or non-existing. The strength of recommendation is weak or non-existing for most topics discussed. Several knowledge gaps are also summarized. The special challenge for low- and middle-income countries (LMIC) is discussed. Key Messages: Newborn resuscitation is still not evidence-based, although great progress has been achieved the recent years. We have identified several knowledge gaps which should be prioritized in future research. The challenge of obtaining evidence-based knowledge from LMIC should be focused on in future research. [ABSTRACT FROM AUTHOR]

Background. Recent studies have reported that using a stylet does not provide any advantages during intubation within a diverse infant population. Our research focuses on the issue, specifically in premature infants who undergo elective or rescue intubation (EI or RI) in the delivery room (DR). Methods. We conducted a single-center retrospective observational study comparing the number of intubation attempts, the duration of intubation procedure until successful, and the rate of associated desaturations exceeding 20%. We derived outcomes from video recordings and performed statistical analyses. Results. We have analyzed 104 intubation attempts in 70 infants with a mean gestational age and birth weight of 25±1.9 weeks and 736±221 grams, respectively; 39 of these attempts involved stylet use, and 65 did not. 75% of infants requiring intubation were less than 26 weeks of gestational age. The use of a stylet increased the rate of successful initial attempts [OR (95% CI) 4.3 (1.3–14.8), P=0.019], reduced the duration of the intubation procedure [median (IQR) seconds: 43 (30–72) vs 140 (62–296), P<0.001], and decreased the occurrences of desaturation exceeding 20% (13% vs 50%, P=0.003). Conclusion. The benefits of using a stylet during rescue and elective intubations of premature infants in the delivery room outweigh the potential harms. Its use may be advantageous in settings where proactive approaches are implemented for periviable infants. [ABSTRACT FROM AUTHOR]

PURPOSE: This study aimed to evaluate the knowledge and practices of delivery room midwives on delayed cord clamping (DCC). METHOD: This descriptive study was conducted with a total of 1,274 delivery room midwives from five regions of Turkey between February 9, 2021 and September 26, 2022. The data were collected using a Google survey form. RESULTS: The highest cord clamping times of midwives ranged from 0 to 10 seconds in term and preterm newborns (34.7% and 54.8%, respectively). The rates of applying DCC were 17.6% and 5.3% in term and preterm newborns, respectively. Dealing with the mother, having a workload, considering that the newborn would have respiratory distress and get cold, preventing polycythemia and hyperbilirubinemia, and being afraid of dropping the newborn were the most common reasons for midwives not to apply DCC to newborns. The majority of the midwives reported that they had no DCC protocol in their institution (80.5%) and did not receive in-service training on DCC (76.5%). CONCLUSION: This study has concluded that most midwives who do not apply DCC correctly, have quite short cord clamping times, have no DCC protocol in their institutions, and do not receive in-service training. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this scoping review is to map the knowledge about the multisensory birthing room regarding the birth experience and birth outcomes. Background: The concept of multisensory birthing rooms is relatively novel, making it relevant to explore its impact. Methods: Five databases were searched. The search was limited to articles in English, Danish, Norwegian, and Swedish. There were no time limitations. Fourteen relevant articles were identified providing knowledge about multisensory birthing rooms. Results: Eight articles focused on birth experience, six articles focused on birth outcome, and one on the organization of the maternity care. Seven of the studies identified that sensory birthing rooms have a positive impact on the birth experience and one qualitative study could not demonstrate a better overall birth experience. Five articles described an improvement for selected birth outcomes. On the other hand, a randomized controlled trial study could not demonstrate an effect on either the use of oxytocin or birth outcomes such as pain and cesarean section. The definition and description of the concept weaken the existing studies scientifically. Conclusions: This scoping review revealed that multisensory birthing rooms have many definitions and variations in the content of the sensory exposure; therefore, it is difficult to standardize and evaluate the effect of its use. There is limited knowledge concerning the multisensory birthing room and its impact on the birth experience and the birth outcome. Multisensory birthing rooms may have a positive impact on the birth experience. Whereas there are conflicting results regarding birth outcomes. [ABSTRACT FROM AUTHOR]

Objectives: At our center, natural home‐like delivery settings have been established in or near conventional labor wards, for the care of pregnant women who prefer little or no medical intervention during labor and birth. We compared obstetrical and neonatal outcomes of women in active spontaneous labor, between those who chose to deliver in a natural‐delivery setup and those who chose a conventional setting. Methods: This retrospective study included low‐risk women who delivered at term between March 1, 2020 and December 31, 2022, in a single tertiary university affiliated medical center. Birth outcomes were compared between 124 women who delivered by natural birth (the study group) and 244 who gave birth in a conventional setting (the control group). Results: No cesarean deliveries were performed in the study group, compared to 18 (7.4%) of the control group, p = 0.004. Intrapartum fever, postpartum hemorrhage, and uterotonic administration were similar between the groups. For the study compared to the control group, breastfeeding was more common (71.3% vs. 12.3%, p < 0.001), analgesia administration within 48 h delivery was lower (4.1% vs. 10.7%, p = 0.033), and maternal and neonatal length of hospitalization were shorter. Of the women initially admitted to the natural‐delivery room, 14 (11.5%) were transferred to a conventional‐delivery room. Conclusions: Birth in a hospital natural‐delivery setting was associated with increased likelihood of vaginal birth, increased immediate breastfeeding and breastfeeding at discharge, and lower postpartum pain. [ABSTRACT FROM AUTHOR]

Background: Healthcare providers (HCPs) working in labour and delivery rooms need to undergo regular refresher courses to maintain their neonatal resuscitation skills, which are shown to decline over time. However, due to their irregular schedules and limited time, HCPs encounter difficulties in readily accessing refresher programs. RETAIN is a digital game that simulates a delivery room to facilitate neonatal resuscitation training for HCPs. Objective: This study aims to ascertain whether participants enjoyed the RETAIN digital game simulator and whether it was at least as good as a video lecture at refreshing and maintaining participants' neonatal resuscitation knowledge. Methods: In this randomized controlled simulation trial, n = 42 labour and delivery room HCPs were administered a pre-test of neonatal resuscitation knowledge using a manikin. Then, they were randomly assigned to a control or a treatment group. For 20–30 min, participants in the control group watched a neonatal resuscitation lecture video, while those in the treatment group played the RETAIN digital game simulator of neonatal resuscitation scenarios. Then, all participants were administered a post-test identical to the pre-test. Additionally, participants in the treatment group completed a survey of attitudes toward the RETAIN simulator that provided a measure of enjoyment of the RETAIN game simulator. After two months, participants were administered another post-test identical to the pre-test. Results: For the primary outcome (neonatal resuscitation performance), an analysis of variance revealed that participants significantly improved their neonatal resuscitation performance over the first two time points, with a significant decline to the third time point, the same pattern of results across conditions, and no differences between conditions. For the secondary outcome (attitudes toward RETAIN), participants in the treatment condition also reported favourable attitudes toward RETAIN. Conclusions: Labour and delivery room healthcare providers in both groups (RETAIN simulator or video lecture) significantly improved their neonatal resuscitation performance immediately following the intervention, with no group differences. The findings suggest that participants enjoyed interacting with the RETAIN digital game simulator, which provided a similar boost in performance right after use to the more traditional intervention. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore the risk factors of delivery room (DR) resuscitation and assess the association of DR resuscitation with neonatal outcomes in very preterm infants (VPIs).MethodsA multicenter retrospective cross-sectional study included VPIs with gestational age (GA)

Aim: According to delivery room guidelines, an optimal position is not specified for the stabilization of the baby. This study aimed to define the positions effects on postnatal adaptation parameters and cerebral oxygenation in non-resuscitated neonates. Materials and Methods: A total of 60 neonates delivered by cesarean section stabilized randomly in the supine, right-side, left-side, or prone positions were enrolled. Apgar scores, heart rates (HR), arterial oxygen saturations via pulse oximetry, and perfusion indexes (PI) at the 2nd, 5th and 10th minutes were recorded. Cerebral regional oxygen saturation (SpO2) of the patients was monitored by near-infrared spectroscopy. Results: In the prone position, the 1st minute Apgar score was significantly lower than other groups, but no difference was observed at the 5th minute Apgar scores (1st min Apgarprone, p=0.05). Although there was no statistically significant difference, the prone position had the lowest HR at the 2nd minute, while the supine posture had the greatest HR at the 5th and 10th minutes. While the groups’ SpO2 values were similar, the left-side group’s perfusion rates increased at the 5th and 10th minute marks (5th and 10th min PIleft-side, p=0.67, p=0.21, respectively). Regional cerebral oxygen saturation (rScO2) and cerebral fractional oxygen extraction did not differ significantly between groups at the 5th and 10th minute time intervals. Although right and left rScO2 were found to be higher in the first 5 minutes in the prone position, this elevation did not lead to a statistically significant difference, and right and left rScO2 values were found to be similar in all groups at the 10th minute. Conclusion: Adaptation parameters were not affected by position, except for lower 1st minute Apgar scores in the prone group and higher perfusion indices in the left lateral position. Cerebral perfusion was similar in all groups. The left-side position, which results in a higher PI, may be a good alternative. Studies with larger case series may provide further information.

Abstract Background Immediately after birth, the oxygen saturation is between 30 and 50%, which then increases to 85–95% within the first 10 min. Over the last 10 years, recommendations regarding the ideal level of the initial fraction of inspired oxygen (FiO2) for resuscitation in preterm infants have changed from 1.0, to room air to low levels of oxygen (

Aim: According to delivery room guidelines, an optimal position is not specified for the stabilization of the baby. This study aimed to define the positions effects on postnatal adaptation parameters and cerebral oxygenation in non-resuscitated neonates. Materials and Methods: A total of 60 neonates delivered by cesarean section stabilized randomly in the supine, right-side, left-side, or prone positions were enrolled. Apgar scores, heart rates (HR), arterial oxygen saturations via pulse oximetry, and perfusion indexes (PI) at the 2nd, 5th and 10th minutes were recorded. Cerebral regional oxygen saturation (SpO2) of the patients was monitored by near-infrared spectroscopy. Results: In the prone position, the 1st minute Apgar score was significantly lower than other groups, but no difference was observed at the 5th minute Apgar scores (1st min Apgarprone, p=0.05). Although there was no statistically significant difference, the prone position had the lowest HR at the 2nd minute, while the supine posture had the greatest HR at the 5th and 10th minutes. While the groups' SpO2 values were similar, the left-side group's perfusion rates increased at the 5th and 10th minute marks (5th and 10th min PIleft-side, p=0.67, p=0.21, respectively). Regional cerebral oxygen saturation (rScO2) and cerebral fractional oxygen extraction did not differ significantly between groups at the 5th and 10th minute time intervals. Although right and left rScO2 were found to be higher in the first 5 minutes in the prone position, this elevation did not lead to a statistically significant difference, and right and left rScO2 values were found to be similar in all groups at the 10th minute. Conclusion: Adaptation parameters were not affected by position, except for lower 1st minute Apgar scores in the prone group and higher perfusion indices in the left lateral position. Cerebral perfusion was similar in all groups. The left-side position, which results in a higher PI, may be a good alternative. Studies with larger case series may provide further information. [ABSTRACT FROM AUTHOR]

Aim: our study aimed to characterize the lung ultrasound (LUS) patterns noted immediately after delivery in term and near-term neonates, and to investigate whether the LUS scores or patterns observed at that point could anticipate the need for respiratory support in the sample of patients studied. Materials and methods: We performed two ultrasound examinations: one in the delivery room and the second at one hour of age. The anterior and lateral regions of both lungs were examined. We assessed the correlation between the LUS scores or patterns and the gestational age, umbilical arterial blood gases, the need for respiratory support (CPAP or mechanical ventilation), the presence of respiratory distress, and the need for the administration of oxygen. Results: LUS scores were significantly higher in the delivery room examination (8.05 ± 1.95) than at 1 h of age (6.4 ± 1.75) (p < 0.001). There were also statistically significant differences between the LUS patterns observed in different lung regions between the delivery room exam and the exam performed at 1 h of age (p values between 0.001 and 0.017). There were also differences noted regarding the LUS patterns between different lung regions at the exam in the delivery room (the right anterior region LUS patterns were significantly worse than the right lateral LUS patterns (p < 0.004), left anterior LUS patterns (p < 0.001), and left lateral LUS patterns (p < 0.001)). A statistically significant correlation was found between LUS scores and the gestational age of the patients (r = 0.568, p < 0.001—delivery room; r = 4.0443, p < 0.001—one hour of age). There were statistically significant associations between LUS scores, patterns at delivery (p < 0.001) and 1 h of age (p < 0.001), and the need for respiratory support (CPAP or mechanical ventilation). Conclusions: LUS in the delivery room offers important information regarding lung fluid elimination and aeration of the lungs, and early LUS features are significantly associated with the risk of respiratory distress and the need for respiratory support. [ABSTRACT FROM AUTHOR]

Background: A major proportion of preterm neonates require positive pressure ventilation (PPV) immediately after delivery. PPV may be administered through a face mask (FM) or nasal prongs. Current literature indicates that either of these are associated with similar outcomes. Summary: Nonetheless, FM remains the most utilized and the best choice. However, most available FM sizes are too large for extremely preterm infants, which leads to mask leak and ineffective PPV. Challenges to providing effective PPV include poor respiratory drive, complaint chest wall, weak thoracic muscle, delayed liquid clearance, and surfactant deficiency in preterm infants. Mask leak, airway obstruction, poor technique, and inappropriate size are correctable causes of ineffective PPV. Visual assessment of chest rise is often used to assess the efficacy of PPV. However, its accuracy is debatable. Though end tidal CO2 may adjudge the effectiveness of PPV, clinical studies are limited. The compliance of a preterm lung is highly dynamic. The inflating pressure set on T-piece is constant throughout the resuscitation, but the lung volume and dynamics changes with every breath. This leads to huge fluctuations of tidal volume delivery and can trigger inflammatory cascade in preterm infants leading to brain and lung injury. Respiratory function monitoring in the delivery room has potential for guiding and optimizing delivery room resuscitation. This is, however, limited by high costs, complex information that is difficult to interpret during resuscitation, and absence of clinical trials. Key Messages: This review summarizes the existing literature on PPV in preterm infants, the various aspects related to it such as the pathophysiology, interfaces, devices utilized to deliver it, appropriate technique, emerging technologies, and future directions. [ABSTRACT FROM AUTHOR]

Objective This study aimed to assess if 24-hour in-house neonatologist (NN) coverage is associated with delivery room (DR) resuscitation/stabilization and outcomes among inborn infants <29 weeks' gestational age (GA). Study design Survey-linked cohort study of 2,476 inborn infants of 23 to 28 weeks' gestation, admitted between 2014 and 2015 to Canadian Neonatal Network Level-3 neonatal intensive care units (NICUs) with a maternity unit. Exposures were classified using survey responses based on the most senior provider offering 24-hour in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, and retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders. Results Among the 28 participating NICUs, most senior providers ensuring 24-hour in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). No NN/fellow coverage and 24-hour fellow coverage were associated with higher odds of infants receiving DR chest compressions/epinephrine compared with 24-hour NN coverage (adjusted odds ratio [aOR] = 4.72, 95% confidence interval [CI]: 2.12–10.6 and aOR = 3.33, 95% CI: 1.44–7.70, respectively). Rates of mortality/major morbidity did not differ significantly among the three groups: NN, 63% (249/395 infants); fellow, 64% (1092/1700 infants); no NN/fellow, 70% (266/381 infants). Conclusion 24-hour in-house NN coverage was associated with lower rates of DR chest compressions/epinephrine. There was no difference in neonatal outcomes based on type of coverage; however, further studies are needed as ecological fallacy cannot be ruled out. Key Points Lower rates of DR cardiopulmonary resuscitation with 24h in-house NN coverage The type of 24h in-house coverage was not associated with mortality and/or major morbidity. High-volume centers more often have 24h in-house neonatal fellow coverage [ABSTRACT FROM AUTHOR]

Background: Immediately after birth, the oxygen saturation is between 30 and 50%, which then increases to 85–95% within the first 10 min. Over the last 10 years, recommendations regarding the ideal level of the initial fraction of inspired oxygen (FiO2) for resuscitation in preterm infants have changed from 1.0, to room air to low levels of oxygen (< 0.3), up to moderate concentrations (0.3–0.65). This leaves clinicians in a challenging position, and a large multi-center international trial of sufficient sample size that is powered to look at safety outcomes such as mortality and adverse neurodevelopmental outcomes is required to provide the necessary evidence to guide clinical practice with confidence. Methods: An international cluster, cross-over randomized trial of initial FiO2 of 0.3 or 0.6 during neonatal resuscitation in preterm infants at birth to increase survival free of major neurodevelopmental outcomes at 18 and 24 months corrected age will be conducted. Preterm infants born between 230/7 and 286/7 weeks' gestation will be eligible. Each participating hospital will be randomized to either an initial FiO2 concentration of either 0.3 or 0.6 to recruit for up to 12 months' and then crossed over to the other concentration for up to 12 months. The intervention will be initial FiO2 of 0.6, and the comparator will be initial FiO2 of 0.3 during respiratory support in the delivery room. The sample size will be 1200 preterm infants. This will yield 80% power, assuming a type 1 error of 5% to detect a 25% reduction in relative risk of the primary outcome from 35 to 26.5%. The primary outcome will be a composite of all-cause mortality or the presence of a major neurodevelopmental outcome between 18 and 24 months corrected age. Secondary outcomes will include the components of the primary outcome (death, cerebral palsy, major developmental delay involving cognition, speech, visual, or hearing impairment) in addition to neonatal morbidities (severe brain injury, bronchopulmonary dysplasia; and severe retinopathy of prematurity). Discussion: The use of supplementary oxygen may be crucial but also potentially detrimental to preterm infants at birth. The HiLo trial is powered for the primary outcome and will address gaps in the evidence due to its pragmatic and inclusive design, targeting all extremely preterm infants. Should 60% initial oxygen concertation increase survival free of major neurodevelopmental outcomes at 18–24 months corrected age, without severe adverse effects, this readily available intervention could be introduced immediately into clinical practice. Trial registration: The trial was registered on January 31, 2019, at ClinicalTrials.gov with the Identifier: NCT03825835. [ABSTRACT FROM AUTHOR]

Introduction: The time of umbilical cord clamping is an important strategy for better prognosis of preterm and full-term infants, and all health care providers should be informed about the components and importance of this approach. The present study was performed with aim to investigate the time and duration of umbilical cord clamping in the delivery or operating room of Khorasan Razavi Hospitals.Methods: This descriptive study was conducted on 1237 babies born in the delivery or operating room of Khorasan Razavi public Hospitals between 2020 and 2022 with available sampling. In each hospital, a researcher assistant midwife who was not involved in the delivery process recorded the time of umbilical cord clamping after birth, and in the next step, she recorded the possible cause of early umbilical cord clamping by asking the obstetrician. Data were analyzed by SPSS software (version 26) and descriptive statistics tests. P

This study is part of a European survey on delivery room practices endorsed by the Union of European Neonatal and Perinatal Societies (UENPS) and the Romanian Association of Neonatology (ANR). The aim of our study was to evaluate the current neonatal resuscitation practices in Romanian maternity hospitals and to compare the results between level III and level II centers.

BackgroundObjectiveMethodologyResultsConclusionFathers’ birth attendance is associated with support for mothers in infant care, positive child health outcomes, and parental well-being.This study was conducted in a randomised controlled experimental design to investigate the effect of fathers’ birth attendance on paternal-infant attachment and the perception of parental role.Pregnant women during the childbirth process and their husbands were included in the study and were randomised according to fathers’ birth attendance. The data were collected with the Information Form (IF), Paternal Antenatal Attachment Questionnaire (PAAQ), Self-Perception of Parental Role Scale (SPPRS), Postnatal Paternal-Infant Attachment Questionnaire (PPAQ), and Edinburgh Postnatal Depression Scale (EPDS). The IF data were obtained from women before birth, and the EPDS data were obtained from women 15 days after birth.Individual characteristics of mothers and fathers in the groups, and prenatal PAAQ and SPPRS scores of the fathers were similar (p > 0.05). In the postnatal period, a significant difference was found in favour of the intervention group in the PPAQ total (p < 0.01), Patience and Tolerance (p < 0.05) and Pleasure in Interaction (p < 0.01) sub-dimensions. The within-group variation of the SPPRS scores of fathers in the intervention and control groups was analysed. The postnatal Competence (p < 0.01) and Integration (p < 0.05) sub-dimension scores statistically significantly increased in both the intervention and control groups compared to the antenatal period.While husbands’ accompanying their wives in the delivery room positively affects paternal-infant attachment, its effect on the perception of parental role is an issue that needs to be further investigated. [ABSTRACT FROM AUTHOR]

(1) Background: Our survey aimed to gather information on respiratory care in Neonatal Intensive Care Units (NICUs) in the European and Mediterranean region. (2) Methods: Cross-sectional electronic survey. An 89-item questionnaire focusing on the current modes, devices, and strategies employed in neonatal units in the domain of respiratory care was sent to directors/heads of 528 NICUs. The adherence to the "European consensus guidelines on the management of respiratory distress syndrome" was assessed for comparison. (3) Results: The response rate was 75% (397/528 units). In most Delivery Rooms (DRs), full resuscitation is given from 22 to 23 weeks gestational age. A T-piece device with facial masks or short binasal prongs are commonly used for respiratory stabilization. Initial FiO2 is set as per guidelines. Most units use heated humidified gases to prevent heat loss. SpO2 and ECG monitoring are largely performed. Surfactant in the DR is preferentially given through Intubation-Surfactant-Extubation (INSURE) or Less-Invasive-Surfactant-Administration (LISA) techniques. DR caffeine is widespread. In the NICUs, most of the non-invasive modes used are nasal CPAP and nasal intermittent positive-pressure ventilation. Volume-targeted, synchronized intermittent positive-pressure ventilation is the preferred invasive mode to treat acute respiratory distress. Pulmonary recruitment maneuvers are common approaches. During NICU stay, surfactant administration is primarily guided by FiO2 and SpO2/FiO2 ratio, and it is mostly performed through LISA or INSURE. Steroids are used to facilitate extubation and prevent bronchopulmonary dysplasia. (4) Conclusions: Overall, clinical practices are in line with the 2022 European Guidelines, but there are some divergences. These data will allow stakeholders to make comparisons and to identify opportunities for improvement. [ABSTRACT FROM AUTHOR]

Objectives: Birth anxiety is defined as a negative evaluation of the prepartum, partum and postpartum period and an anxious approach to labor. In our study, it was aimed to reveal the prevalence of birth anxiety among nulliparous health workers working in the delivery room and to investigate some factors that may be effective in the development of birth anxiety and the relationship between these factors. Materials and Methods: The study, which was planned to be based on a cross-sectional descriptive questionnaire, involved 160 nulliparous female health personnel who were working in the delivery room of Başakşehir Çam and Sakura City Hospital Gynecology Clinic between 01.10.2022 and 01.11.2022. The study used the 19-question Sociodemographic Data Form and the 13-question Scale of Traumatic Childbirth Perception (STCP) prepared by the researcher as data collection tools. Results: 160 nulliparous female health personnel participated in our study. It was found that half of the patients had moderate birth anxiety. A statistically significant negative relationship was found between the total score of the STCP and the age (years). Those who witnessed a complicated birth had higher overall scores of the STCP compared to those who did not. Participants who preferred cesarean delivery had higher overall scores of STCP compared to those who preferred normal birth. Conclusion: The study findings suggest that nulliparous female health personnel experience birth anxiety, and several factors contribute to the development of birth anxiety. Therefore, it may be recommended that professional support is provided to female health personnel before and during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: The time of umbilical cord clamping is an important strategy for better prognosis of preterm and full-term infants, and all health care providers should be informed about the components and importance of this approach. The present study was performed with aim to investigate the time and duration of umbilical cord clamping in the delivery or operating room of Khorasan Razavi Hospitals. Methods: This descriptive study was conducted on 1237 babies born in the delivery or operating room of Khorasan Razavi public Hospitals between 2020 and 2022 with available sampling. In each hospital, a researcher assistant midwife who was not involved in the delivery process recorded the time of umbilical cord clamping after birth, and in the next step, she recorded the possible cause of early umbilical cord clamping by asking the obstetrician. Data were analyzed by SPSS software (version 26) and descriptive statistics tests. P<0.05 was considered statistically significant. Results: In this study, 165 neonates (13.4%) were premature and 1072 neonates (86.6%) were born full term. In addition, 915 neonates (73.96%) were born naturally and other 322 neonates (26.04%) by cesarean section. The mean duration of the umbilical cord clamping of the newborns was 35.25 ± 27.29 second, which was reported as 21.29 ± 14.95 second in cesarean section and 40.22 ± 28.92 second in natural delivery. In 719 neonates (58.1%), the umbilical cord is closed before 30 seconds and in 322 neonates (26%) before 15 seconds. Among the causes of early umbilical cord clamping, hasting by obstetrician (30%), caesarean section (3.7%), doctor's routine (2.1%) and mother's non-cooperation (1.5%) were the most common causes. Conclusion: Umbilical cord clamping is done quickly or very quickly in the delivery room of Khorasan Razavi public hospitals, and in caesarean section, this urgency is very noticeable, and the most common cause of hasting is obstetrician. Therefore, correcting the thinking of the obstetrician in order to improve the time of umbilical cord clamping seems necessary. Delaying umbilical cord clamping plays an important role in the transition from fetal to newborn blood circulation and improves the health of newborns. [ABSTRACT FROM AUTHOR]

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 short-term 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 O2/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. [ABSTRACT FROM AUTHOR]

Objective: To compare two polyethylene bags in preventing admission hypothermia in preterm infants born at 1000 g and >28 weeks gestation. The intervention group also had a higher median of temperature at admission – 36.8 °C (interquartile range 36.5–37.1) vs. 36.5 °C (interquartile range 36.1–36.9 °C), p = 0.001, and showed a higher hyperthermia rate (9.2% vs. 1.0%, p = 0.023). Birth weight was also associated to the outcome, and it represented a 30% chance reduction for every 100-g increase (OR, 0.997; 95% CI, 0.996–0.999). The in-hospital mortality rate was similar between groups. Conclusion: The intervention polyethylene bag was more effective in preventing admission hypothermia. Nonetheless, the risk of hyperthermia is a concern during its use.

Introduction: The "golden hour" concept is a new evolving strategy for better prognosis of preterm and term infants, and all health care providers should be informed about the components and importance of the golden hour approach. The present study was performed with aim to investigate the percentage and sequence of primary care measures for newborns in the delivery or operating rooms in Khorasan Razavi hospitals. Methods: This descriptive study was conducted in 2021-2022 on 1286 babies born in the maternity ward and operating room in Khorasan Razavi public hospitals. The percentage and sequence of taking care of newborns were investigated immediately after birth. Data were analyzed by SPSS software (version 26) and Statistical indices. P< 0.05 was considered statistically significant. Results: Drying and warming in 98%, making skin to skin contact of the baby with the mother's breast in 65%, positioning in 61%, emptying mouth secretions and stimulating the baby in 41%, putting on a hat in 61%, controlling the number Breathing in 48%, heart rate in 38% and temperature check in 25% were done among babies. The summary of the order of care measures performed for newborns was: tying the umbilical cord, starting skin-to-skin contact, drying, warming, stimulating, emptying mouth secretions, putting on a hat, determination of first minute Apgar, weight control, height control, head circumference control, determination of fifth minute Apgar, first respiratory rate control, first pulse rate control, first breastfeeding, body temperature control, foot impressions, vitamin K injection, diapering, and transfer to obstetrics department. Conclusion: In maternity wards and operating room of Khorasan Razavi public hospitals, essential measures such as vital signs are evaluated in less than half of the babies, and the order of care is not appropriate. Therefore, the modification and training of the neonates' care worker needs a serious revision and it is necessary for the health care workers to review the care and order of their performance.

Background and Objectives: Pregnancy is a beautiful and challenging time in a woman's life. A pregnant woman needs more care and support from her husband and family during this time because of physical and hormonal changes in her body. Husbands' attendance and support of women during labor can positively affect pregnant women and child's health. The purpose of this study is to assess women's attitudes towards the presence of their husbands during labor in Erbil city. Method: A descriptive cross-sectional study was conducted on pregnant women who visited primary health care and Maternity Teaching Hospital in Erbil city. Epi Info 7 was used to determine the sample size which Three hundred participants were the sample of the calculation. Statistical Package for Social Science (SPSS) version 26 was used to analyze and organize the data thorough using frequency, percentage, and chi-square test. Result: The study revealed that 62% of the participants were in the age group 20-30 years old. Most of the women obtained an elementary school certificate, with a percentage 23.3%. Most of the participants were urban residents, which was 81.3%. Regarding the income of the participants, the result indicated that most of them were in conditions sufficient for daily living, which was about 57.3%. Women expressed a good level of attitude towards husbands' attendance in the delivery room 80.3%. Conclusion: This survey illustrated that most pregnant women agreed to the husband's attendance in the delivery room. Pregnant women needed their husbands during labor which is important in their life. [ABSTRACT FROM AUTHOR]

Copyright of Diversitas Journal is the property of Diversitas Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Healthcare providers (HCPs) working in labour and delivery rooms need to undergo regular refresher courses to maintain their neonatal resuscitation skills, which are shown to decline over time. However, due to their irregular schedules and limited time, HCPs encounter difficulties in readily accessing refresher programs. RETAIN is a digital game that simulates a delivery room to facilitate neonatal resuscitation training for HCPs. Objective: This study aims to ascertain whether participants enjoyed the RETAIN digital game simulator and whether it was at least as good as a video lecture at refreshing and maintaining participants’ neonatal resuscitation knowledge. Methods: In this randomized controlled simulation trial, n = 42 labour and delivery room HCPs were administered a pre-test of neonatal resuscitation knowledge using a manikin. Then, they were randomly assigned to a control or a treatment group. For 20–30 min, participants in the control group watched a neonatal resuscitation lecture video, while those in the treatment group played the RETAIN digital game simulator of neonatal resuscitation scenarios. Then, all participants were administered a post-test identical to the pre-test. Additionally, participants in the treatment group completed a survey of attitudes toward the RETAIN simulator that provided a measure of enjoyment of the RETAIN game simulator. After two months, participants were administered another post-test identical to the pre-test. Results: For the primary outcome (neonatal resuscitation performance), an analysis of variance revealed that participants significantly improved their neonatal resuscitation performance over the first two time points, with a significant decline to the third time point, the same pattern of results across conditions, and no differences between conditions. For the secondary outcome (attitudes toward RETAIN), participants in the treatment condition also reported favourable attitudes toward RETAIN. Conclusions: Labour and delivery room healthcare providers in both groups (RETAIN simulator or video lecture) significantly improved their neonatal resuscitation performance immediately following the intervention, with no group differences. The findings suggest that participants enjoyed interacting with the RETAIN digital game simulator, which provided a similar boost in performance right after use to the more traditional intervention.

Aim: our study aimed to characterize the lung ultrasound (LUS) patterns noted immediately after delivery in term and near-term neonates, and to investigate whether the LUS scores or patterns observed at that point could anticipate the need for respiratory support in the sample of patients studied. Materials and methods: We performed two ultrasound examinations: one in the delivery room and the second at one hour of age. The anterior and lateral regions of both lungs were examined. We assessed the correlation between the LUS scores or patterns and the gestational age, umbilical arterial blood gases, the need for respiratory support (CPAP or mechanical ventilation), the presence of respiratory distress, and the need for the administration of oxygen. Results: LUS scores were significantly higher in the delivery room examination (8.05 ± 1.95) than at 1 h of age (6.4 ± 1.75) (p < 0.001). There were also statistically significant differences between the LUS patterns observed in different lung regions between the delivery room exam and the exam performed at 1 h of age (p values between 0.001 and 0.017). There were also differences noted regarding the LUS patterns between different lung regions at the exam in the delivery room (the right anterior region LUS patterns were significantly worse than the right lateral LUS patterns (p < 0.004), left anterior LUS patterns (p < 0.001), and left lateral LUS patterns (p < 0.001)). A statistically significant correlation was found between LUS scores and the gestational age of the patients (r = 0.568, p < 0.001—delivery room; r = 4.0443, p < 0.001—one hour of age). There were statistically significant associations between LUS scores, patterns at delivery (p < 0.001) and 1 h of age (p < 0.001), and the need for respiratory support (CPAP or mechanical ventilation). Conclusions: LUS in the delivery room offers important information regarding lung fluid elimination and aeration of the lungs, and early LUS features are significantly associated with the risk of respiratory distress and the need for respiratory support.

Background: An umbilical venous catheter (UVC) is the preferred route of epinephrine administration during neonatal resuscitation but requires specialized equipment, expertise, and time. Hypothesis: Direct injection of epinephrine into the umbilical vein (UV) followed by milking a ~20 cm segment of cut umbilical cord to flush the epinephrine (DUV + UCM) will lead to a quicker administration and earlier return of spontaneous circulation (ROSC) compared with epinephrine given through a UVC. Design: Eighteen near-term asphyxiated lambs were randomized to receive a low-UVC or DUV + UCM of epinephrine at 0.02 or 0.03 mg/kg doses. Outcome measures: A total of 16/18 lambs achieved ROSC with a similar mean (±SEM) time to ROSC [DUV + UCM vs. low-UVC (4.67 ± 0.67 vs. 3.99 ± 0.58 min); p = 0.46]. Two out of ten lambs in the DUV + UCM group required UVC placement for additional epinephrine. The administration of the first dose of epinephrine was similar (DUV + UCM—2.97 ± 0.48 vs. UVC—4.23 ± 0.58 min; p = 0.12). Both methods yielded similar epinephrine concentrations (peak concentrations of 253 ± 63 and 328 ± 80 ng/mL for DUV + UCM and UVC EPI, respectively). Conclusions: DUV + UCM resulted in a ROSC success of 78% following the first epinephrine dose and showed similar epinephrine concentrations to UVC. Clinical studies evaluating DUV + UCM as an alternate route for epinephrine while intravenous access is being established are warranted.

Background and Objectives: Pregnancy is a beautiful and challenging time in a woman's life. A pregnant woman needs more care and support from her husband and family during this time because of physical and hormonal changes in her body. Husbands' attendance and support of women during labor can positively affect pregnant women and child’s health. The purpose of this study is to assess women’s attitudes towards the presence of their husbands during labor in Erbil city. Method: A descriptive cross-sectional study was conducted on pregnant women who visited primary health care and Maternity Teaching Hospital in Erbil city. Epi Info 7 was used to determine the sample size which Three hundred participants were the sample of the calculation. Statistical Package for Social Science (SPSS) version 26 was used to analyze and organize the data thorough using frequency, percentage, and chi-square test. Result: The study revealed that 62% of the participants were in the age group 20-30 years old. Most of the women obtained an elementary school certificate, with a percentage 23.3%. Most of the participants were urban residents, which was 81.3%. Regarding the income of the participants, the result indicated that most of them were in conditions sufficient for daily living, which was about 57.3%. Women expressed a good level of attitude towards husbands' attendance in the delivery room 80.3%. Conclusion: This survey illustrated that most pregnant women agreed to the husband's attendance in the delivery room. Pregnant women needed their husbands during labor which is important in their life.

The aim of the present study, endorsed by the Union of European Neonatal and Perinatal Societies (UENPS) and the Italian Society of Neonatology (SIN), was to analyze the current delivery room (DR) stabilization practices in a large sample of European birth centers that care for preterm infants with gestational age (GA) < 33 weeks. Cross-sectional electronic survey was used in this study. A questionnaire focusing on the current DR practices for infants < 33 weeks' GA, divided in 6 neonatal resuscitation domains, was individually sent to the directors of European neonatal facilities, made available as a web-based link. A comparison was made between hospitals grouped into 5 geographical areas (Eastern Europe (EE), Italy (ITA), Mediterranean countries (MC), Turkey (TUR), and Western Europe (WE)) and between high- and low-volume units across Europe. Two hundred and sixty-two centers from 33 European countries responded to the survey. At the time of the survey, approximately 20,000 very low birth weight (VLBW, < 1500 g) infants were admitted to the participating hospitals, with a median (IQR) of 48 (27–89) infants per center per year. Significant differences between the 5 geographical areas concerned: the volume of neonatal care, ranging from 86 (53–206) admitted VLBW infants per center per year in TUR to 35 (IQR 25–53) in MC; the umbilical cord (UC) management, being the delayed cord clamping performed in < 50% of centers in EE, ITA, and MC, and the cord milking the preferred strategy in TUR; the spotty use of some body temperature control strategies, including thermal mattress mainly employed in WE, and heated humidified gases for ventilation seldom available in MC; and some of the ventilation practices, mainly in regard to the initial FiO2 for < 28 weeks' GA infants, pressures selected for ventilation, and the preferred interface to start ventilation. Specifically, 62.5% of TUR centers indicated the short binasal prongs as the preferred interface, as opposed to the face mask which is widely adopted as first choice in > 80% of the rest of the responding units; the DR surfactant administration, which ranges from 44.4% of the birth centers in MC to 87.5% in WE; and, finally, the ethical issues around the minimal GA limit to provide full resuscitation, ranging from 22 to 25 weeks across Europe. A comparison between high- and low-volume units showed significant differences in the domains of UC management and ventilation practices. Conclusion: Current DR practice and ethical choices show similarities and divergences across Europe. Some areas of assistance, like UC management and DR ventilation strategies, would benefit of standardization. Clinicians and stakeholders should consider this information when allocating resources and planning European perinatal programs. What is Known: • Delivery room (DR) support of preterm infants has a direct influence on both immediate survival and long-term morbidity. • Resuscitation practices for preterm infants often deviate from the internationally defined algorithms. What is New: • Current DR practice and ethical choices show similarities and divergences across Europe. Some areas of assistance, like UC management and DR ventilation strategies, would benefit of standardization. • Clinicians and stakeholders should consider this information when allocating resources and planning European perinatal programs. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ege University Nursing Faculty (JEUNF) is the property of Journal of Ege University Nursing Faculty (JEUNF) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To compare two polyethylene bags in preventing admission hypothermia in preterm infants born at <34 weeks gestation. Method: Quasi-randomized unblinded clinical trial conducted at a level III neonatal unit between June 2018 to September 2019. The authors assign infants between 240/7 and 336/7 weeks' gestation to receive NeoHelpTM bag (intervention group) or a usual plastic bag (control group). The primary outcome was admission hypothermia, considering an axillary temperature at admission to the neonatal unit of <36.0 ℃. Hyperthermia was considered if the admission temperature reached 37.5 ℃ or more. Results: The authors evaluated 171 preterm infants (76, intervention group; 95, control group). The rate of admission hypothermia was significantly lower in the intervention group (2.6% vs. 14.7%, p = 0.007), with an 86% reduction in the admission hypothermia rate (OR, 0.14; 95% CI, 0.03-0.64), particularly for infants weighing >1000 g and >28 weeks gestation. The intervention group also had a higher median of temperature at admission - 36.8 ℃ (interquartile range 36.5-37.1) vs. 36.5 ℃ (interquartile range 36.1-36.9 ℃), p = 0.001, and showed a higher hyperthermia rate (9.2% vs. 1.0%, p = 0.023). Birth weight was also associated to the outcome, and it represented a 30% chance reduction for every 100-g increase (OR, 0.997; 95% CI, 0.996-0.999). The in-hospital mortality rate was similar between groups. Conclusion: The intervention polyethylene bag was more effective in preventing admission hypothermia. Nonetheless, the risk of hyperthermia is a concern during its use. [ABSTRACT FROM AUTHOR]

Introduction: Infants with congenital diaphragmatic hernia (CDH) are commonly intubated immediately after birth. Consensus on whether to provide sedation prior to intubation in the delivery room is lacking, although avoidance of stress is especially important in this population with high risk of pulmonary hypertension. We aimed at obtaining an overview of local pharmacological interventions and at providing guidance on delivery room management. Methods: An electronic survey was sent to international clinicians in referral centres for prenatal and postnatally diagnosed infants with CDH. This survey addressed demographic information, use of sedation and/or muscle relaxant prior to intubation, and use of pain scales in the delivery room. Results: We received 93 relevant responses from 59 centres. Most centres were from Europe (n = 33, 56%), followed by North America (n = 16, 27%), Asia (n = 6, 10%), Australia (n = 2, 3%), and South America (n = 2, 3%). A total of 19% (11/59) of the centres routinely provided sedation prior to intubation in the delivery room, with midazolam and fentanyl being most often used. Methods of administration varied for all medications provided. Only 5 of 11 centres using sedation reported an adequate sedative effect prior to intubation. Muscle relaxants prior to intubation were used in 12% (7/59) of the centres, although not always in combination with sedation. Conclusion: This international survey shows a substantial variation in sedation practices in the delivery room and scarce use of both sedative agents and muscle relaxants prior to intubation of CDH infants. We provide guidance on developing protocols for pre-intubation medication in this population. [ABSTRACT FROM AUTHOR]

Objective: To describe the challenges facing the obstetric division following a cyberattack and discuss ways of preparing for and overcoming another one. Methods: A retrospective descriptive study conducted in a mid‐sized medical center. Division activities, including the number of deliveries, cesarean sections, emergency room visits, admissions, maternal–fetal medicine department occupancy, and ambulatory encounters, from 2 weeks before the attack to 8 weeks following it (a total of 11 weeks), were compared with the retrospective period in 2019 (pre‐COVID‐19). In addition, we present the challenges and adaptation measures taken at the division and hospital levels leading up to the resumption of full division activity. Results: On the day of the cyberattack, critical decisions were made. The media announced the event, calling on patients not to come to our hospital. Also, all elective activities other than cesarean deliveries were stopped. The number of deliveries, admissions, and both emergency room and ambulatory clinic visits decreased by 5%–10% overall for 11 weeks, reflecting the decrease in division activity. Nevertheless, in all stations, there were sufficient activities and adaptation measures to ensure patient safety, decision‐making, and workflow of patients were accounted for. Conclusions: The risk of ransomware cyberattacks is growing. Healthcare systems at all levels should recognize this threat and have protocols for dealing with them once they occur. Synopsis: We present the challenges and adaptation measures following a cyberattack on our obstetric division for data sharing and future learning. [ABSTRACT FROM AUTHOR]

Background and Objective: Most Fathers-to-be within Indian setting find it difficult to cooperate with their spouse's labour and encounter a great deal of stress during the journey of Childbirth. The study objective is to assess the impact of Childbirth preparation sessions (CPS) in a private maternity centre at Chennai towards shaping the willingness and attitudes of fathers-to be regarding their willingness and ability to accompany their wives during childbirth in the delivery room and to compare the attitudes with those fathers who did not attend the Childbirth preparation sessions. Materials and methods: A pilot study was conducted between October 2022 to January 2023 at a tertiary maternity hospital in a metropolitan city (Chennai) with a convenient sample of fathers-to-be who attended (Group 1, n=30) CPS and those who did not attend (Group 2, n =30). A questionnaire was given to fathers who had less than 2 year old child to analyze the difference in willingness and ability to go to the labour room among those who attended child birth preparation sessions and those who did not. Results: All men were well educated Indians and the mean age of men who attended childbirth preparation sessions were 33 years and most of them were fathers-to-be for the first time. The results showed that fathers-to-be who attended the childbirth preparation sessions were more likely to express willingness to attend labour room. Though majority of men (51 men out of 60) were willing to go to the labour room, only 47 men were able to go to the labour room out of which 28 had attended the CPS. There was a high significance in their ability to go to the labour room among those who attended the CPS (P-value - 0.010). Conclusions: The preliminary results of this pilot study indicated that a well-structured and delivered CPS could not only enhance the shared role of fathers-to-be in the critical childbirth journey but also provide them with adequate psychosocial support. [ABSTRACT FROM AUTHOR]

This article is retracted as requested by the authors. The previously published article is in volume 7, issue 2, 2022. The authors suspected that we do not exercise proper publication workflow and threaten us to report to all of our indexers if we do not fulfill the request. We are maintaining good relationship with everyone involves in our workflow, hence the retraction. To make everyone happy, the authors in this case. We are not a business entity. We are supporting the open access initiatives fully and try to maintain a proper publication process. The publication of the authors' articles are based on the authors' proposals. We never beg authors to submit their manuscripts. Those entirely based on authors request for publication.

Introduction: Parturient women’s privacy preservation and respectful maternity care (RMC) in delivery room is an important principle in the high quality of midwifery care to achieve maternal satisfaction and positive childbirth experience. Hence, it is essential to make natural vaginal delivery (NVD) a positive experience and increase the mothers’ satisfaction. This study aimed to investigate the privacy preservation of parturient women’s in the delivery room. Methods: Using conventional content analysis, this qualitative study was conducted from June 2018 to December 2020 at two hospitals and three health centers in Shahroud, Iran. Purposeful sampling was employed and it was continued till data saturation through in-depth interviews with 37 participants. Results: The results of interviews with 21 women with NVD experience and 16 maternity health service providers resulted in the extraction of four themes including physical, spiritual-mental, informational, and social privacy. Conclusion: Various mechanisms were found to promote the privacy and satisfaction of parturient women in the delivery room. They included the necessity continuous education, monitoring about mother’s privacy preservation and intervention to improve effective communication skills among staff in delivery rooms.

Abstract Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.