Infant, Newborn, Disease Clinical Trial
Official title:
Time of Initiation of Positive Pressure Ventilation in Non-vigorous Infants Born Through Meconium-stained Amniotic Fluid: a Cross-over Randomized, Control Trial
Background: Meconium stained amniotic fluid (MSAF) complicates 3 to 14% of pregnancies,
causing meconium aspiration syndrome (MAS) in 5-10% of neonates born. Due to lack of evidence
of benefits of endotracheal suctioning at birth in non-vigorous infants, recent neonatal
resuscitation guidelines do not recommend it as a routine and they suggest to start
ventilation within the first minute of life, which may be critical to reverse asphyxia and
stabilize the neonate. There are concerns regarding the safety and efficacy of this change in
practice because it is not based on large randomized controlled trials. Besides that, the
delay in the beginning of the PPV in these babies has not been previously explored.
Objective: to compare the time of PPV initiation between performing immediate laryngoscopy
with intubation and suctioning and performing immediate PPV without intubation in a manikin.
Methods: Level III NICU consultants, residents, and fellows trained in advanced airway
management will be randomly assigned to AB arm (endotracheal suction, followed by the
procedure without endotracheal suction) and to BA arm (reverse sequence), with a washout
period of 6 hour. During each simulation, an external observer will record the time of PPV
initiation. The primary outcome measure will be the time of PPV initiation in the
endotracheal suction arm compared to the control arm.
Background: Meconium stained amniotic fluid (MSAF) complicates 3 to 14% of pregnancies,
causing meconium aspiration syndrome (MAS) in 5-10% of neonates born. Due to lack of evidence
of benefits of endotracheal suctioning at birth in non-vigorous infants, recent neonatal
resuscitation guidelines do not recommend it as a routine and they suggest to start
ventilation within the first minute of life, which may be critical to reverse asphyxia and
stabilize the neonate. There are concerns regarding the safety and efficacy of this change in
practice because it is not based on large randomized controlled trials. Besides that, the
delay in the beginning of the PPV in these babies has not been previously explored.
Objective: to compare the time of PPV initiation between performing immediate laryngoscopy
with intubation and suctioning and performing immediate PPV without intubation in a manikin.
Methods: Level III NICU consultants, residents, and fellows trained in advanced airway
management will be randomly assigned to AB arm (endotracheal suction, followed by the
procedure without endotracheal suction) and to BA arm (reverse sequence), with a washout
period of 6 hour. During each simulation, an external observer will record the time of PPV
initiation. The primary outcome measure will be the time of PPV initiation in the
endotracheal suction arm compared to the control arm.
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