102: Neonatal Resuscitation Following Elective Caesarean Section: An Observational Study
Notice bibliographique
Résumé
Infants delivered by elective caesarean section have similar need for resuscitation as infants delivered by spontaneous vaginal deliveries. Approximately 10% of deliveries are estimated to require neonatal resuscitation with 1% requiring extensive measures. A health care provider certified by the Neonatal Resuscitation Program but without advanced airway skills is therefore considered sufficient at low risk deliveries. Despite this, a retrospective chart review at our institution had suggested that over 40% of all caesarian section deliveries received suctioning or bag/mask ventilation. We undertook this study to confirm the extent to which suctioning and bag mask ventilation were undertaken following elective caesarean section deliveries and to explore whether these resuscitation efforts were indicated. This was an observational study of 50 elective caesarean deliveries in a small urban centre (approximately 4000 deliveries each year) between May 2014 and September 2014. Mothers were recruited for the study from the antenatal clinic and provided informed consent. All elective indications were included. Emergency caesarean sections were excluded. Presence of meconium, age at first cry (seconds), APGAR score, and timing of resuscitation interventions if used (suctioning, bag/mask ventilation) were recorded. Frequency distributions were used to describe data that was categorical in nature. Continuous data is presented as means and standard deviations or as medians and interquartile ranges (IQR indicates the 25th and 75th percentile) where the data was not normally distributed. Fifty-four infants were delivered through 50 elective caesarean sections. Caesarean section occurred due to maternal request (2%), maternal illness indicators (7%), fetal indicators (11%), and previous caesarean sections (80%). One infant was born through meconium liquor and one infant had a heart rate less than 120 bpm prior to delivery. 22/54 (41%) infants received suctioning during the first 10 minutes following delivery (mean = 99.1 seconds, range = 34–604 seconds). Eight of 54 (14%) infants received bag/mask ventilation using air and five (9%) infants received oxygen via bag/mask. All but one infant had a robust cry prior to suctioning or bag/mask. Median 1-minute APGAR's were 9 (IQR 8–9) and median 5 minute Apgar's were 9 (IQR 9–9). In observed deliveries, suctioning and bag/mask ventilation occurred after a robust cry by the infant in all but one case. This finding suggests that suctioning and bag/mask ventilation is occurring more frequently than indicated by Neonatal Resuscitation Program guidelines at our centre. Reasons for this observation need to be explored.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».