102: Neonatal Resuscitation Following Elective Caesarean Section: An Observational Study
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".