Neonatal Resuscitation Practices in Romania: A Survey of the Romanian Association of Neonatology (ANR) and the Union of European Neonatal and Perinatal Societies (UENPS)

	Total (n=33)	Level III maternity hospitals (n=15)	Level II maternity hospitals (n=18)	P
Umbilical cord management in term infants

Vaginally delivered
Physiologically based cord clamping (PBCC)	7 (21.2)	4/15 (26.7)	3/18 (16.7)	0.264
Delayed cord clamping (DCC)	23 (69.7)	8/15 (53.3)	10/18 (55.6)
Immediate cord clamping (ICC)	2 (6.1)	3/15 (20.0)	4/18 (22.2)
Milking	1 (3.0)	0/15 (0)	1/18 (5.6)

Elective cesarean-delivered
PBCC	6 (18.2)	4/15 (26.7)	2/18 (11.1)	0.598
DCC	13 (39.4)	4/15 (26.7)	4/18 (22.2)
ICC	12 (36.4)	6/15 (40.0)	11/18 (61.1)
Milking	2 (6.1)	1/15 (6.7)	1/18 (5.6)

Emergency cesarean-delivered
PBCC	1 (3.0)	0/15 (0)	1/18 (5.6)	0.216
DCC	2 (6.1)	0/15 (0)	2/18 (11.1)
ICC	26 (78.8)	13/15 (86.7)	13/18 (72.2)
Milking	4 (12.1)	2/15 (13.3)	2/18 (11.1)

Umbilical cord management in preterm infants

Late preterm

Vaginally delivered
PBCC	6 (18.2)	4/15 (26.7)	2/18 (11.1)	0.732
DCC	21 (63.6)	5/15 (33.3)	11/18 (55.6)
ICC	6 (18.2)	6/15 (40.0)	6/18 (33.3)
Milking	0 (0)	0/15 (0)	0/18 (0)

Cesarean-delivered
PBCC	4 (12.1)	3/15 (20.0)	1/18 (5.5)	0.970
DCC	11 (33.3)	3/15 (20.0)	5/18 (27.8)
ICC	15 (45.5)	6/15 (40.0)	12/18 (66.7)
Milking	3 (9.1)	3/15 (20.0)	0/18 (0)

29–32 weeks preterm

Vaginally delivered
PBCC	11 (33.3)	6/14 (42.8)	5/18 (27.8)	0.079
DCC	6 (18.2)	5/14 (35.7)	1/18 (5.5)
ICC	8 (24.2)	1/14 (7.1)	7/18 (38.9)
Milking	7 (21.2)	2/14 (14.2)	5/18 (27.8)

Cesarean-delivered
PBCC	7 (21.2)	5/15 (33.3)	2/18 (11.1)	0.051
DCC	8 (24.2)	5/15 (33.3)	3/18 (16.7)
ICC	12 (36.4)	3/15 (20.0)	9/18 (50.0)
Milking	6 (18.2)	2/15 (13.3)	4/18 (22.2)

<29 weeks preterm

Vaginally delivered
PBCC	8 (24.2)	5/15 (33.3)	3/18 (16.7)	0.164
DCC	7 (21.2)	4/15 (26.7)	3/18 (16.7)
ICC	12 (36.4)	4/15 (26.7)	8/18 (44.4)
Milking	6 (18.2)	2/15 (13.3)	4/18 (22.2)

Cesarean-delivered
PBCC	7 (21.2)	5/15 (33.3)	2/18 (11.1)	0.160
DCC	7 (21.2)	4/15 (26.7)	3/18 (16.7)
ICC	13 (39.4)	3/15 (20.0)	10/18 (55.6)
Milking	6 (18.2)	3/15 (20.0)	3/18 (16.7)

Education

	Total (n=33)	Level III maternity hospitals (n=15)	Level II maternity Hospitals (n=18)	P
Courses on neonatal resuscitation routinely
6–12 months	20 (60.1)	11/15 (73.3)	9/18 (50.0)	0.157
12–24 months	13 (39.4)	4/15 (26.7)	9/18 (50.0)
>24 months	0 (0)	0/15 (0)	0/18 (0)
Neonatal Resuscitation algorithm
American Academy of Pediatrics (AAP)	28 (84.8)	11/15 (73.3)	17/18 n (94.4)	0.185
European Resuscitation Council (ERC)	3 (9.1)	2/15 (13.3)	1/18 (5.5)
Romanian Resuscitation Guidelines	3 (9.1)	2/15 (13.3)	1/18 (5.5)

Characteristics of centers and organizational aspects before birth

	Total No (%)	Level III maternity hospital (n=15)	Level II maternity hospital (n=18)	p
Maternity hospital	33	15	18
Academic hospital	18	15	3
Number of births 2018	81139	45431	35708	0.006
Number of births 2018	81139	3028.73±1258.38	1983.78±769.99	0.006
Lowest GA of routinely assisted infants in Delivery Room (DR)	33 (100)	25.07±3.03 (23–32)	30.44±3.28 (23–33)	<0.001
	33 (100)	Median 24	Median 32	<0.001
Inborn infants with BW<1500 admitted to NICU in 2018/No of reporting centres	23 (69.7)	66.86±39.14	22.87±31.50	0.002
	23 (69.7)	14/15 (93.33)	15/18 (83.33)	0.002
Outborn infants with BW<1500 admitted to NICU in 2018/No of reporting centres	20 (60.1)	15.50±11.02	8.93±14.99	0.193
	20 (60.1)	14/15 (93.33)	15/18 (83.33)	0.193
Antenatal counseling before the delivery	13/33 (39.4)	9/15 (60.0)	4/18 (22.2)	0.027
Available facilities in maternity hospitals
Nasal CPAP/HFNC	33 (100)	15/15 (100)	18/18 (100)	NA
Mechanical ventilation (MV)	29 (87.9)	15/15 (100)	14/18 (77.8)	0.229
High frequency oscillatory ventilation (HFOV)	20 (60.6)	12/15 (80.0)	8/18 (44.4)	0.041
Inhaled nitric oxide (iNO)	7 (21.2)	7/15 (46.7)	0/18 (0)	0.002
Therapeutic hypothermia	10 (30.3)	8/15 (53.3)	2/18 (11.1)	0.012
CPAP in delivery room	33 (100)	15/15 (100)	18/18 (100)	NA
ECMO	0 (0)	0/15 (0)	0/18 (0)	NA
Resuscitation team present at every delivery	27 (81.8)	12/15 (80)	15/18 (83.3)	0.459
Routinely resuscitation team for a low-risk delivery
Pediatrician/neonatologist	29 (87.9)	13/15 (86.7)	16/18 (88.9)	0.626
Obstetrician	3 (9.1)	1/15 (6.7)	2/18 (11.1)	0.570
Anesthesiologist	1 (3.0)	0/15 (0)	1/18 (5.6)	0.545
Nurse	6 (18.2)	2/15 (13.3)	4/18 (22.2)	0.423
Midwife	32 (97)	15/15 (100)	17/18 (94.4)	0.545
Routinely resuscitation team for a high-risk delivery
Pediatrician/neonatologist	33 (100)	15/15 (100)	18/18 (100)	NA
Obstetrician	4 (12.1)	2/15 (13.3)	2/18 (11.1)	0.626
Anesthesiologist	3 (9.1)	1/15 (6.7)	2/18 (11.1)	0.570
Nurse	6 (18.2)	3/15 (20.0)	3/18 (16.7)	0.577
Midwife	33 (100)	15/15 (100)	18/18 (100)	NA
Resuscitation team members qualified with full resuscitation skills
Pediatrician/neonatologist	33 (100)	15/15 (100)	18/18 (100)	NA
Obstetrician	0 (0)	0/15 (0)	0/18 (0)	NA
Anesthesiologist	8 (24.2)	3/15 (20.0)	5/18 (27.38)	0.459
Nurse	0 (0)	0/15 (0)	0/18 (0)	NA
Gestational age limit for initiating full resuscitation at birth
Yes	19 (57.6)	15/15 (100.0)	18/18 (100)	NA
Range	20 (60.6)	22–32	22–32	-
Median gestational age	20 (60.6)	24	24	NA
Gestational age limit /No of reporting centres	20 (60.6)	23.53±0.74	24.44±2.04	0.111
Time limit to stop full resuscitation in severely asphyxiated infant
Yes	24 (72.7)	11/15 (73.3)	13/18 (72.2)	0.627
Time limit (minutes±SD) /No of reporting centers	23 (69.7)	22.73±13.85 / 11/15 (73.3)	20.83±6.33 / 12/18 (66.7)	0.673

Temperature and Thermal Management in the Delivery Room

	Total (n=33)	Level III maternity hospitals (n=15)	Level II maternity Hospitals (n=18)	p
Temperature (T°) of DR °C	33 (100)	24.40±1.05	24.39±1.24	0.978
T° of operating room °C	33 (100)	23.33±2.02	23.83±1.82	0.461
Thermal management for preterm infants (<32 weeks)
Increasing DR T°	13 (39.4)	5/15 (33.3)	8/18 (44.4)	0.386
Preheating the radiant warmer	29 (87.9)	15/15 (100.0)	17/18 (94.4)	0.370
Servo-controlled T°	23 (69.7)	11/15 (73.3)	12/18 (66.7)	0.488
Pre-warmed towels	33 (100)	15/15 (100)	18/18 (100)	NA
Polyethylene plastic bag or wrap	24 (72.7)	11/15 (73.3)	13/18 (72.2)	0.627
Hat	20 (60.6)	10/15 (66.7)	10/18 (55.6)	0.386
Thermal mattress	7 (21.2)	3/15 (20.0)	4/18 (22.2)	0.609
Heated/humidified gases	18 (54.5)	13/15 (86.7)	14/18 (77.8)	0.525
Thermal management for infants considered at risk of HIE - Passive cooling started:
Within 1 hour
1–2 hours	19 (57.5)	9/15 (60.0)	10/18 (55.6)	-
2–4 hours	2 (6.1)	1/15 (6.7)	1/18 (5.5)
4–6 hours	12 (36.4)	5/15 (33.3)	7/18 (38.9)
Mean±SD	33 (100)	2.53±1.96	2.72±1.93	0.783
Range	33 (100)	1–5	1–5	-
Median	33 (100)	1.0	1.5	-

Circulation, and Medications in the delivery room

	Total (n=33)	Level III maternity (n=15)	Level II maternity (n=18)	P
Heart rate assessment
Palpation of the umbilical cord	21 (63.6)	8/15 (53.3)	13/18 (72.2)	0.224
Palpation of peripheral pulses	1 (3.0)	0/15 (0)	1/18 (5.5)	0.545
Stethoscope	33 (100)	15/15 (100)	18/18 (100)	NA
Three-lead ECG monitor	2 (6.1)	0/15 (0)	2/18 (11.1)	0.290
Pulse oximeter	22 (66.7)	11/15 (73.3)	11/18 (61.1)	0.357
Surfactant use in delivery room
Yes	12 (36.4)	7/15 (46.7)	5/18 (27.8)	0.224
LISA	2 (6.1)	1/14 (7.1)	1/18 (5.5)	0.692
INSURE	9 (27.3)	6/15 (40.0)	3/18 (16.7)	0.135
Caffeine use in delivery room
Yes	4 (12.1)	2/15 (13.3)	2/18 (11.1)	0.626
Sodium bicarbonate use in delivery room
Yes	3 (9.1)	0/15 (0)	3/18 (16.7)	0.150
Asphyxia	1 (3.0)	0/15 (0)	1/18 (5.5)	0.253
Severe metabolic acidosis	2 (6.1)	0/15 (0)	2/18 (11.1)	0.253

Airway and ventilation in the delivery room

	Total	Level III maternity hospitals (n=15)	Level II maternity Hospital (n=18)	P
Available facilities in hospitals
Air/oxygen blender	29 (87.9)	15/15 (100)	14/18 (77.8)	0.075
Pulse oximeter	29 (87.9)	15/15 (100)	14/18 (77.8)	0.075
Heated/humidified gases availability	17 (51.5)	8/15 (53.3)	9/18 (50.0)	0.483
Initial FiO₂
≥35-week
21%	27 (81.8)	12/15 (80.0)	15/18 (83.3)	-
30%	5 (15.2)	3/15 (20.0)	2/18(11.1)	-
50%	1 (3.0)	0/15 (0)	1 (5.5)	-
Mean±SD	33 (100)	22.80±3.72	23.61±7.19	0.696
Range	33 (100)	21–30	21–100	-
Median	33 (100)	21	21	-
<35-week infant
21%	5 (15.2)	1/15 (6.7)	4/18 (22.2)	-
25–30%	24 (70.7)	14/15 (93.3)	10/18 (55.5)	-
40%	2 (6.1)	0/15 (0)	2/18 (11.1)	-
60%	1 (3.0)	0/15 (0)	1/18 (5.5)	-
100%	1 (3.0)	0/15 (0)	1/18 (5.5)	-
Mean±SD	33 (100)	29.40±2.32	34.31±18.79	0.316
Range	33 (100)	21–30	21–100	-
Median	33 (100)	30	30	-
PPV
Self-inflating bag	12 (36.4)	7/15 (46.7)	5/18 (27.8)	0.514
T-piece device (Neopuff)	21 (63.6)	10/15 (66.7)	11/18 (61.1)	0.514
Mechanical ventilator	0 (0)
Ventilatory interface routinely used
Facial mask	24 (72.7)	14/15 (93.3)	10/18 (55.5)	0.018
Short binasal prongs	9 (27.3)	1/15 (6.7)	8/18 (44.4)	0.018
Laryngeal mask	4 (12.1)	2/15 (13.3)	2/18 (11.1)	0.626
The skill of the team on intubation
Excellent	16 (48.5)	10/15 (66.7)	6/18 (33.3)	0.141
Good	13 (39.4)	5/15 (33.3)	8/18 (44.4)
Sufficient	3 (9.11)	0/15 (0)	3/18 (16.7)
Insufficient	3 (3.0)	0/15 (0)	1/18 (5.5)
Sustained lung inflation
Yes, routinely	7 (24.2)	2/15 (13.3)	5/18 (27.8)	0.140
Yes, occasionally	8 (21.2)	6/15 (40.0)	2/18 (11.1)
Never	18 (54.5)	7/15 (46.7)	11/18 (61.1)
PIP levels routinely administered to start PPV (cmH₂O)
Late preterm and term infants
<18 cm H₂O	7 (21.2)	2/15 (13.3)	5/18 (27.8)	0.225
20 cm H₂O	9 (27.3)	4/15 (26.7)	5/18 (27.8)
25 cm H₂O	17 (51.5)	9/15 (60.0)	8/18 (44.4)
Mean±SD	33 (100)	22.0±3.23	20.72±2.69
Range	33 (100)	15–25	16–25
Median	33 (100)	21	20
Preterm infants
<18 cm H₂O	14 (42.4)	4/12 (33.3)	10/17 (58.8)	-
20 cm H₂O	11 (33.3)	3/12 (25.0)	1/17 (5.9)	-
25 cm H₂O	4 (12.1)	5/12 (41.7)	6/17 (35.3)	-
Mean±SD	33 (100)	20.42±3.39	18.76±3.68	0.230
Range	33 (100)	15–25	8–25	-
Median	33 (100)	20	18	-
PEEP levels (cmH₂O)
Late preterm and term infants
4	1 (3.0)	0/15 (0)	1/18 (5.5)	-
5	16 (48.5)	9/15 (60.0)	7/18 (38.9)	-
6	14 (42.4)	5/15 (33.3)	9/18 (50.0)	-
7	1 (3.0)	1/15 (6.7)	1/18 (5.5)	-
8	1 (3.0)	0/15 (0)	0/18 (0)	-
Mean±SD	33 (100)	5.47±0.64	5.61±0.85	0.592
Range	33 (100)	5–7	4–8	-
Median	33 (100)	5	6	-
Preterm infants
5	18 (54.5)	8/12 (66.7)	10/17 (58.8)	-
6	10 (30.3)	3/12 (25.0)	7/17 (41.2)	-
7	1 (3.0)	1/12 (8.3)	0/17 (0)	-
8	0 (0)	0/12	0/17	-
Mean±SD	33 (100)	5.42±0.67	5.41±0.50	0.982
Range	33 (100)	5–7	5–6	-
Median	33 (100)	5	5	-
Meconium-stained amniotic fluid management in a non-vigorous infant
Suctioning of the oro- and nasopharynx before delivery of the shoulders	5 (15.2)	2/14 (14.3)	3/18 (16.7)	0.467
Intubation and subglottic aspiration	5 (15.2)	1/14 (7.1)	4/18 (22.2)
Starting PPV after removing secretions	22 (66.7)	11/14 (78.6)	11/18 (61.1)

eISSN:: 2393-1817
Lingua:: Inglese

Frequenza di pubblicazione:: 4 volte all'anno
Argomenti della rivista:: Medicine, Clinical Medicine, Internal Medicine, other, Surgery, Anaesthesiology, Emergency Medicine and Intensive-Care Medicine

Feed RSS della rivista

Neonatal Resuscitation Practices in Romania: A Survey of the Romanian Association of Neonatology (ANR) and the Union of European Neonatal and Perinatal Societies (UENPS)

Article Category: Research Article

Pubblicato online: 30 gen 2024

Pagine: 19 - 29

Ricevuto: 18 ott 2023

Accettato: 08 gen 2024

DOI: https://doi.org/10.2478/jccm-2024-0010

Parole chiaveRomania, delivery room, neonatal resuscitation, survey

© 2024 Manuela Cucerea et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Umbilical Cord Management

Education

Characteristics of centers and organizational aspects before birth

Temperature and Thermal Management in the Delivery Room

Circulation, and Medications in the delivery room

Airway and ventilation in the delivery room

Parole chiave
Romania, delivery room, neonatal resuscitation, survey