Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie
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Multicenter Study Comparative Study Observational Study
[Implementation of a specific premedication protocol for tracheal intubation in the delivery room. Practice in two level-III hospitals].
Tracheal intubation in neonates is a painful procedure performed daily in the delivery room despite the widespread development of noninvasive ventilation. Specific analgesia is not commonly performed. The objective of this observational study was to compare practices between two level-III centers: one with a specific protocol for premedication before tracheal intubation of newborns in the delivery room, the other without. ⋯ One hundred and fifteen neonates were intubated in the delivery room and included over a 4-month period: 25% of them received specific premedication before intubation, exclusively in the center with the protocol. None of the extreme premature neonates (age≤28 gestational weeks) received analgosedation before the procedure. Nalbuphine, midazolam, and sufentanil were mainly used, via the intravenous or intrarectal route. Infants receiving a premedication were significantly heavier and had a greater gestational age than the others (1500 g [range, 1180-2260 g] vs. 1170 [range, 860-1680 g] P=0.003, and 31 GW [range, 29-34 GW] vs. 29 [range, 27-32 GW] P=0.014, respectively). Most pediatricians (85-100%) favored a specific protocol for sedation before tracheal intubation. Implementation of a specific protocol allows specific analgesia to be implemented for newborns undergoing tracheal intubation. Further studies should be conducted to determine the best strategies for pain management during tracheal intubation of neonates, especially in the delivery room.
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Prompt initiation of appropriate neonatal resuscitation skills is critical for the neonate experiencing difficulty transitioning to extra-uterine life. Expertise in neonatal resuscitation is essential for personnel involved in the care of newborns, above all for midwives who are sometimes alone to initiate the first resuscitation. The use of simulation training is considered to be an indispensable tool to address these challenges, not only in continuing education but also in midwifery education. ⋯ The significant improvement in knowledge during the session and its preservation after a few months confirmed the efficacy of this teaching method. The simulation training increased the participants' perceptions of their knowledge, skills, and confidence in conducting neonatal resuscitation. These preliminary results are very encouraging and argue in favor of generalizing this teaching method. However, this training could be more profitable if it was proposed earlier in the midwifery curriculum and organized with a multidisciplinary team (pediatric and anesthesia residents).