NeoIPC Digest #5: April 2023

April 17, 2023

Every month, we ask one NeoIPC Consortium member to review an interesting paper on infection prevention and control in neonatal care.


This month, Julia Bielicki from University Children’s Hospital Basel and St George’s University of London is reviewing:

Cavallin F, Lupi F, Bua B, et al. Impact of personal protective equipment on neonatal resuscitation procedures: a randomised, cross-over, simulation study. Arch Dis Child Fetal Neonatal Ed. 2022;107(2):211-215. Published 2021 Sept 6.

Read the paper


What’s happening?

In the context of the COVID-19 pandemic greater awareness of the importance of stringent application of PPE in resuscitation situations developed. In these situations aerosol-generating procedures are likely to take place. However, neonatal clinicians have voiced concern about delays to critical resuscitation measures when full PPE is mandated.


What was the study design?

An Italian neonatal intensive care unit ran a randomized controlled cross-over simulation trial to compare the timing of neonatal resuscitation procedures in a manikin model between donning full PPE and without PPE. Twenty-four physician-nurse teams were randomized in a AB/BA design to provide evidence on time to positive pressure ventilation initiation under the two conditions. Secondary outcome measures focused on timing of tracheal intubation, chest compressions and correct use and discomfort/limitations of PPE.


What did the study find?

There were statistically significant but small differences in the primary outcome (difference timing of positive pressure ventilation 6-11 seconds) as well as tracheal intubation and chest compressions. The most common issues with PPE use were incorrect use, such as applying PPE in the delivery room rather than outside, visual limitations, discomfort and limitations in communication. In a manikin model, using PPE resulted in some delay to neonatal resuscitation procedures.


What does this mean?

The trial focused on the simulation setting, and it is unclear how transferrable the results would be to real-life settings. Furthermore, although the authors conclude that delays may be relevant to resuscitation outcomes, the observed differences were relatively small (32 seconds at most for chest compressions done by consultant-nurse teams). However, the study highlights the need to consider how to facilitate use of PPE in inherently stressful and time-sensitive neonatal resuscitation procedures in the delivery room and on neonatal wards.