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Innovation in immediate neonatal care: development of the Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support (BASICS) trolley

by:Aoqi     2020-06-02
Purpose the baby receives oxygen through the umbilical cord within the uterus and minutes after birth.
At present, if the baby is not breathing well at birth, cut off the umbilical cord in order to transfer the newborn to the recovery room.
We are trying to develop a mobile recovery trolley where newborn babies can recover while still receiving oxygen blood and \"placenta transfer\" through the umbilical cord.
This will also prevent separation between the mother and the baby in the first minute after birth.
Design multi-disciplinary iterative product development.
Set up clinical engineering department of University teaching hospital.
After the initial design meeting, a series of prototypes were developed.
At each stage, the team of experts in the laboratory and hospital delivery kits reviewed the prototype to determine ease of use and applicability.
A commercial company was identified to work with conformit é europe enne mark on the development and safety marking of the trolley, allowing the trolley to be introduced into clinical practice.
The result is based on the concept of a super bed, and the trolley is a small mobile recovery device.
It can be manipulated within 50 cm of the mother\'s pelvis, so that the umbilical cord can remain intact during recovery, regardless of whether the baby is born naturally, through a device delivery or a caesarean section.
The warmth of the newborn comes from the heating mattress, and the trolley has facilities for suction, oxygen and air.
Conclusion This is the first mobile resuscitation device designed specifically to facilitate bedside neonatal recovery and is equipped with a complete umbilical cord.
The next step is to evaluate its safety, acceptability to clinicians and parents, and to determine if it allows recovery with a complete cord.
Purpose the baby receives oxygen through the umbilical cord within the uterus and minutes after birth.
At present, if the baby is not breathing well at birth, cut off the umbilical cord in order to transfer the newborn to the recovery room.
We are trying to develop a mobile recovery trolley where newborn babies can recover while still receiving oxygen blood and \"placenta transfer\" through the umbilical cord.
This will also prevent separation between the mother and the baby in the first minute after birth.
Design multi-disciplinary iterative product development.
Set up clinical engineering department of University teaching hospital.
After the initial design meeting, a series of prototypes were developed.
At each stage, the team of experts in the laboratory and hospital delivery kits reviewed the prototype to determine ease of use and applicability.
A commercial company was identified to work with conformit é europe enne mark on the development and safety marking of the trolley, allowing the trolley to be introduced into clinical practice.
The result is based on the concept of a super bed, and the trolley is a small mobile recovery device.
It can be manipulated within 50 cm of the mother\'s pelvis, so that the umbilical cord can remain intact during recovery, regardless of whether the baby is born naturally, through a device delivery or a caesarean section.
The warmth of the newborn comes from the heating mattress, and the trolley has facilities for suction, oxygen and air.
Conclusion This is the first mobile resuscitation device designed specifically to facilitate bedside neonatal recovery and is equipped with a complete umbilical cord.
The next step is to evaluate its safety, acceptability to clinicians and parents, and to determine if it allows recovery with a complete cord.
Introduction obstetricians have encouraged early or even immediate clamping of the umbilical cord since the 1960 s as part of actively managing the third stage of delivery to prevent maternal bleeding.
1 for full-term delivery, the timing of umbilical cord clamp has no clear impact on postpartum blood loss.
Immediate clamping, however, can reduce neonatal hemoglobin and neonatal jaundice.
While these effects are usually transient and well tolerated, a decrease in iron levels can still be seen at 3-6 months, an effect associated with developmental delays.
3. Who, 5 International Federation of Obstetrics and Gynecology, 6 and National Institute of excellence in health care (NICE)
In UK7, it is now recommended to postpone the wire clip.
In the UK, about a third newborn was taken care of by a newborn reviver at birth.
Everything that happens to most people is assessment, stimulation, heat care and simple airway management.
About 15% of babies received positive recovery at birth, such as face mask ventilation, intubation, heart massage or medication.
When an infant needs to be assessed or stabilized and supported at birth, the standard practice so far is to clamp and cut the cord immediately and then bring the infant to the recovery platform, usually on one side of the room or another.
This means that the transitional circulation period has been shortened.
In addition, parents often do not see or touch their children at birth.
Evidence from other areas of adult and child recovery suggests that relatives and staff9-13 prefer family presence and are now standard in these settings.
This issue has not been explored after birth for care, and so far the newborn recovery has been kept away from women and her partner.
With the increase of premature birth, the demand for neonatal care and support has increased.
For premature infants, delayed umbilical cord clamp and decreased blood transfusion for anemia, decreased low blood pressure requiring positive force support, and low-
Compared to the immediate clamping, there is a grading of the ventricular hemorrhage.
Jaundice increased, but jaundice for a long time
The term effect is not clear.
Systematic reviews suggest that strategies for increasing placenta transfusion after birth may increase neonatal mortality in very premature infants, 15 but it is not yet certain whether delayed recovery will offset any benefits, so, the European recovery Council\'s current recommendation states that \"recovery intervention remains a priority for infants in need of recovery.
\"17 very premature babies are most likely to experience these major diseases and have the potential to benefit from delayed clamping.
Therefore, it seems important to develop a strategy for the initial recovery of the umbilical cord in good condition.
In 2009, a survey of the UK\'s extended Neonatal Network found that two
Thirty people surveyed suggested that initial care to maintain the integrity of the umbilical cord could be feasible for premature vaginal delivery.
Less than half of people think it is possible to have a premature Caesarean section (
Du Li, personal communications, 2009).
The purpose of this paper is to describe the development and preliminary testing of the mobile trolley to enable the newborn to perform care and support at the bedside, potentially with complete ropes for care and support.
Several authors described an initial conceptual recovery with a complete cord, 18-21, but no consistent technique appeared.
On January 2010, DH held 1-
A day meeting of eight British clinicians and researchers in Worcester (
AB, SB, LD, AG, AMH, DH, DO and ADW-
See confirmation)
Common concern about practical methods for initiating neonatal assessment and recovery before the umbilical cord is clamped and cut off.
This resulted in the idea of a small mobile bedside recovery trolley, extending the concept of a platform for rope clamping Research in Glasgow (figure 1).
The initial acronym word basis for \"bedside assessment, stability and initial cardio support\" was proposed, which established the working name of \"basic trolley.
The key concept is that this trolley needs to keep the baby warm, allowing suction and breathing support within a 50 cm radius from the mother\'s womb.
ADW drafted the design during the meeting (figure 2).
The two sides agreed that he would formalize these things, work with Liverpool\'s medical engineering department to advance the design of the trolley and register the design rights.
Download figureOpen in Figure 1 of the new tabDownload powerpoint, the Glasgow trolley used by Aladangady et al in the study, which inspires the first of bedside assessment, stability, and initial cardio supportBASICS)trolley (
Photos provided by AMH).
Download figureOpen in figure 2 of the new tabDownload powerpoint. The design drawing after the discussion of the first group meeting in Worcestershire shows (A)
Car design and (B)
The way it may be located on the operating table at the time of caesarean section (
The drawings of ADW on February 2010 are reproduced with his permission).
The National Institutes of Health received prototype funding to support the development of concepts into prototypes (NIHR; LD)
With the additional support of the Liverpool Women\'s Hospital \"newborn appearance.
In collaboration with the clinical engineering department of the Royal Liverpool University Hospital, the first prototype was developed by PW using an improved hospital superbed table (figure 3).
The first early prototype was developed with the support of the development team (
LD, AG, DH, PW, ADW and CWY)
The meeting in Liverpool includes the opinions of the service user representative.
To evaluate the optimal size and contact range of the trolley platform, various simulation delivery scenarios were designed.
Discussion includes what equipment is needed on the trolley to provide a mix of oxygen and air and to provide a positive terminal
Breath pressure.
Liverpool prototype (figure 4)
At the Medical Futures awards in June 2011, it was awarded \"The Best Redesign of cardiovascular medicine \".
Download the normal delivery of the location of the car drawn by the new tabDownload figureOpen powerpointFigure3 (
PW\'s painting in March 2011 was reproduced with his permission).
Download the first bedside assessment, stabilization, and initial cardio support in figure 4 of the new tabDownload powerpoint (BASICS)prototype (
PW was reprinted with his permission on April 2011).
Note that the problem of how to keep your baby warm has not been solved.
A key issue with the first prototype is how to keep the baby warm.
The traditional Fusu has an overhead heater, but it is impractical for a trolley, and it is designed to be under the legs of a woman on a cut stone position or operating table.
Business Company (Inditherm plc)
They were approached to adapt their heated mattress to the trolley.
The company then agreed to cooperate on further development with the aim of bringing products to market.
A second prototype developed in cooperation with Inditherm and manufactured by them (figure 5)
, Increased mobility and flexibility, allowing to adjust the height and position of the trolley platform.
The trolley is marked with a European logo (CE)
The logo was sold in October 2012 and is now sold by Inditherm as \"Art of Life.
Download the new tabDownload figureOpen powerpointFigure5 Inditherm LifeStart trolley (
Licensed, October 2012).
The key element of the design of the basic trolley is flexibility, allowing the baby to be placed on the trolley in the condition that the umbilical cord is intact.
This requires the trolley platform to be manipulated: when in the position of the cut stone, it is possible to put it down on the mother\'s leg, or raise it high and reach the woman on the operating table.
The umbilical cord may be very short, so the platform must be able to be close to the female introversion.
This is achieved by having a central pillar that can be adjusted up and down and a narrow platform that stretches out from a pillar with a raised edge to ensure safety.
Even if the mother sends the baby to the floor, the trolley can move to the place of birth and provide the baby with the necessary recovery gas and suction to maintain contact with the mother.
The CosyTherm electric heating mattress provides thermal support.
The temperature through a series is adjustable and can be heated in just a few minutes.
The trolley has a timer built into the platform and at 1 and 5 minutes the Apgar reminder makes a sound.
There are two general-purpose media tracks fixed around the central pillar for additional equipment.
This allows each hospital to customize the trolley according to their specific requirements.
Our early assessment used the Tom Thumb infant recovery device (
Viamed, Kingsley, United Kingdom)
Oxygen mixer (
Enlightenment Health Care Co. , Ltd.
Leicester, UK)
Suction cups driven by walls-
Supply of air (Oxylitre Ltd.
Manchester, UK)
Control Unit of CosyTherm heating mattress (
Rotherham, United Kingdom.
We connect it to the hose supplied by air and oxygen walls.
Other devices that can be added are lights, saturation monitors, or storage baskets on flexible rods (
Used to support the suspension of the mirror, hat, saturation monitor).
Several authors 18-21 described the initial conceptual recovery with complete ropes, but no consistent technique appeared.
On January 2010, DH held 1-
A day meeting of eight British clinicians and researchers in Worcester (
AB, SB, LD, AG, AMH, DH, DO and ADW-
See confirmation)
Common concern about practical methods for initiating neonatal assessment and recovery before the umbilical cord is clamped and cut off.
This resulted in the idea of a small mobile bedside recovery trolley, extending the concept of a platform for rope clamping Research in Glasgow (figure 1).
The initial acronym word basis for \"bedside assessment, stability and initial cardio support\" was proposed, which established the working name of \"basic trolley.
The key concept is that this trolley needs to keep the baby warm, allowing suction and breathing support within a 50 cm radius from the mother\'s womb.
ADW drafted the design during the meeting (figure 2).
The two sides agreed that he would formalize these things, work with Liverpool\'s medical engineering department to advance the design of the trolley and register the design rights.
Download figureOpen in Figure 1 of the new tabDownload powerpoint, the Glasgow trolley used by Aladangady et al in the study, which inspires the first of bedside assessment, stability, and initial cardio supportBASICS)trolley (
Photos provided by AMH).
Download figureOpen in figure 2 of the new tabDownload powerpoint. The design drawing after the discussion of the first group meeting in Worcestershire shows (A)
Car design and (B)
The way it may be located on the operating table at the time of caesarean section (
The drawings of ADW on February 2010 are reproduced with his permission).
The National Institutes of Health received prototype funding to support the development of concepts into prototypes (NIHR; LD)
With the additional support of the Liverpool Women\'s Hospital \"newborn appearance.
In collaboration with the clinical engineering department of the Royal Liverpool University Hospital, the first prototype was developed by PW using an improved hospital superbed table (figure 3).
The first early prototype was developed with the support of the development team (
LD, AG, DH, PW, ADW and CWY)
The meeting in Liverpool includes the opinions of the service user representative.
To evaluate the optimal size and contact range of the trolley platform, various simulation delivery scenarios were designed.
Discussion includes what equipment is needed on the trolley to provide a mix of oxygen and air and to provide a positive terminal
Breath pressure.
Liverpool prototype (figure 4)
At the Medical Futures awards in June 2011, it was awarded \"The Best Redesign of cardiovascular medicine \".
Download figureOpen in new tabDownload powerpoint figure 3 for normal shipping (
PW\'s painting in March 2011 was reproduced with his permission).
Download the first bedside assessment, stabilization, and initial cardio support in figure 4 of the new tabDownload powerpoint (BASICS)prototype (
PW was reprinted with his permission on April 2011).
Note that the problem of how to keep your baby warm has not been solved.
A key issue with the first prototype is how to keep the baby warm.
The traditional Fusu has an overhead heater, but it is impractical for a trolley, and it is designed to be under the legs of a woman on a cut stone position or operating table.
Business Company (Inditherm plc)
They were approached to adapt their heated mattress to the trolley.
The company then agreed to cooperate on further development with the aim of bringing products to market.
A second prototype developed in cooperation with Inditherm and manufactured by them (figure 5)
, Increased mobility and flexibility, allowing to adjust the height and position of the trolley platform.
The trolley is marked with a European logo (CE)
The logo was sold in October 2012 and is now sold by Inditherm as \"Art of Life.
Download the new tabDownload figureOpen powerpointFigure5 Inditherm LifeStart trolley (
Licensed, October 2012).
The key element of the design of the basic trolley is flexibility, allowing the baby to be placed on the trolley in the condition that the umbilical cord is intact.
This requires the trolley platform to be manipulated: when in the position of the cut stone, it is possible to put it down on the mother\'s leg, or raise it high and reach the woman on the operating table.
The umbilical cord may be very short, so the platform must be able to be close to the female introversion.
This is achieved by having a central pillar that can be adjusted up and down and a narrow platform that stretches out from a pillar with a raised edge to ensure safety.
Even if the mother sends the baby to the floor, the trolley can move to the place of birth and provide the baby with the necessary recovery gas and suction to maintain contact with the mother.
The CosyTherm electric heating mattress provides thermal support.
The temperature through a series is adjustable and can be heated in just a few minutes.
The trolley has a timer built into the platform and at 1 and 5 minutes the Apgar reminder makes a sound.
There are two general-purpose media tracks fixed around the central pillar for additional equipment.
This allows each hospital to customize the trolley according to their specific requirements.
Our early assessment used the Tom Thumb infant recovery device (
Viamed, Kingsley, United Kingdom)
Oxygen mixer (
Enlightenment Health Care Co. , Ltd.
Leicester, UK)
Suction cups driven by walls-
Supply of air (Oxylitre Ltd.
Manchester, UK)
Control Unit of CosyTherm heating mattress (
Rotherham, United Kingdom.
We connect it to the hose supplied by air and oxygen walls.
Other devices that can be added are lights, saturation monitors, or storage baskets on flexible rods (
Used to support the suspension of the mirror, hat, saturation monitor).
Results after CE marking, the trolley was introduced to the clinical service of Liverpool Women\'s Hospital.
We describe our early experiences here.
A more formal assessment of the safety and acceptability of clinicians and parents has been reported separately.
22 The first use was an out-of-uterus treatment procedure at the time of caesarean section on October 2012.
Feedback from staff and parents is positive.
Then use the extension to lowRisk delivery.
All parents seem to appreciate being with their children at the very first moments of their lives.
Clinicians are slow to receive initial bedside care and express anxiety about parents being so close to the baby during recovery.
There are also some practical issues that need to be addressed, especially in workplaces where air and oxygen pipelines may cause a trip hazard.
It is also clear that the introduction of carts at birth for initial care and stability requires teamwork.
The equipment must be checked and moved to the location where it is ready for delivery.
The positioning of the trolley and newborn team close to women requires consultation with the midwife and the obstetrics team.
So for now, the newborn team is called up earlier than the traditional room care.
Once the baby is born, the midwife and obstetrics team need to understand what is going on during bedside care and will often play a role in supporting the woman and her partner and explain to them what is going on.
When using a trolley during caesarean section, the platform is covered with a sterile Mayo tray cover.
Newborn team members who will provide care at birth will scrub and wear sterile gowns and gloves to prevent contamination of the surgical site.
Once the baby is on the trolley platform, the aseptic rules are relaxed so that the scrubbed newborn team members can touch and use the non-
Sterile equipment such as telephones, timers, hats, etc.
So, it\'s important that the sterile site is not reopened.
Enter or be contaminated
If sustained recovery is required, then, after cutting off the cord, the trolley can be removed from the operating table in order to continue care without interrupting the surgeon.
The discussion primarily found that we developed a mobile newborn recovery trolley that allows the newborn to evaluate and recover with the mother, whether or not there is a full umbilical cord.
Advantages and limitations clinicians and researchers who want to implement and evaluate Deferred umbilical cord clamping for all babies born previously faced a problem: how do you achieve this for those babies who need immediate recovery?
This trolley has demonstrated the feasibility of providing initial neonatal care and stability at the bedside, and to do so in case the umbilical cord is intact.
The trolley now needs to be evaluated to assess its safety in regular clinical services and the acceptability of it by clinicians and parents.
While parents of premature babies say their first physical contact is very important, it is often delayed to a period of time after the birth of the special care baby ward.
With the basic trolley, mothers can touch and talk to newborns when they are assessed, and our initial experience is that parents value this opportunity.
The introduction of neonatal care at the bedside requires a multi-disciplinary approach.
Participating teams need to be prepared and confident to provide neonatal recovery under the supervision of closer parents more directly.
Everyone present at birth needs to understand their role in supporting this care strategy and supporting women and her partner.
Currently, for very premature infants, \"deferred\" umbilical cord clamping occurs after the age of 30-45, although placenta transfusion may last longer.
This reflects the desire not to delay the initial care and support of the newborn.
The basic trolley should allow the assessment of all babies born, including those who are sick and very premature, to clamp the umbilical cord in a more physiological way.
An ongoing pilot randomized trial compared umbilical cord clamping within 20 weeks of birth under 32 weeks of pregnancy and umbilical cord clamping after at least 2 minutes (ISRCTN21456601).
In this study, some units are using basic trolleys while others are using their normal recovery to move to the bedside.
The pilot was designed to assess the feasibility of a large UK randomized trial.
In the main study we developed a mobile newborn recovery trolley that allows the newborn to be evaluated and revived around the mother, whether or not there is a full umbilical cord.
Advantages and limitations clinicians and researchers who want to implement and evaluate Deferred umbilical cord clamping for all babies born previously faced a problem: how do you achieve this for those babies who need immediate recovery?
This trolley has demonstrated the feasibility of providing initial neonatal care and stability at the bedside, and to do so in case the umbilical cord is intact.
The trolley now needs to be evaluated to assess its safety in regular clinical services and the acceptability of it by clinicians and parents.
While parents of premature babies say their first physical contact is very important, it is often delayed to a period of time after the birth of the special care baby ward.
With the basic trolley, mothers can touch and talk to newborns when they are assessed, and our initial experience is that parents value this opportunity.
The introduction of neonatal care at the bedside requires a multi-disciplinary approach.
Participating teams need to be prepared and confident to provide neonatal recovery under the supervision of closer parents more directly.
Everyone present at birth needs to understand their role in supporting this care strategy and supporting women and her partner.
Currently, for very premature infants, \"deferred\" umbilical cord clamping occurs after the age of 30-45, although placenta transfusion may last longer.
This reflects the desire not to delay the initial care and support of the newborn.
The basic trolley should allow the assessment of all babies born, including those who are sick and very premature, to clamp the umbilical cord in a more physiological way.
An ongoing pilot randomized trial compared umbilical cord clamping within 20 weeks of birth under 32 weeks of pregnancy and umbilical cord clamping after at least 2 minutes (ISRCTN21456601).
In this study, some units are using basic trolleys while others are using their normal recovery to move to the bedside.
The pilot was designed to assess the feasibility of a large UK randomized trial.
Conclusion This is the first mobile resuscitation device designed specifically for bedside neonatal resuscitation with a complete umbilical cord.
Further evaluation will assess safety and acceptability, and whether a complete umbilical cord recovery to extend the time of circulation of the newborn will improve the outcome.
The author thanks the Royal Hospital of Worcester, which hosted the first development conference.
They thanked Inditherm and his president, Nick BATUS (NB)
Because they have developed a full-featured CE-marked mobile Fosun from the original prototype.
They thank David Odd (DO)
Rabia Imtiaz MS at the preliminary design meeting at Royal Hospital in Worcester. Gill Gyte (GG)
Participated in the Liverpool Design Conference and provided an important input for trolley design.
Tony Fisher, head of clinical engineering, teaching hospital, University of Royal Liverpool, provided important advice on intellectual property and agreed to develop basic prototypes in his department at a discounted price. David Hutchon (DH)
The original meeting was held at the Royal Hospital of Worcester to explore practical methods for neonatal recovery with a complete umbilical cord and was named one of the original registered inventors.
He is also a member of the 2010 Medical Futures award team, providing input into the design of the basic trolley prototype and for the first time identifying Inditherm as a business partner.
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135 openurlcross refpmedfootnotestwitter and Andrew . . @ adweeks and Amanda Burley delayedclampingconsultants early week trolley concept and design by AB, SB, LD, AG, AMH, Department of Health, DH do and ADW at meetings organized by Worcester.
Subsequent meetings attended by AB, NB, LD, AG, GG, DH, ADW, PW and CWY resulted in the development of the prototype.
ADW wrote the first draft of the manuscript, which was subsequently modified by AB, SB, LD, AG, AMH, ADW, PW, and CWY.
The final version of the manuscript was approved by all authors.
This paper introduces independent research funded by the National Institutes of Health (NIHR)
According to the program allocation for the research funding scheme (RP–PG–0609-10107).
The Department of Clinical Engineering provided additional support, they provided services at a lower cost, and the \"new appetite\" of Liverpool Women was supported.
AB and DH provide individual funding to attend all meetings and medical futures awards.
The final trolley was manufactured by Inditherm Ltd and CE marks were obtained.
The parties agreed to donate any financial compensation from the original development team to the charity.
LD is the lead investigator for trials comparing umbilical cord clamping time replacement strategies, for which this trolley is a strategy to provide care at the bedside.
Trolley for commercial production (with CE mark)
Subsequently, after the approval of the medical device board, the R & D supervisor and the clinical director of the neonatal department, was introduced to the clinical services of the Liverpool Women\'s Hospital.
Uncommissioned source and peer review;
External peer review.
After the author makes the application, the unpublished technical documents about the development of the trolley can be obtained.
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