International Journal of Healthcare Simulation

Background:

Childbirth can be unpredictable in its timing and clinical course. Unplanned pre-hospital birth occurs in 0.5% of babies [1]. Premature babies are also born in the community and in these cases, every minute matters in order to reduce morbidity and mortality. Hypothermia has been shown to causes a rise in mortality in low-birth-weight infants – in fact a 28% rise per 1 degree decrease in admission temperature [2].

In 2020–21 webinars were delivered to West Midlands Ambulance Service (WMAS) paramedics to improve their knowledge and expertise when attending preterm births [3]. This encompassed training on basic Neonatal Life Support skills and a focus on thermoregulation. A heated mattress is also now carried routinely by WMAS. There was overwhelming positive feedback [3] so the education was expanded.

Our aim was to show the clinical management of a marginal preterm infant in the community focussing on simple interventions known to improve outcomes such as delayed cord clamping and optimal thermal care.

Methods:

The simulation involved a low-risk term pregnant woman who went in to preterm labour and quickly delivered at 35 weeks. The paramedics attended as the baby delivered. It established regular respirations with simple airway manoeuvres. They used a heated gel mattress to maintain the baby’s temperature and allowed delayed cord clamping and then conveyed the mother and infant to hospital for assessment.

Results:

The simulation was recorded and is now being used to deliver training to West Midlands Ambulance Service. The paramedics who attended stated how much it had increased their confidence in managing a preterm delivery and consolidated their learning from the previous webinar.

Conclusion:

We expect that with increased staff training and confidence, the incidence of preterm babies admitted with hypothermia following an unexpected birth in the community will reduce, thus reducing mortality.

References

1. Loughney A, Collis R, Dastgir S. Birth before arrival at delivery suite: associations and consequences. British Journal of Midwifery. 2006;14(4):204–208.

2. Laptook AR, Salhab W, Bhaskar B; Neonatal Research Network. Admission temperature of low-birth-weight infants: predictors and associated morbidities. Pediatrics. 2007;119(3): e643-e649

3. Aguirre D, Henry S, Fernandez CP, Brown S. 46 ‘Born Too Soon’Virtual Simulation for Ambulance Services On Premature Babies Born Unexpectedly in the Community. International Journal of Healthcare Simulation. 2021; 1(suppl 1): A50.