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Defining information needs in neonatal resuscitation with work domain analysis

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Abstract

Objective

To gain a deeper understanding of the information requirements of clinicians conducting neonatal resuscitation in the first 10 min after birth.

Background

During the resuscitation of a newborn infant in the first minutes after birth, clinicians must monitor crucial physiological adjustments that are relatively unobservable, unpredictable, and highly variable. Clinicians’ access to information regarding the physiological status of the infant is also crucial to determining which interventions are most appropriate. To design displays to support clinicians during newborn resuscitation, we must first carefully consider the information requirements.

Methods

We conducted a work domain analysis (WDA) for the neonatal transition in the first 10 min after birth. We split the work domain into two ‘subdomains’; the physiology of the neonatal transition, and the clinical resources supporting the neonatal transition. A WDA can reveal information requirements that are not yet supported by resources.

Results

The physiological WDA acted as a conceptual tool to model the exact processes and functions that clinicians must monitor and potentially support during the neonatal transition. Importantly, the clinical resources WDA revealed several capabilities and limitations of the physical objects in the work domain—ultimately revealing which physiological functions currently have no existing sensor to provide clinicians with information regarding their status.

Conclusion

We propose two potential approaches to improving the clinician’s information environment: (1) developing new sensors for the information we lack, and (2) employing principles of ecological interface design to present currently available information to the clinician in a more effective way.

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Acknowledgements

Support for this research was provided by Jelena Zestic’s research higher degree (RHD) support funds at The University of Queensland, and her Australian Government Research Training Program (RTP) Scholarship. The project was also supported by The University of Queensland School of Psychology Strategic funds. We gratefully acknowledge the contributions of Dr Robert Loeb in the early phases of constructing the work domain analysis, and Dr Callum Gately for verifying aspects of lung ultrasound.

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Authors and Affiliations

  1. School of Psychology, The University of Queensland, St Lucia, QLD, 4072, Australia

    Jelena Zestic & Penelope Sanderson

  2. School of ITEE, The University of Queensland, St Lucia, QLD, 4072, Australia

    Penelope Sanderson

  3. School of Clinical Medicine, The University of Queensland, St Lucia, QLD, 4072, Australia

    Penelope Sanderson & Helen Liley

  4. The Royal Women’s Hospital, Melbourne, 3052, Australia

    Jennifer Dawson

  5. Mater Mothers’ Hospital and Mater Research Institute, Brisbane, 4101, Australia

    Helen Liley

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  1. Jelena Zestic
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  4. Helen Liley
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Correspondence to Penelope Sanderson.

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Conflict of interest

Penelope Sanderson is coinventor of a respiratory sonification display (US patent 7070570, Sanderson and Watson). None of the other authors have conflicts of interest to declare.

Ethical approval

This project has been reviewed by The University of Queensland Office of Research Ethics and is deemed to be exempt from ethics review under the National Statement on Ethical Conduct in Human Research and The University of Queensland Policy (Clearance Number 2018002297). Approval for re-use of the Dawson [9] data underlying Fig. 1 was granted by the Royal Women’s Hospital (Melbourne) Research and Ethics Secretariat.

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Appendix

Appendix

See Figs. 4, 5, 6, and 7.

Fig. 4
figure 4

Adapted from Siew et al. [106]

In utero, the fetus exhibits several unique physiological intracardiac and extracardiac shunts. The fetal shunts include: (a) the Ductus Venosus (DV), which shunts most of the umbilical vein flow directly to the inferior vena cava, (b) the Foramen Ovale (FO), which shunts blood from the right atrium to the left atrium, and (c) the Ductus Arteriosus (DA), which shunts blood from the pulmonary artery to the aorta, away from the lungs

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Fig. 5
figure 5

Adapted from Siew et al. [106]

A representation of the transition to the neonatal circulatory system—as a consequence of the dramatic fall in pulmonary vascular resistance with the first breaths and increase in pulmonary blood flow. Typically, if the umbilical cord is clamped immediately, the DA shunt becomes bi-directional and then reverses to become a left to right shunt, filling the expanding pulmonary circulation from the aorta, before the functional ductal closure. The cessation of blood flow from the placenta, together with the low portal venous return from the newborn abdominal organs, triggers the functional closure of the DV within minutes of birth, and reduces right atrial pressure. Additionally, the increase in pulmonary blood flow increases pulmonary venous return to the left atrium. Consequently, the left atrial pressure rises, exceeding the falling right atrial pressure and gradually closing the FO

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Fig. 6
figure 6

Adapted from Siew et al. [106]

Transition to neonatal circulatory system—cardiovascular transitions following delayed (or physiological) umbilical cord clamping after onset of lung aeration. Recent studies have shown that if umbilical cord clamping is delayed until or after the onset of lung aeration, the right atrium continues to fill from the placental venous return and right ventricular output supports the expanding pulmonary circulation, stabilising pressures in the heart and major vessels and better supporting perfusion of vital systemic organs. Consequently, the fetal shunts remain patent until the umbilical cord is clamped

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Fig. 7
figure 7

Adapted from Siew et al. [106]

The neonatal circulatory system once cardiovascular transitions are near complete at about 10 min after birth. The closure of the DA is strongly influenced by increasing oxygen levels and vasoactive mediators, which cause smooth muscle contraction that gradually (over up to 10–15 h) close the lumen of the vessel. Overall, the cardiovascular adaptations serve the purpose of increasing pulmonary blood flow to facilitate an effective match of lung perfusion and ventilation to improve oxygenation, while maintaining perfusion of systemic organs

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Zestic, J., Sanderson, P., Dawson, J. et al. Defining information needs in neonatal resuscitation with work domain analysis. J Clin Monit Comput 35, 689–710 (2021). https://doi.org/10.1007/s10877-020-00526-7

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