Introduction: The practice of neonatal resuscitation involves superior technical skills, an ability to lead an interdisciplinary team as well as make clinical decisions based on complex dynamic transitional physiology within a narrow timeline. These skills are a mandatory component of pediatric residency training and have been assessed using standardized assessment tools such as certifying board exams, procedure checklists, and in training exams. Recent literature has raised concerns about trainees’ competency in the technical skills for neonatal resuscitation. This project sought to explore trainees’ perceptions of competency for neonatal resuscitation, as well as potential barriers that challenge this process. Methods: This project employed an interpretive design qualitative methodology, using an a priori educational theory incorporating the principles of social cognitive theory, deliberate practice, distributive practice, and ‘choke phenomenon’. Semi structured focus groups of residents and pediatricians were used for data collection. Interpretive analysis in the style of Crabtree and Miller was employed. Validity criteria as described by Lincoln and Guba were applied. Institutional ethics board approval was obtained. Results: The participants identified four attributes for competency in neonatal resuscitation required to ensure successful transition towards readiness for independent practice: (a) medical expertise, (b) leadership, (c) transferability, and (d) self-efficacy. The enablers and barriers towards acquisition of these four aspects during residency training and transition to practice were identified and explored. Conclusions: Through the self-reported experiences of trainees and practitioners and informed by educational theory, this study describes a “across rocky seas” graduated conceptual model of a sailing ship for competency acquisition in neonatal resuscitation. An understanding and application of this model may thus inform the development of new competency-based curricula. / Thesis / Master of Science (MSc) / The practice of neonatal resuscitation is challenging because practitioners are dealing with an infant who is critically ill, requiring multiple interventions within a very short duration of time. Despite residency training, literature reports challenges with acquiring and maintaining resuscitation skills. Using qualitative methods, specifically interpretive design, this project sought to explore trainees’ perceptions of competency for neonatal resuscitation, as well as potential barriers to this process. The principles of repeated exposure over different times in training, performance under pressure and the confidence in one’s abilities required to achieve a specific goal were used to inform data collection and analysis. The participants identified four attributes for competency in neonatal resuscitation required to ensure successful transition towards readiness for independent practice: (a) medical expertise, (b) leadership, (c) transferability, and (d) self-efficacy. Informed by educational theory, these constructs were then used to describe a conceptual model for competency acquisition in neonatal resuscitation

No / Lung inflation is the most important, and most difficult step in newborn resuscitation. A wide variety of devices are used to achieve lung inflation, but there are relatively few data to guide clinicians in their choice of device. We tested the ability of instructors and trained candidates on a newborn life support course to deliver initial inflation breaths to a test lung, using a pressure limited blow-off valve, a 240-ml self-inflating bag and a 500-ml self-inflating bag in sequence. Use of a 240-ml self-inflating bag was associated with shorter initial inflations of 1.8 s mean (95% CI 1.60-1.99 s), compared with 2.42 s (2.24-2.61 s), 2.40 s (2.08-2.71 s) for 500-ml self-inflating bags and 'Tom Thumb' T piece, respectively. Delivery of breaths within a target pressure range of 30 � 5 cm H2O was significantly better using a T piece than either self-inflating bag (proportion within target range 0.05 (95% CI 0-0.11), 0.17 (95% CI 0.12-0.23), 0.89 (95% CI 0.83-0.94) for 240-ml and 500-ml self-inflating bags and 'Tom Thumb' T piece, respectively. Excessive pressure delivery with both sizes of self-inflating bag was frequent. These data do not support use of 240-ml or 500-ml self-inflating bags for resuscitation of newborn term infants. A variable pressure T piece blow-off system may be the easiest device to use for newborn resuscitation and the most reliable at delivering desired pressures for set times.

No description available.

Introduction: Around 140 million children are born every year and post-natal transition is uncomplicated in the vast majority. However, around 5%–15% of neonates receive supportive interventions during transition. Recent data on the interventions used is scarce. More data on the frequencies with which these interventions are used is needed to evaluate neonatal resuscitation, guide recommendations and to generate hypotheses for further research. The following protocol describes an international, multicentre survey on the interventions currently applied during neonatal resuscitation. Objectives: To determine the frequencies at which different supportive interventions recommended by European Resuscitation Council (ERC) guidelines for neonatal resuscitation are used. To compare the frequencies between hospitals and patient groups and to investigate possible factors influencing any differences found. Methods: Participating hospitals will collect data on all interventions performed during neonatal resuscitation over a period of 6 months. All hospitals providing perinatal care are eligible regardless of size and designated level of neonatal care. Every neonate requiring more interventions than basic drying and tactile stimulation during the first 30 min of life will be included. The targeted sample size is at least 4,000 neonates who receive interventions. After anonymization, the data is pooled in a common database and descriptive and statistical analysis is performed globally and in subgroups. Possible correlations will be investigated with phi coefficient and chi square testing. Ethics and dissemination: Consent of the institutional review board of the Technical University Dresden was obtained for the local data collection under the number BO-EK-198042022. Additionally, approval of local ethical or institutional review boards will be obtained by the participating hospitals if required. Results will be published in peer-reviewed journals and presented at suitable scientific conferences.

Bakgrund: Det finns stora fördelar för både barn och föräldrar med vård hud-mot-hud. I akuta situationer har det länge varit norm med separation, trots en strävan efter nollseparation inom förlossnings- och eftervården.  Syfte: Att undersöka barnmorskors erfarenheter och tankar kring akut omhändertagande av nyfödda barn hud-mot-hud med modern inne på förlossningsrum.  Metod: Kvalitativ design. Semistrukturerade intervjuer med nio barnmorskor med erfarenhet av akut omhändertagande av nyfött barn hud-mot-hud med modern. Data analyserades med en kvalitativ innehållsanalys. Resultat: Innehållsanalysen resulterade i tre kategorier: en strävan att inte skilja mor och barn åt, omgivande faktorer samt individuella förutsättningar hos den enskilda barnmorskan. Barnmorskorna som intervjuades upplevde att arbetssättet med neopelare gav fördelar för både barn och föräldrar i form av möjlighet till nollseparation, hud-mot-hud och sen avnavling. För att kunna använda arbetssättet i en högre omfattning och med mer trygghet krävs mer träning. Arbetssättet upplevdes generellt ta mer plats jämfört med barnbord och krävde mer anpassning av barnmorskorna. Det upplevdes vara svårare att optimera barnets position vid ventilering. Vid mycket dåliga barn ansågs barnbordet nödvändigt.  Slutsats: Den generella uppfattningen var att arbetssättet med neopelaren var fördelaktigt och kunde utvecklas för användning i högre grad. Barnmorskorna hade en gemensam strävan efter nollseparation. Studiens resultat överensstämmer med tidigare forskning kring vinster med nollseparation och värdet av löpande utbildning för personal. Vidare forskning i ämnet kan ge ökad kunskap hos vårdpersonal vilket i framtiden kan hjälpa i arbetet med minskad separation. / Background: Both parent and infant enjoy many benefits from skin-to-skin care. The norm has previously been to separate the mother and infant in emergency situations, even though there is a consensus to strive for zero-separation during birth and postpartum care.  Aim: To explore midwives’ experiences about resuscitation of newborn infants skin-to-skin to the mother in the birthing room.   Method: A qualitative design. Semi structured interviews with nine midwives with experience of emergency care of newborn infants skin-to-skin. Data was analyzed with a qualitative content analysis.  Results: The content analysis resulted in three categories: a strive to not separate mother and infant, surrounding factors and individual prerequisites of the midwife. The midwives experienced benefits in the form of ability to practice zero separation, skin-to-skin and late cord clamping. More practice is needed to expand the use of the work procedure and sense of security. It was perceived as more space consuming and demanded adaptation. It was more difficult to optimize the infant’s position during ventilation. A separation was perceived as necessary when taking care of very sick infants.  Conclusion: The general comprehension was that the work procedure was beneficial and there was room for improvement. The midwives had a mutual strive for zero separation. The results of the study are consistent with earlier studies about the benefits of zero separation and continuous education for health workers. More studies on the topic can increase awareness among health workers, which in turn can help to reduce separation.

Despite the unprecedented improvement in child health in last 15 years, burden of stillbirth and neonatal death remain the key challenge in Nepal and the reduction of these deaths will be crucial for reaching the health targets for Sustainable development goal by 2030. The aim of this thesis was to explore the risk factors for stillbirth and neonatal death and change in perinatal outcomes after the introduction of the Helping Babies Breathe Quality Improvement Cycle (HBB QIC) in Nepal. This was a prospective cohort study with a nested case-control design completed in a tertiary hospital in Nepal. Information were collected from the women who had experienced perinatal death and live birth among referent population; a video recording was done in the neonatal resuscitation corner to collect information on the health workers’ performance in neonatal resuscitation.  Lack of antenatal care had the highest association with antepartum stillbirth (aOR 4.2, 95% CI 3.2–5.4), births that had inadequate fetal heart rate monitoring were associated with intrapartum stillbirth (aOR 1.9, CI 95% 1.5–2.4), and babies who were born premature and small-for-gestational-age had the highest risk for neonatal death in the hospital (aOR 16.2, 95% CI 12.3–21.3). Before the introduction of the HBB QIC, health workers displayed poor adherence to the neonatal resuscitation protocol. After the introduction of HBB QIC, the health workers demonstrated improvement in their neonatal resuscitation skills and these were retained until six months after training. Daily bag-and-mask skill checks (RR 5.1 95% CI 1.9–13.5), preparation for birth (RR 2.4, 95% CI 1.0–5.6), self-evaluation checklists (RR 3.8, 95% CI 1.4–9.7) and weekly review and reflection meetings (RR 2.6, 95% 1.0–7.4) helped the health workers to retain their neonatal resuscitation skills. The health workers demonstrated improvement in ventilation of babies within one minute of birth and there was a reduction in intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and first-day neonatal mortality (aOR 0.51, 95% CI 0.31–0.83).  The study provides information on challenges in reducing stillbirth and neonatal death in low income settings and provides a strategy to improve health workers adherence to neonatal resuscitation to reduce the mortality. The HBB QIC can be implemented in similar clinical settings to improve quality of care and survival in Nepal, but for primary care settings, the QIC need to be evaluated further.

United Nations has lately stated ambitious health targets for 2030 in the Sustainable Development Goal agenda, following the already achieved progress between 1990 and 2015 when the number of children dying before the age of five was reduced by more than half. However, the mortality reduction in the first month of life after birth has not kept the same pace. Furthermore, a large number of stillbirths have previously not been accounted for. The aim of this thesis was to evaluate the impact of clinical training in neonatal resuscitation, and to identify strategies for an effective implementation at a maternal health facility in Nepal. Focus group discussions were used to explore the perceptions of teamwork among staff working closest to the infant at the facility. A prospective cohort study with nested referents was applied to determine effect on birth outcomes after an intervention with Helping Babies Breathe, a simplified protocol for neonatal resuscitation. Sustainability of the acquired skills after training was addressed by employing a quality improvement cycle. Video recordings of health workers performance were collected to analyse adherence to protocol. Midwives described the need for universal protocols in neonatal resuscitation and management involvement in clinical audit and feedback. There was a reduction of intrapartum stillbirth (aOR 0.46, 95% CI 0.32–0.66) and neonatal mortality within 24 hours of life (aOR 0.51, 95% CI 0.31–0.83) after the intervention. Ventilation of infants increased (OR 2.56, 95% CI 1.67–3.93) and potentially harmful suctioning was reduced (OR 0.13, 95% CI 0.09–0.17). Neonatal death from intrapartum-related complications was reduced and preterm infants survived additional days in the neonatal period after the intervention. Low birth weight was not found to be a predictor of deferred resuscitation in the studied context. This study confirmed the robustness of Helping Babies Breathe as an educational tool for training in neonatal resuscitation. Accompanied with a quality improvement cycle it reduced intrapartum stillbirth and mortality on the day of delivery in a low-income facility setting. Improved postnatal care is needed to maintain the gains in survival through the neonatal period. Increased management involvement in audit and quality of care could improve clinical performance among health workers.

Introdução: A assistência ao parto no Brasil tem enfrentado desafios nos últimos anos, no sentido de reduzir práticas desnecessárias e inseguras. No entanto, medidas utilizadas para acelerar o trabalho de parto e demais intervenções durante o trabalho de parto e parto ainda são frequentes e podem impactar negativamente as condições de vitalidade do recém-nascido. Objetivos: Analisar a associação entre os fatores sociodemográficos, organizacionais, obstétricos e assistenciais e desfecho neonatal desfavorável entre RNs de termo e estimar sua frequência. Método: Estudo transversal, a partir dos dados do inquérito nacional Nascer no Brasil, referentes à região Sudeste. A amostra foi composta por puérperas que tiveram RNs vivos, natimortos (peso 500 gramas e/ou idade gestacional 22 semanas), nascidos em hospitais com 500 partos em 2011 e 2012. Foram excluídos os recém-nascidos prematuros, gemelares e aqueles com malformações. A variável dependente desfecho neonatal desfavorável foi construída por meio da composição das variáveis intubação traqueal, massagem cardíaca, uso de drogas na reanimação neonatal, internação em UTI neonatal e Apgar <7 no 5.o minuto de vida no período pós-natal imediato. A associação entre as variáveis de interesse e a variável desfecho foi estimada por meio de regressão logística binária univariada e múltipla, calculando-se Odds ratio (OR) brutas e ajustadas com intervalos de confiança de 95 por cento (IC 95 por cento ). Resultados: A amostra foi composta por 8.783 mulheres e seus RNs. A proporção de RNs que apresentou desfecho neonatal desfavorável foi de 9,6 por cento (844). Ensino fundamental incompleto (OR=2,139; IC 95 por cento 1,292-3,540), baixo peso ao nascer (peso 2.500g; OR=2,822; IC 95 por cento 1,641-4,851), intercorrência obstétrica (OR=1,421; IC 95 por cento 1,055-1,914) e parto fórceps (OR=3,761; IC 95 por cento 1,824-7,754) constituíram fatores associados ao desfecho neonatal desfavorável. Discussão: Os fatores independentemente associados ao desfecho neonatal desfavorável na Região Sudeste do Brasil foram em sua maioria condições clínicas que têm influência sobre a condição do recém-nascido no período pós-parto imediato. Recém-nascidos com baixo peso e aqueles filhos de mulheres com problemas obstétricos têm condições como líquido amniótico reduzido ou insuficiência placentária que resultam em alterações da vitalidade. Mulheres com baixa escolaridade têm maior dificuldade em acessar os serviços de saúde, o que pode dificultar a identificação e tratamento de problemas obstétricos e baixo peso ao nascer. O parto fórceps pode representar a resolução de trabalhos de parto distócicos e também ser um marcador para os fetos cuja vitalidade encontrava-se alterada durante o trabalho de parto. Conclusões: Fatores clínicos e associados a desigualdades sociais têm impacto negativo sobre a vitalidade dos recém-nascidos. Os desfechos neonatais desfavoráveis ainda são pouco investigados, por isso ações que visem à melhoria da atenção pré-natal e do trabalho de parto, principalmente entre mulheres com baixa escolaridade e aquelas com complicações obstétricas, podem resultar em melhores desfechos de saúde para o recém-nascido. Encontramos uma proporção de 9,6 por cento (844) entre os recém-nascidos no termo gestacional que apresentaram desfecho neonatal desfavorável. Neste estudo foi possível observar a existência de associação entre fatores sociodemográficos, clínicos e assistenciais maternos e desfechos neonatais desfavoráveis entre os RNs de termo / Introduction: Childbirth care in Brazil has faced challenges in recent years to reduce unnecessary and unsafe practices. However, measures used to accelerate labour and other interventions during labour and delivery are still frequent and may negatively impact the vitality of the newborn. Objectives: To analyze the association between sociodemographic, organizational, obstetric and care factors and unfavorable neonatal outcomes among term newborns and to estimate the frequency of these outcomes. Method: A cross-sectional study, based on data from the national survey \"Birth in Brazil\" in the the Southeast region of Brazil. The sample consisted of mothers who had live births, stillbirths (weight 500 grams and / or gestational age 22 weeks) in hospitals with 500 births in 2011 and 2012. Premature babies, twins, preterm newborns and those with malformations were excluded from the analysis. The dependent variable \"unfavorable neonatal outcome\" was constructed through the composition of the variables tracheal intubation, cardiac massage, drug use in neonatal resuscitation, neonatal ICU admission, and Apgar <7 at the 5th minute of life in the immediate postnatal period. The association between the variables of interest and the outcome variable was estimated using univariate and multiple binary logistic regression, calculating crude and adjusted Odds Ratio (OR) with 95 per cent confidence intervals (95 per cent CI). Results: The sample consisted of 8,773 women and their newborns. The proportion of newborns who presented an unfavorable neonatal outcome was 9.6 per cent (844). Incomplete primary education (OR = 2.139, 95 per cent CI 1.292-3.540), low birth weight (weight 2.500g, OR = 2.822, 95 per cent CI 1.641-4.851), obstetric complication (OR = 1.421, 95 per cent CI 1.055-1.914) and Forceps (OR = 3.761, 95 per cent CI, 1.824-7.754) were factors associated with unfavorable neonatal outcome. Discussion: Factors independently associated with unfavorable neonatal outcomes in the Southeast Region of Brazil were mostly clinical conditions that influence the condition of the newborn in the immediate postpartum period. Infants with low birth weight and those of women with obstetric problems have conditions such as reduced amniotic fluid or placental insufficiency that result in changes in vitality. Women with low schooling have greater difficulty in accessing health services, which make it difficult to identify and treat obstetric problems and low birth weight. Forceps delivery may represent resolution of dystocic labor and was also be a marker for fetuses whose vitality was altered during labor. Conclusions: Clinical factors associated with social inequalities have a negative impact on the vitality of newborns. Negative neonatal outcomes are still poorly investigated, so actions aimed at improving prenatal care and labor, especially among women with low schooling and those with obstetric complications, may result in better health outcomes for the newborn. We found a proportion of 9.6 per cent (844) among neonates in the gestational term who presented an unfavorable neonatal outcome. In this study it was possible to observe the existence of an association between sociodemographic, clinical and maternal care factors and unfavorable neonatal outcomes among the term newborns

Introdução: A assistência ao parto no Brasil tem enfrentado desafios nos últimos anos, no sentido de reduzir práticas desnecessárias e inseguras. No entanto, medidas utilizadas para acelerar o trabalho de parto e demais intervenções durante o trabalho de parto e parto ainda são frequentes e podem impactar negativamente as condições de vitalidade do recém-nascido. Objetivos: Analisar a associação entre os fatores sociodemográficos, organizacionais, obstétricos e assistenciais e desfecho neonatal desfavorável entre RNs de termo e estimar sua frequência. Método: Estudo transversal, a partir dos dados do inquérito nacional Nascer no Brasil, referentes à região Sudeste. A amostra foi composta por puérperas que tiveram RNs vivos, natimortos (peso 500 gramas e/ou idade gestacional 22 semanas), nascidos em hospitais com 500 partos em 2011 e 2012. Foram excluídos os recém-nascidos prematuros, gemelares e aqueles com malformações. A variável dependente desfecho neonatal desfavorável foi construída por meio da composição das variáveis intubação traqueal, massagem cardíaca, uso de drogas na reanimação neonatal, internação em UTI neonatal e Apgar <7 no 5.o minuto de vida no período pós-natal imediato. A associação entre as variáveis de interesse e a variável desfecho foi estimada por meio de regressão logística binária univariada e múltipla, calculando-se Odds ratio (OR) brutas e ajustadas com intervalos de confiança de 95 por cento (IC 95 por cento ). Resultados: A amostra foi composta por 8.783 mulheres e seus RNs. A proporção de RNs que apresentou desfecho neonatal desfavorável foi de 9,6 por cento (844). Ensino fundamental incompleto (OR=2,139; IC 95 por cento 1,292-3,540), baixo peso ao nascer (peso 2.500g; OR=2,822; IC 95 por cento 1,641-4,851), intercorrência obstétrica (OR=1,421; IC 95 por cento 1,055-1,914) e parto fórceps (OR=3,761; IC 95 por cento 1,824-7,754) constituíram fatores associados ao desfecho neonatal desfavorável. Discussão: Os fatores independentemente associados ao desfecho neonatal desfavorável na Região Sudeste do Brasil foram em sua maioria condições clínicas que têm influência sobre a condição do recém-nascido no período pós-parto imediato. Recém-nascidos com baixo peso e aqueles filhos de mulheres com problemas obstétricos têm condições como líquido amniótico reduzido ou insuficiência placentária que resultam em alterações da vitalidade. Mulheres com baixa escolaridade têm maior dificuldade em acessar os serviços de saúde, o que pode dificultar a identificação e tratamento de problemas obstétricos e baixo peso ao nascer. O parto fórceps pode representar a resolução de trabalhos de parto distócicos e também ser um marcador para os fetos cuja vitalidade encontrava-se alterada durante o trabalho de parto. Conclusões: Fatores clínicos e associados a desigualdades sociais têm impacto negativo sobre a vitalidade dos recém-nascidos. Os desfechos neonatais desfavoráveis ainda são pouco investigados, por isso ações que visem à melhoria da atenção pré-natal e do trabalho de parto, principalmente entre mulheres com baixa escolaridade e aquelas com complicações obstétricas, podem resultar em melhores desfechos de saúde para o recém-nascido. Encontramos uma proporção de 9,6 por cento (844) entre os recém-nascidos no termo gestacional que apresentaram desfecho neonatal desfavorável. Neste estudo foi possível observar a existência de associação entre fatores sociodemográficos, clínicos e assistenciais maternos e desfechos neonatais desfavoráveis entre os RNs de termo / Introduction: Childbirth care in Brazil has faced challenges in recent years to reduce unnecessary and unsafe practices. However, measures used to accelerate labour and other interventions during labour and delivery are still frequent and may negatively impact the vitality of the newborn. Objectives: To analyze the association between sociodemographic, organizational, obstetric and care factors and unfavorable neonatal outcomes among term newborns and to estimate the frequency of these outcomes. Method: A cross-sectional study, based on data from the national survey \"Birth in Brazil\" in the the Southeast region of Brazil. The sample consisted of mothers who had live births, stillbirths (weight 500 grams and / or gestational age 22 weeks) in hospitals with 500 births in 2011 and 2012. Premature babies, twins, preterm newborns and those with malformations were excluded from the analysis. The dependent variable \"unfavorable neonatal outcome\" was constructed through the composition of the variables tracheal intubation, cardiac massage, drug use in neonatal resuscitation, neonatal ICU admission, and Apgar <7 at the 5th minute of life in the immediate postnatal period. The association between the variables of interest and the outcome variable was estimated using univariate and multiple binary logistic regression, calculating crude and adjusted Odds Ratio (OR) with 95 per cent confidence intervals (95 per cent CI). Results: The sample consisted of 8,773 women and their newborns. The proportion of newborns who presented an unfavorable neonatal outcome was 9.6 per cent (844). Incomplete primary education (OR = 2.139, 95 per cent CI 1.292-3.540), low birth weight (weight 2.500g, OR = 2.822, 95 per cent CI 1.641-4.851), obstetric complication (OR = 1.421, 95 per cent CI 1.055-1.914) and Forceps (OR = 3.761, 95 per cent CI, 1.824-7.754) were factors associated with unfavorable neonatal outcome. Discussion: Factors independently associated with unfavorable neonatal outcomes in the Southeast Region of Brazil were mostly clinical conditions that influence the condition of the newborn in the immediate postpartum period. Infants with low birth weight and those of women with obstetric problems have conditions such as reduced amniotic fluid or placental insufficiency that result in changes in vitality. Women with low schooling have greater difficulty in accessing health services, which make it difficult to identify and treat obstetric problems and low birth weight. Forceps delivery may represent resolution of dystocic labor and was also be a marker for fetuses whose vitality was altered during labor. Conclusions: Clinical factors associated with social inequalities have a negative impact on the vitality of newborns. Negative neonatal outcomes are still poorly investigated, so actions aimed at improving prenatal care and labor, especially among women with low schooling and those with obstetric complications, may result in better health outcomes for the newborn. We found a proportion of 9.6 per cent (844) among neonates in the gestational term who presented an unfavorable neonatal outcome. In this study it was possible to observe the existence of an association between sociodemographic, clinical and maternal care factors and unfavorable neonatal outcomes among the term newborns

Aim: Despite the lack of evidence, current resuscitation guidelines recommend tactile stimulation in apneic infants within the first minutes of life. The aim was to investigate whether timing, duration or intensity of tactile stimulation influences the extent of non-invasive respiratory support in extremely preterm infants during neonatal resuscitation. Methods: In an observational study, we analyzed 47 video recordings and physiological parameters during postnatal transition in preterm infants below 320/7 weeks of gestational age. Infants were divided into three groups according to the intensity of respiratory support. Results: All infants were stimulated at least once during neonatal resuscitation regardless of their respiratory support. Only 51% got stimulated within the first minute. Rubbing the feet was the preferred stimulation method and was followed by rubbing or touching the chest. Almost all very preterm infants were exposed to stimulation and manipulation most of the time within their first 15 min of life. Tactile stimulation lasted significantly longer but stimulation at multiple body areas started later in infants receiving prolonged non-invasive respiratory support. Conclusion: This observational study demonstrated that stimulation of very preterm infants is a commonly used and easy applicable method to stimulate spontaneous breathing during neonatal resuscitation. The concomitant physical stimulation of different body parts and therefore larger surface areas might be beneficial.