Georg Schmölzer

Georg Schmölzer
Royal Alexandra Hospital · Neonatal Research Unit

M.D., Ph.D.

About

398
Publications
77,336
Reads
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7,044
Citations
Citations since 2016
245 Research Items
5518 Citations
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Additional affiliations
July 2014 - present
Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital
Position
  • Research Director
April 2012 - present
Position
  • NRP (Neonatal Resuscitation Program)
March 2012 - June 2014
Royal Alexandra Hospital
Position
  • PostDoc Position

Publications

Publications (398)
Article
Full-text available
To assess the role of nasal continuous positive airway pressure (CPAP) initiated at birth for prevention of death and bronchopulmonary dysplasia in very preterm infants. Systematic review. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and online Pediatric Academic Society abstracts from the year of inception to June 2013. Rand...
Article
Full-text available
Guidelines on neonatal resuscitation recommend 90 chest compressions (CC) and 30 manual inflations (3:1) per minute in newborns. The study aimed to determine if CC s during sustained inflations (SI) improves recovery of asphyxiated newborn piglets compared to coordinated 3:1 resuscitation. Term newborn piglets (n=8/group) were anesthetized, intubat...
Article
Full-text available
As neonatal resuscitation critically depends upon lung aeration at birth, knowledge of the progression of this process is required to guide ongoing care. We investigated whether expired CO2 (ECO2) levels indicate the degree of lung aeration immediately after birth in two animal models and in preterm infants. Lambs were delivered by caesarean sectio...
Article
Full-text available
Background Respiratory distress is common during transition after birth, but the effect of continuous positive airway pressure applied in the delivery room has not been systematically evaluated in spontaneously breathing term and ≥34⁺⁰ weeks’ gestation infants. We aimed to compare delivery room continuous positive airway pressure with no delivery r...
Article
Full-text available
Background: To compare chest compression (CC) rates of 90/min with 180/min and their effect on the time to return of spontaneous circulation (ROSC), survival, hemodynamic, and respiratory parameters. We hypothesized that asphyxiated newborn piglets that received CC at 180/min vs. 90/min during cardiopulmonary resuscitation would have a shorter time...
Article
Full-text available
Background: During pediatric cardiopulmonary resuscitation (CPR), resuscitation guidelines recommend 100% oxygen (O2); however, the most effective O2 concentration for infants unknown. Aim: We aimed to determine if 21% O2 during CPR with either chest compression (CC) during sustained inflation (SI) (CC + SI) or continuous chest compression with asy...
Article
Background and objectives: Positive pressure ventilation (PPV) is the most important component of neonatal resuscitation, but face mask ventilation can be difficult. Compare supraglottic airway devices (SA) with face masks for term and late preterm infants receiving PPV immediately after birth. Methods: Data sources include Medline, Embase, Coch...
Article
Background Delayed cord clamping (DCC) and umbilical cord milking (UCM) provide placental transfusion to vigorous newborns. Delayed cord clamping in non-vigorous newborns may not be provided due to perceived need for immediate resuscitation. UCM is an alternative since it can be performed more quickly than DCC and may confer similar benefits. Obje...
Article
Background: Internationally recognized guidelines recommend the judicious use of low oxygen (21-30%), titrated to peripheral oxygen saturation targets, for the initiation of resuscitation of very and extremely preterm infants (<32 weeks' gestation). However, despite more than 10 randomized controlled trials on this question, the ideal initial oxyg...
Article
Full-text available
We present a novel approach of ventilation, using high-frequency oscillation ventilation (HFOV), during neonatal cardiopulmonary resuscitation (CPR) of a very preterm neonate. This case report highlights the importance of adequate lung inflation, which is a current topic, with neonatal resuscitation guidelines recommending a coordinated 3:1 compres...
Article
Prolonged resuscitation in neonates, although quite rare, may occur in response to profound intractable bradycardia as a result of asphyxia. In these instances, chest compressions and medications may be necessary to facilitate return of spontaneous circulation. While performing chest compressions, the two thumb method is preferred over the two fing...
Article
Full-text available
Objective To compare short term respiratory outcomes in preterm infants treated with bovine lipid extract surfactant or poractant alfa. Study design Prospective comparative effectiveness cohort study of infants <32 weeks’ gestational age requiring surfactant in thirteen centers. Each center provided bovine lipid extract surfactant for a set period...
Article
Full-text available
In order to predict which newborns will require advanced resuscitation (ANR), we developed an ANR risk calculator ( calculator .) using a bootstrap sample size of 52 973 from a case–control study of newborns ≥34 weeks gestation. Multivariable logistic regression coefficients were obtained for the 10 original risk factors and two interaction terms....
Article
Background Current neonatal resuscitation guidelines recommend that chest compressions (CCs) be delivered at a rate of 90/min. The aim of the study was to investigate the haemodynamic effects of different CC rates in a neonatal piglet model. Methods Six asphyxiated piglets were randomised to CC with rates of 60/min, 90/min, 120/min, 150/min and 18...
Article
Importance Animal and observational human studies report that delivery of excessive tidal volume (V T ) at birth is associated with lung and brain injury. Using a respiratory function monitor (RFM) to guide V T delivery might reduce injury and improve outcomes. Objective To determine whether use of an RFM in addition to clinical assessment versus...
Article
Importance The benefits of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome are uncertain. Objective To examine the effect of selective application of MIST at a low fraction of inspired oxygen threshold on survival without bronchopulmonary dysplasia (...
Preprint
Full-text available
Background To compare chest compression (CC) rates of 90/min with 180/min and their effect on the time to return of spontaneous circulation (ROSC), survival, hemodynamic, and respiratory parameters. We hypothesized that asphyxiated newborn piglets that received CC at 180/min vs. 90/min during cardiopulmonary resuscitation would have a shorter time...
Article
Key points • To successfully complete fetal-to-neonatal transition newborn infants have to undergo physiologic changes including lung liquid clearance, generation of functional residual capacity, and start of breathing to enable gas exchange and tissue oxygenation. • Failed or incomplete immediate transition indicates provision of medical support...
Article
Full-text available
Background The feasibility and benefits of continuous sustained inflations (SIs) during chest compressions (CCs) during delayed cord clamping (physiological-based cord clamping; PBCC) are not known. We aimed to determine whether continuous SIs during CCs would reduce the time to return of spontaneous circulation (ROSC) and improve post-asphyxial bl...
Article
Full-text available
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Tre...
Poster
BACKGROUND Results RESULTS Neonatal resuscitation guidelines recommend epinephrine administration during cardiopulmonary resuscitation (CPR)-to elevate coronary perfusion pressure (CPP) and to allow more oxygenated blood to enter the coronary arteries, which improves myocardial blood flow. However, no study has assessed the effects of epinephrine o...
Article
Full-text available
There is a need for feasible and non-invasive diagnostics in perinatal asphyxia. Metabolomics is the study of small molecular weight products of cellular metabolism that may, directly and indirectly, reflect the level of oxidative stress. Saliva analysis is a novel approach that has a yet unexplored potential in metabolomics in perinatal asphyxia....
Article
Full-text available
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Tre...
Article
Full-text available
Background: Optimal starting oxygen concentration for delivery room resuscitation of extremely preterm infants (<29 weeks) remains unknown, with recommendations of 21-30% based on uncertain evidence. Individual patient randomized trials designed to answer this question have been hampered by poor enrolment. Hypothesis: It is feasible to compare 3...
Article
Full-text available
Premature infants born after less than 25 weeks’ gestation are particularly vulnerable at birth and stabilization in the delivery room (DR) is challenging. After birth, infants born after <25 weeks’ gestation develop respiratory and hemodynamic instability due to their immature physiology and anatomy. Successful stabilization at birth has the poten...
Article
Aim: To determine clinician opinion regarding oxygen management in moderate-late preterm resuscitation. Methods: An anonymous online questionnaire was distributed through email/social messaging platforms to neonatologists in 21 countries (October 2020-March 2021) via REDCap. Results: Of the 695 respondents, 69% had access to oxygen blenders an...
Article
Full-text available
Background: Differences in management and outcomes of extremely preterm infants have been reported across European countries. Implementation of standardized guidelines and interventions within existing neonatal care facilities can improve outcomes of extremely preterm infants. This study evaluated whether a multifactorial educational training (MET)...
Article
Objective Intraosseous access is recommended as a reasonable alternative for vascular access during newborn resuscitation if umbilical access is unavailable, but there are minimal reported data in newborns. We compared intraosseous with intravenous epinephrine administration during resuscitation of severely asphyxiated lambs at birth. Methods Near...
Article
Objective To assess the reliability, accuracy and precision of distal end-tidal capnography (detCO 2 ) in neonates compared with transcutaneous (tcCO 2 ) carbon dioxide measurements. Design Observational, prospective clinical study. Setting Neonatal intensive care unit at Medical University of Vienna. Participants Conventionally ventilated neona...
Article
Neonatal encephalopathy due to a hypoxic-ischemic event is commonly associated with cardiac dysfunction and acute pulmonary hypertension; both therapeutic hypothermia and rewarming modify loading conditions and blood flow. The pathophysiological contributors to disease are complex with a high degree of clinical overlap and traditional bedside measu...
Article
Objective To characterize respiratory function monitor (RFM) measurements of sustained inflations and intermittent positive pressure ventilation (IPPV) delivered non-invasively to infants in the Sustained Aeration of Infant Lungs (SAIL) trial and to compare vital sign measurements between treatment arms. Study design We analyzed RFM data from SAIL...
Article
Aim The study aimed to examine the optimal anterior-posterior depth which will reduce the time to return of spontaneous circulation and improve survival during chest compressions. Asphyxiated neonatal piglets receiving chest compression resuscitated with a 40% anterior-posterior chest depth compared with 33%, 25% or 12.5% will have reduced time to...
Article
Background Chest compression (CC) during sustained inflations (CC+SI) compared with CC with asynchronized ventilation (CCaV) during cardiopulmonary resuscitation in asphyxiated pediatric piglets will reduce time to return of spontaneous circulation (ROSC). Methods and Results Piglets (20–23 days of age, weighing 6.2–10.2 kg) were anesthetized, int...
Article
Full-text available
Severe desaturation or bradycardia often occur during neonatal endotracheal intubation. Using continuous gas flow through the endotracheal tube might reduce the incidence of these events. We hypothesized that continuous gas flow through the endotracheal tube during nasotracheal intubation compared to standard nasotracheal intubation will reduce the...
Article
Context: Positive pressure ventilation (PPV) is the most important intervention during neonatal resuscitation. Objective: To compare T-piece resuscitators (TPRs), self-inflating bags (SIBs), and flow-inflating bags for newborns receiving PPV during delivery room resuscitation. Data sources: Medline, Embase, Cumulative Index to Nursing and Alli...
Article
Full-text available
Aim We aimed to describe the cognitive processes of healthcare providers participating as airway leads in delivery room neonatal resuscitations using eye-tracking assisted debriefing to facilitate recall and provide situational context. Methods Delivery room neonatal resuscitations were recorded using eye-tracking glasses worn by participants who...
Article
Full-text available
Approximately 800,000 newborns die annually due to birth asphyxia. The resuscitation of asphyxiated term newly born infants often occurs unexpected and is challenging for healthcare providers as it demands experience and knowledge in neonatal resuscitation. Current neonatal resuscitation guidelines often focus on resuscitation of extremely and/or v...
Article
Full-text available
Aim of the study Analysis of the impact of bradycardia and hypoxemia on the course of cerebral and peripheral oxygenation parameters in preterm infants in need for respiratory support during foetal-to-neonatal transition. Methods The first 15 minutes after birth of 150 preterm neonates in need for respiratory support born at the Division of Neonat...
Article
Full-text available
Background: Bi-level noninvasive ventilation (NIV) has been used in respiratory distress syndrome (RDS) as primary treatment, post-extubation, and to treat apnea. This review summarizes studies on bi-level NIV in premature infants with RDS. Nonsynchronized nasal intermittent positive pressure ventilation (nsNIPPV) and synchronized NIPPV (SNIPPV) u...
Article
Context: The International Liaison Committee on Resuscitation prioritized scientific review of umbilical cord management at term and late preterm birth. Objective: To assess effects of umbilical cord management strategies (clamping timing and cord milking) in infants ≥34 weeks' gestational age. Data sources: Cochrane Central Register of Contro...
Article
Context: The International Liaison Committee on Resuscitation prioritized scientific review of umbilical cord management strategies at preterm birth. Objective: To determine the effects of umbilical cord management strategies (including timing of cord clamping and cord milking) in preterm infants <34 weeks' gestation. Data sources: Cochrane Ce...
Article
Full-text available
Respiratory failure is a common condition faced by critically ill neonates with respiratory distress syndrome (RDS). High frequency oscillatory ventilation (HFOV) is often used for neonates with refractory respiratory failure related to RDS. Volume guarantee (VG) mode has been added to some HFOV ventilators for providing consistent tidal volume. We...
Article
Background Current neonatal resuscitation guidelines recommend chest compressions (CCs) should be delivered to a depth of approximately 1/3 of the anterior–posterior (AP) chest diameter. The aim of the study was to investigate the haemodynamic effects of different CC depths in a neonatal piglet model. Methods CCs were performed with an automated C...
Article
Full-text available
Approximately 0.1% for term and 10–15% of preterm infants receive chest compression (CC) in the delivery room, with high incidence of mortality and neurologic impairment. The poor prognosis associated with receiving CC in the delivery room has raised concerns as to whether specifically-tailored cardiopulmonary resuscitation methods are needed. The...
Article
Context Parent/family presence at pediatric resuscitations has been slow to become consistent practice in hospital settings and has not been universally implemented. A systematic review of the literature on family presence during pediatric and neonatal resuscitation has not been previously conducted. Objective To conduct a systematic review of the...
Article
Full-text available
Objective: Pulseless electrical activity (PEA) occurs in asphyxiated newborn piglets and infants. We aimed to examine whether different cardiac rhythms (asystole, bradycardia, PEA) affects the resuscitation outcomes during continuous chest compressions (CC) during sustained inflations (CC+SI). Design: This study is a secondary analysis of four prev...
Article
Full-text available
Background: Simulation education can benefit healthcare providers (HCPs) by providing opportunities to practice complex neonatal-resuscitation tasks in low-stake environments. To our knowledge, no study investigated the role of growth mindset on longitudinal performance on neonatal resuscitation before and after simulation-based training. Objective...
Article
It is recommended to delay cord clamping in healthy term infants for at least 60- and 180-seconds in high- and limited-resource environments, as delayed cord clamping lowers the incidence of anemia and iron deficiency and improves neurodevelopment. There are improvements in hemodynamic parameters such as peripheral arterial oxygen saturation, heart...
Article
Importance The current neonatal resuscitation guidelines recommend positive pressure ventilation via face mask or nasal prongs at birth. Using a nasal interface may have the potential to improve outcomes for newborn infants. Objective To determine whether nasal prong/nasopharyngeal tube versus face mask during positive pressure ventilation of infa...
Article
Full-text available
Purpose: To safely care for their newborn patients, health-care professionals (HCP) must undergo frequent training to improve and maintain neonatal resuscitation knowledge and skills. However, the current approach to neonatal resuscitation simulation training is time and resource-intensive, and often inaccessible. Digital neonatal resuscitation sim...
Article
Full-text available
Background: Eye exam for Retinopathy of prematurity (ROP) is a painful procedure and pharmacological analgesia might be ineffective. We hypothesized that magnetic auricular acupuncture (MAA) compared to placebo will decrease pain during ROP exam in preterm infants. Methods: Multicentre randomized controlled trial conducted in three hospitals (Austr...
Article
Context: The International Liaison Committee on Resuscitation prioritized review of sustained inflation (SI) of the lung at birth. Objective: To complete a systematic review and meta-analysis comparing strategies using 1 or more SI ≥1 second with intermittent inflations <1 second for newborns at birth. Data sources: Medline, Embase, and Eviden...
Article
Full-text available
Objective: Human errors or protocol deviations during neonatal resuscitation are common. Excess workload has been proposed as a contributor to human error during medical tasks. We aim to characterize healthcare providers' perceived workload during neonatal resuscitation. Design: Perceived workload was measured using a multi-dimensional retrospectiv...
Article
Full-text available
Background Neonatal resuscitation involves a complex sequence of actions to establish an infant’s cardiorespiratory function at birth. Many of these responses, which identify the best action sequence in each situation, are taught as part of the recurrent Neonatal Resuscitation Program training, but they have a low incidence in practice, which leave...
Article
Full-text available
Background: Male newborns have a greater risk of poor cardiovascular and respiratory outcomes compared to females. The mechanisms associated with the “male disadvantage” remains unclear. We have previously shown no difference between male and female newborn piglets during hypoxia, asphyxia, resuscitation, and post-resuscitation recovery. However, i...
Article
Background: Pediatric resuscitation guidelines recommend continuous chest compressions (CC) with asynchronized ventilation (CCaV) during cardiopulmonary resuscitation (CPR) once an airway has been secured. However, the optimal CC technique remains unknown. Aim: To determine if CCs during sustained inflations (SI) improves return of spontaneous circ...
Article
Introduction: Neonatal chest compression (CC) should be performed to a 1/3 anterior-posterior (AP) chest diameter depth, however, the optimal AP depth is unknown. Hypothesis: We hypothesized that in asphyxiated neonatal piglets a 40% AP depth compared to 1/3, or 1/4 AP depth will reduce time to achieve return of spontaneously circulation and improv...
Article
Full-text available
Background: Frequent and objective summative assessment of neonatal healthcare providers is important to ensure high-quality care to patients during neonatal resuscitation. Currently, neonatal resuscitation providers are only individually assessed using an at-home online multiple-choice questionnaire. While simulation-based assessment is preferred,...
Article
Objective This study aimed to determine whether outcomes differed between infants enrolled in the PREMOD2 trial and those otherwise eligible but not enrolled, and whether the use of waiver effected these differences. Study Design The multicenter PREMOD2 (PREmature infants receiving Milking Or Delayed cord clamping) trial was approved for waiver of...