The NEU-STIM Trial

Rationale: A randomised study demonstrated that preterm infants who received repetitive stimulation at birth (10 second episodes of stroking of the soles of the feet and/or back, followed by 10 seconds rest) showed an increase in respiratory effort. This may in turn improve clinical outcomes as improved breathing effort may reduce the need for invasive respiratory support. Tactile stimulation can be immediately and easily performed at birth at no extra cost. It therefore has great potential to be implemented in delivery rooms (DRs) worldwide.

Objective: To determine the effect of repetitive tactile stimulation compared to selective stimulation on oxygenation of the infant at 5 minutes after birth.

Study design: This is a stepped-wedge cluster randomised controlled trial. The participating centre, rather than the individual infant, will be the unit of randomisation. This design is appropriate to test the effect of an intervention that encompasses a behavioral aspect - in this case the performance of tactile stimulation.

Study population: Infants born before 32 weeks of gestation will be included in this trial.

Intervention: At the start of the study, each participating centre will perform selective tactile stimulation in accordance with international guidelines, as is their usual practice. Clinicians will gently rub the back, chest, extremities or soles of the feet if they consider the breathing of the infant to be insufficient or absent. In the second stage of the study, centres will be randomised to switch their stimulation approach to repetitive stimulation. Clinicians will then gently rub the back, chest, extremities or soles of the feet for 10 seconds. To avoid extinction of the stimulatory effect (reflex), every 10 second period of stimulation will be followed by 10 seconds of rest (no stimulation). Repetitive stimulation will be performed for the first 5 minutes of life, or longer if the breathing is still considered insufficient or absent.

Main study parameter: The proportion of infants with pre-ductal oxygen saturation (SpO2) ≥ 80%.

• Heart rate [Срок оценки: At 5 minutes after birth]
• Number of infants who received CPAP <10min [Срок оценки: Within 10 minutes after birth]
• Number of infants who received PPV <10min [Срок оценки: Within 10 minutes after birth]
• Number of infants who were intubated <10min [Срок оценки: Within 10 minutes after birth]
• Number of infants who received chest compressions <10min [Срок оценки: Within 10 minutes after birth]
• Number of infants who were administered adrenaline <10min [Срок оценки: Within 10 minutes after birth]
• Number of infants who were administered volume expansion <10min [Срок оценки: Within 10 minutes after birth]
• Max FiO2 [Срок оценки: In the first 10 minutes after birth]
• Death <10min [Срок оценки: Within 10 minutes after birth]
• Number of infants who were supported by CPAP in first week [Срок оценки: In the first week after birth]
• Number of infants who received surfactant in first week [Срок оценки: In the first week after birth]
• Surfactant doses [Срок оценки: In the first week after birth]