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Physical stimulation of newborn infants in the delivery room
  1. Vincent D Gaertner1,2,3,
  2. Sophie A Flemmer1,2,3,
  3. Laila Lorenz1,4,
  4. Peter G Davis1,2,5,
  5. C Omar Farouk Kamlin1,2,5
  1. 1 Neonatal Services, The Royal Women’s Hospital, Parkville, Victoria, Australia
  2. 2 Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
  3. 3 School of Medicine, University Medical Center Regensburg, Regensburg, Germany
  4. 4 Department of Neonatology, University Children’s Hospital of Tübingen, Tübingen, Germany
  5. 5 Clinical Sciences Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  1. Correspondence to Dr C Omar Farouk Kamlin, Neonatal Services, The Royal Women’s Hospital, Corner Grattan Street and Flemington Road, Parkville, VIC 3052, Australia; omar.kamlin{at}


Objective Neonatal resuscitation guidelines recommend that newborn infants are stimulated to assist with the establishment of regular respirations. The mode, site of application and frequency of stimulations are not stipulated in these guidelines. The effectiveness of stimulation in improving neonatal transition outcomes is poorly described.

Methods We conducted a retrospective review of video recordings of neonatal resuscitation at a tertiary perinatal centre. Four different types of stimulation (drying, chest rub, back rub and foot flick) were defined a priori and the frequency and infant response were documented.

Results A total of 120 video recordings were reviewed. Seventy-five (63%) infants received at least one episode of stimulation and 70 (58%) infants were stimulated within the first minute after birth. Stimulation was less commonly provided to infants <30 weeks’ gestation (median (IQR) number of stimulations: 0 (0–1)) than infants born ≥30 weeks’ gestation (1 (1–3); p<0.001). The most common response to stimulation was limb movement followed by infant cry and facial grimace. Truncal stimulation (drying, chest rub, back rub) was associated with more crying and movement than foot flicks.

Conclusion Less mature infants are stimulated less frequently compared with more mature infants and many very preterm infants do not receive any stimulation. Most infants were stimulated within the first minute as recommended in resuscitation guidelines. Rubbing the trunk may be most effective but this needs to be confirmed in prospective studies.

  • stimulation
  • neonate
  • resuscitation
  • respiratory support

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  • Contributors All authors were involved in planning, conducting and reporting of the work. VDG and SAF watched the videos, performed data analyses, interpreted data and wrote the first version of the manuscript. LL, COFK and PGD were involved in data interpretation as well as manuscript writing and supervised the project. All authors approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Due to the number of studied patients it is not possible to trace back the individual identities. We do not show any figures or videos of individual patients.

  • Ethics approval The Human Research and Ethics Committees of The Royal Women’s Hospital, Melbourne.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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