Assessment of tourism activity in the Great Barrier Reef Marine Park Region

This report contains an assessment of current tourism activity and expenditure trends in the Great Barrier Reef Marine Park (GBRMP, mainland and adjacent islands combined) region. Estimates of tourism generated employment are also provided as well as a brief summary of investment

Oxygen saturation after birth in resuscitated neonates in Uganda: A video-based observational study

Background Monitoring of peripheral capillary oxygen saturation (SpO 2) during neonatal resuscitation is standard of care in high-resource settings, but seldom performed in low-resource settings. We aimed to measure SpO 2 and heart rate during the first 10 min of life in neonates receiving positive pressure ventilation (PPV) according to the Helping Babies Breathe (HBB) protocol and compare results with SpO 2 and heart rate targets set by the American Heart Association (AHA). Methods A cross-sectional study was conducted at Mulago National Referral Hospital, Kampala, Uganda, as a substudy of the NeoSupra Trial. SpO 2 and heart rate were measured on apnoeic neonates (≥34 weeks) who received PPV according to HBB (room air). Those who remained distressed after PPV received supplemental oxygen (O 2). All resuscitations were video recorded and data were extracted by video review at 1 min intervals until 10 min post partum. Data were analysed for all observations and separately for only observations before and during PPV. Results 49 neonates were analysed. Median SpO 2 at 5 min (n=39) was 67% (49-88) with 59% of the observations below AHA target of 80%. At 10 min median SpO 2 (n=44) was 93% (80-97) and 32% were below AHA target of 85%. When only observations before and during PPV were analysed, median SpO 2 at 5 min (n=18) was 52% (34-66) and 83% were below AHA target. At 10 min (n=15), median SpO 2 was 72% (57-89) and 67% were below AHA target. Median heart rates were above AHA target of 100 beats/min at all time intervals. Conclusions A high proportion of neonates resuscitated with PPV after birth failed to reach the AHA SpO 2 target in this small sample, implying an increased risk of hypoxic-ischaemic encephalopathy. Further studies in low-resource settings are needed to evaluate baseline data and the need for supplemental O 2 and optimal SpO 2 during PPV. Trial registration number This is a substudy to the trial â € Neonatal Resuscitation with Supraglottic Airway Trial (NeoSupra)'; ClinicalTrials.gov Registry (NCT03133572)

Respiratory monitoring during neonatal resuscitation using a supraglottic airway device vs. a face mask

Objective: To evaluate the respiratory function of asphyxiated infants resuscitated with i-gel supraglottic airway (SGA) vs. face mask (FM) in a low-resource setting. Methods: In this sub-study from the NeoSupra trial, respiratory function during the first 60 inflations was evaluated in 46 neonates (23 with SGA and 23 with FM) at the Mulago National Referral Hospital, Uganda. The primary outcome was the mask leak (%). The secondary outcomes included inspired (VTi) and expired (VTe) tidal volumes, and heart rate response to ventilation. Results: Median mask leak was 40% (IQR 22–52) with SGA and 39% (IQR 26–62) with FM (p = 0.38). Median VTe was 7.8 ml/kg (IQR 5.6–10.2) with SGA and 7.3 ml/kg (IQR 4.8–11.9) with FM (p = 0.84), while median VTi was 15.4 ml/kg (IQR 11–4-17.6) with SGA and 15.9 ml/kg (IQR 9.0–22.6) with FM (p = 0.68). A shorter time was needed to achieve heart rate > 100 bpm in SGA (median 13 s IQR 9–15) with respect to FM arm (median 61, IQR 33–140) (p = 0.0002). Conclusion: Respiratory function was not statistically different between neonates resuscitated with SGA vs. FM. SGA was associated with faster heart rate recovery compared to FM in the subgroup of neonates with bradycardia. Further research is needed to investigate possible advantages of SGA on respiratory function at birth