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Variation in current UK and international delivery room resuscitation practice

Presented at the Neonatal Society 2010 Summer Meeting (programme).

Mann C1, Ward C1, Hayes-Gill B2, Crowe J2, Marlow N3, Sharkey D1

1 Academic Child Health, School of Clinical Sciences, University of Nottingham, Nottingham, UK
2 Electrical and Electronic Engineering, University of Nottingham, Nottingham, UK
3 Institute for Women’s Health, UCL, London, UK

Background: Though advances in neonatal intensive care have significantly improved outcomes, very few studies have examined early delivery room (DR) management. Recent studies of DR care include avoidance of 100% oxygen for resuscitation, plastic wraps/bags for temperature regulation, early CPAP and the use of pulse oximetry. There is potential to develop and improve care during the crucial first minutes of life although data on current UK DR practice is lacking.

Aim: To establish current DR resuscitation practices of newborn term and preterm infants in the UK, in light of other available worldwide data.

Methods: We conducted a telephone/email/postal survey of DR management among neonatal units in the UK, from May to December 2009. Of the 192 units surveyed, 171 (89%) responded to the questionnaire. These comprised 65 level III (intensive care) units and 106 level II/I (high dependency/special care). Comparisons were drawn between units of differing level in the UK, and between the UK and other international surveys. Data were analysed using Fisher’s exact test.

Results: Within the UK there were significant differences in management between level III units and level I/II. More level III units use ventilation devices with PEEP (87% vs 78%, P=0.037) and institute DR CPAP (43% vs 16%, P<0.0001). More level III units commence resuscitation in air (49% vs 32%, P=0.01), with fewer commencing 100% oxygen (12% vs 40%, P<0.0001). Though significantly more level III units have DR pulse oximeters (58% vs 29%, P=0.0002), there is no statistical difference in their reported use during early resuscitation (23% vs 12%). There is similarly no statistical difference among use of plastic wraps/bags, preterm elective intubation, or DR surfactant. Comparisons of UK data with respect to published worldwide data are made below.

Table: International figures for DR management (blank boxes indicate data unavailable or not comparable)

Conclusion: These data highlight important differences in DR management between UK level III, often network lead units, and level I/II units. Whilst level III units appear to base practice on recent available evidence, uptake appears slower elsewhere. Despite recent advances in the management of newborns in the DR, variation observed both nationally and internationally, highlights discrepancies between resuscitation guidance and current DR practice. This neglected but important period requires prompt consideration, when setting research and funding priorities, to ensure optimal newborn resuscitation.

Acknowledgements: Funded by Action Medical Research and the MRC

1. Roehr et al (2009) Clinic for Neonatology, Berlin, in press.
2. Iriondo et al (2009) Acta Pædiatrica 98:786-91
3. Braima et al (2008) Irish Med J 101(5):142-44
4. O’Donnell et al (2004) J Paed Child Hlth 40:208-212
5. Leone et al (2006) Pediatrics 117 :e164-75
6. Trevisanuto et al (2006) Arch Dis Child FN 91:F123-24

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