Marked variation in newborn resuscitation practice: A national survey in the UK

• Published in: Resuscitation 2012-05, Vol.83 (5), p.607-611
• Main Authors: Mann, Chantelle, Ward, Carole, Grubb, Mark, Hayes-Gill, Barrie, Crowe, John, Marlow, Neil, Sharkey, Don
• Format: Article
• Language: English
• Subjects: Body Temperature; Clinical Paper; Continuous Positive Airway Pressure - utilization; Delivery Rooms; Emergency; Humans; Infant, Newborn; Intensive Care, Neonatal - methods; Neonatal resuscitation; Oxygen Inhalation Therapy - utilization; Practice variation; Resuscitation - methods; Resuscitation - standards; Survey; Surveys and Questionnaires; United Kingdom
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2012.01.002

Abstract Background Although international newborn resuscitation guidance has been in force for some time, there are no UK data on current newborn resuscitation practices. Objective Establish delivery room (DR) resuscitation practices in the UK, and identify any differences between neonatal intensive care units (NICU), and other local neonatal services. Methods We conducted a structured two-stage survey of DR management, among UK neonatal units during 2009–2010 ( n = 192). Differences between NICU services (tertiary level) and other local neonatal services (non-tertiary) were analysed using Fisher's exact and Student's t -tests. Results There was an 89% response rate ( n = 171). More tertiary NICUs institute DR CPAP than non-tertiary units (43% vs. 16%, P = 0.0001) though there was no significant difference in frequency of elective intubation and surfactant administration for preterm babies. More tertiary units commence DR resuscitation in air (62% vs. 29%, P < 0.0001) and fewer in 100% oxygen (11% vs. 41%, P < 0.0001). Resuscitation of preterm babies in particular, commences with air in 56% of tertiary units. Significantly more tertiary units use DR pulse oximeters (58% vs. 29%, P < 0.01) and titrate oxygen based on saturations. Almost all services use occlusive wrapping to maintain temperature for preterm infants. Conclusions In the UK, there are many areas of good evidence based DR practice. However, there is marked variation in management, including between units of different designation, suggesting a need to review practice to fulfil new resuscitation guidance, which will have training and resource implications.