Elsevier

Resuscitation

Volume 83, Issue 5, May 2012, Pages 607-611
Resuscitation

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

https://doi.org/10.1016/j.resuscitation.2012.01.002Get rights and content
Under a Creative Commons license
open access

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.

Abbreviations

NICU
neonatal intensive care unit
DR
delivery room
ANNP
advanced neonatal nurse practitioner
PEEP
positive end expiratory pressure
CPAP
continuous positive airway pressure
NDAU
Neonatal Data Analysis Unit
NS
not statistically significant

Keywords

Neonatal resuscitation
Survey
Practice variation

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2012.01.002.