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

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.

Fig. 1

Graph summarising routine ventilatory support provided by UK neonatal units in the delivery room (DR), as percentage of responding units (tertiary NICUs, n = 65; non-tertiary local neonatal units and Special Care Units, n = 106). Actual numbers of units displayed as N = (x), *P < 0.05, ***P < 0.001.

Fig. 2

Graph displaying the specific supplemental oxygen concentrations used by 62 tertiary NICUs, when commencing resuscitation for preterm babies. Actual numbers of units displayed as N = (x). ‘Various’ refers to those services which allow individual practice variation.

Fig. 3

Graph displaying modalities routinely used to assess heart rate in the DR, according to unit designation. Data displayed as percentages of each level service respectively (tertiary NICUs, n = 65; non-tertiary local neonatal units and Special Care Units, n = 106). Actual numbers of units displayed as N = (x).