Quality improvement for neonatal resuscitation and delivery room care

Abstract

Quality improvement has become a foundation of neonatal care. Structured approaches to improvement can standardize practices, improve teamwork, engage families, and improve outcomes. The delivery room presents a unique environment for quality improvement; optimal delivery room care requires advanced preparation, adequately trained providers, and carefully coordinated team dynamics. In this article, we examine quality improvement for neonatal resuscitation. We review the published literature, focusing on reports targeting admission hypothermia, delayed cord clamping, and initial respiratory support. We discuss specific challenges related to delivery room quality improvement, including small numbers, data collection, and lack of benchmarking, and potential strategies to address them including simulation, checklists, and state and national collaboratives. We examine how quality improvement can target equity in delivery room outcomes, and explore the impact of the COVID-19 pandemic on delivery room quality of care.

Fig. 1

Example driver diagrams for delivery room quality improvement initiatives: Fig. 1a: Thermoregulation; Fig. 1b: Delayed cord clamping; Fig. 1c: Respiratory care. Note: Driver diagrams are meant to be examples of quality improvement frameworks; actual aims, drivers, change concepts, and measures for a quality improvement effort should be determined by local context and the local improvement team.