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Delivery Room Resuscitation
Leone TA, Rich W, and Finer NN. A Survey of Delivery Room Resuscitation Practices in the United States. Pediatrics (Feb 2006); 117: e164-e175.
Objective: To determine current resuscitation practices of neonatologists in the United States.
Methods: A 15-question survey was developed and mailed to neonatal directors in May 2004.
Results: Of the total of 797 surveys mailed, 84 were returned undeliverable or unanswered and 450 were returned completed (63% response rate). Respondents were mainly (70%) from level III NICUs. Most programs resuscitate newborns in the delivery room (83%), rather than in a separate room. The number and background of individuals attending deliveries vary greatly, with 31% of programs having <3 individuals attending deliveries. Flow-inflating bags are most commonly used (51%), followed by self-inflating bags (40%) and T-piece resuscitators (14%). Pulse oximeters are used during resuscitation by 52% of programs, and 23% of respondents indicated that there was a useful signal within 1 minute after application. Blenders are available for 42% of programs, of which 77% use pure oxygen for the initial resuscitation and 68% use oximeters to alter the fraction of inspired oxygen. Thirty-two percent of programs use carbon dioxide detectors to confirm intubation, 48% routinely and 43% when there is difficulty confirming intubation. Preterm infants are wrapped with plastic wrap to prevent heat loss in 29% of programs, of which 77% dry the infant before wrap application. A majority of programs (76%) attempt to provide continuous positive airway pressure or positive end expiratory pressure (PEEP) during resuscitation, most commonly with a flow-inflating bag (58%), followed by a self-inflating bag with PEEP valve (19%) and T-piece resuscitator (16%). A level of 5 cm H2O is used by 55% of programs.
Conclusions: Substantial variations exist in neonatal resuscitation practices, some of which are not addressed in standard guidelines. Future guidelines should include recommendations regarding the use of blenders, oximeters, continuous positive airway pressure/PEEP, and plastic wrap during resuscitation.
Comments: Clearly, the current NRP guidelines are out of
step with current neonatal resuscitation practices in many of our hospitals.
It is important that the NRP committee update its recommendations to include
new practices such as the use of blended oxygen, oximeters, CPAP, T-Piece
resuscitators (NeoPuff®), and plastic bags. Implementation of these new
practices is more challenging because of a reluctance to practice outside of
current NRP guidelines. ABK.
Date: 12 Feb 2006
Time: 11:48:44
Its interesting to compare the NRP guidelines with the updated guidelines from
the UK Resuscitation Council regarding this topic. They were updated at the end
of 2005.I am an instructor for the NLS and we are adapting our practices as
innovations develop. I did however find in my MSc dissertation that confidence
in practice was increased following attendance on the NLS, especially amongst
midwives, and it is still vital that staff attend the NLS/NRP courses, to
provide consistent excellent care at birth, is spite of the fact that they can
linger behind developments. We now have guidelines that enable us to implement
some of the practices mentioned in the article.
UserName:
Joanne O'Donnell
Institution: Salford Royal Hospitals Trust England
telephone: 0161 206 0880
email:
joanne.o'donnell@srht.nhs.uk
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