ORIGINAL ARTICLE

Changes in resuscitation practice at birth

ACL Allwood¹, RJ Madar¹, JH Baumer¹, L Readdy², D Wright²

¹ Derriford Hospital, Plymouth, UK
² School of Mathematics & Statistics, University of Plymouth, UK

Correspondence to:
For correspondence:
Dr Allwood, Neonatal Intensive Care Unit, Derriford Hospital, Plymouth, Devon PL6 8DH, UK;
alex.allwood{at}virgin.net

Aim: To investigate secular changes in neonatal resuscitation at birth.

Methods: Single centre observational study of 17 890 infants born between May 1993 and April 1997. T-piece ventilation was introduced in April 1995.

Observations: Rates and modes of ventilatory resuscitation, early neonatal encephalopathy, neonatal convulsions, and meconium aspiration syndrome; 1 and 5 min Apgar scores; maternal age and method of delivery; paediatric attendance at delivery and resuscitation.

Results: The rate of all forms of ventilatory resuscitation fell during the four year period from 11.0% to 8.9%. The rate of intubation fell from 2.4% to 1.2%. A reduced rate of intubation was seen at all gestations of 30 weeks and above. There was no difference in rates of relevant neonatal problems during the period except for a reduction in neonatal convulsions. The introduction of T-piece ventilation did not contribute to the reduction in intubation in a logistic regression model that included time trend.

Conclusion: A marked reduction in the rate of intubation was observed, without any reduction in the efficacy of resuscitation. This may reflect improvements and changing emphasis in resuscitation training.

Keywords: bag valve mask; intubation; neonatal resuscitation; T-piece

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