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UK neonatal resuscitation survey
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  • Published on: 11 June 2019
    UK neonatal resuscitation survey - a word of caution
    • Sean B Ainsworth, Consultant Neonatologist NHS Fife
    • Other Contributors:
      • Jonathan Wyllie, Professor of Neonatology
      • Robert Tinnion, Consultant Neonatologist

    As authors of the 2015 guidelines we read with interest the “UK neonatal resuscitation survey” [1]. Comparison with 2012 shows a rewarding positive effect of successive guidelines on newborn resuscitation practice.

    However, we wanted to address this statement: “…updated guidelines have been criticised for failing to consider data from the Targeted Oxygen in the Resuscitation of Preterm Infants [To2rpido]”. To2rpido [2], published 2017, was unavailable for inclusion in 2015 ILCOR reviews of evidence. [3]. The analysis referred to was post-hoc and unprespecified. Clinicians were not blinded and recruitment was problematic. Enrolling only 5% of eligible infants, To2rpido was terminated after reaching 15% of targeted sample size due to loss of equipoise: ironically, clinicians were concerned about using high oxygen concentrations.

    Nonetheless, To2rpido generated such interest that it led to the first neonatal review in ILCOR’s continuous evidence evaluation strategy. [4] Utilising GRADE methodology to rate quality of evidence and strength of recommendations, To2rpido’s impact was downgraded because of high risk of bias. This review [4] continues to recommend “starting with a lower oxygen concentration (21–30%) compared to higher oxygen concentration (60–100%)” whilst highlighting many gaps in our current knowledge.

    The use of end-tidal CO2 (ETCO2) detection was not recommended because the guidelines, and Newborn Life Support (NLS) course, focus on airwa...

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    Conflict of Interest:
    All three authors co-wrote the UK Newborn Life Support (NLS) 2015 guidelines referred to in the original article and the response. JW is current President of the Resuscitation Council (UK) and former Chair of the Resuscitation Council (UK) NLS sub-committee. JW, SA and RT are current members of the RC(UK) NLS sub-committee. JW and SA are members of the European Resuscitation Council Newborn Life Support Science and Education sub-committee.