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Surveys of newborn resuscitation practices1,–,4 have revealed differences between and in countries, but the equipment and techniques used in the UK are guided by the UK Resuscitation Council, and staff involved must undertake a newborn life support course. We hypothesised, therefore, that in the UK there would be consistency of practice regardless of the level of neonatal care, and our aim was to test this hypothesis.
A questionnaire was sent to the lead paediatrician of 212 hospitals with newborn units. Differences in resuscitation practices according to the level of neonatal care were assessed for statistical significance using the χ2 test.
There was an 85% response. The majority of hospitals were with neonatal intensive care units (NICUs) (93%) and local neonatal units (LNUs) (98%), but only 40% of those with special care units (SCUs) replied. In most hospitals (90%), resuscitation was performed in the delivery room, but a side room was used in 6% and in 4% for infants born by caesarean section.
A pressure-controlled T-piece device with positive end expiratory pressure (PEEP) was the commonest mode (86%) of providing positive pressure ventilation (table 1). There was, however, variation in the PIP used with different levels of neonatal care, for term (p<0.001) and prematurely born infants (p<0.001). There was also a difference in the level of PEEP used with different levels of neonatal care for term (p<0.001) and prematurely born infants (p<0.001). Oxygen blenders were more commonly used in hospitals with NICUs (p<0.001). A greater proportion of hospitals with NICUs initially used an FiO2 of 0.21 for infants born at term (p<0.001) and prematurely born infants (p=0.001).
Use of oxygen saturation monitoring varied significantly between hospitals with different levels of neonatal care for term (p=0.005) and prematurely (p=0.002) born infants. Temperature and expired carbon dioxide (CO2) monitoring were used in a minority of hospitals, with significant variation between the level of neonatal care provided (p<0.01). In the majority of hospitals (95%), prematurely born infants were placed in a plastic bag.
In a greater proportion of hospitals (70% vs 7.8%), adrenaline was given for resuscitation of infants born between 25 and 28 weeks of gestation compared with those born at <25 weeks (p<0.001). In all hospitals, a senior trainee, a junior trainee and a neonatal nurse attended deliveries of prematurely born infants. Consultants routinely attended deliveries of infants in 87% of hospitals for infants born at less than 24 weeks of gestation, 68% of infants of 25–28 weeks of gestation and 17% of deliveries of infants born between 29 and 36 weeks of gestation. A transport incubator was used in 44% of hospitals, a Resuscitaire with T-piece or self-inflating bag by 44% and 12% used either.
In conclusion, with the exception of monitoring equipment and the use of resuscitation drugs, this survey highlights that the recommendations of the UK Resuscitation Council are followed in the majority of hospitals, but the aspects of practice differed according to the level of neonatal care provided.
Dr Vadivelam Murthy was funded by the Guy's and St. Thomas' Charitable Trust. The authors thank Professor Janet Peacock for statistical advice and Mrs Deirdre Gibbons for secretarial assistance.
Funding Guy's & St. Thomas Charitable Trust.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.