Elsevier

The Journal of Pediatrics

Volume 163, Issue 6, December 2013, Pages 1553-1557.e1
The Journal of Pediatrics

Original Article
Timing of Interventions in the Delivery Room: Does Reality Compare with Neonatal Resuscitation Guidelines?

Portions of this study were presented at the Pediatric Academic Societies' Neonatal Rescuscitation session, April 28-May 1, 2012, Boston, MA.
https://doi.org/10.1016/j.jpeds.2013.06.007Get rights and content

Objective

To determine the proportion of infants who had the tasks recommended in the neonatal resuscitation guidelines performed within 30 and 60 seconds of birth, and the time taken to perform each task.

Study design

From video recordings in delivery rooms, we determined the time from birth and arrival on a resuscitation table to warm, assess heart rate (HR), attach an oximeter, and provide respiratory support for each infant. We determined the proportion of infants who had these tasks completed by 30 and 60 seconds, and the median time taken to perform each task.

Results

We reviewed and analyzed data from 189 infants (median gestational age, 29 weeks [IQR, 27-34 weeks]; median birth weight, 1220 g [IQR, 930-2197 g]). Twelve infants (6%) were not on the resuscitation table within 30 seconds of birth. Less than 10% of infants were placed in polyethylene bags or had their HR determined by 30 seconds. By 60 seconds, 48% were in polyethylene bags, 33% had their HR determined, 38% received respiratory support, and 60% had an oximeter attached. The median time taken to perform all tasks was greater than that recommended in the guidelines.

Conclusion

Most newborns were not managed within the time frame recommended in resuscitation guidelines. The recommended 30- and 60-second intervals may be too short.

Section snippets

Methods

We performed this study at 2 hospitals, the Royal Women's Hospital (RWH) in Melbourne, Australia and the National Maternity Hospital (NMH) in Dublin, Ireland. Medical and nursing staff received training in neonatal resuscitation in accordance with ILCOR recommendations. High-risk deliveries in both hospitals were attended by a resuscitation team led by a consultant neonatologist or neonatal fellow accompanied by trainee doctors and neonatal nurses.

We defined high-risk deliveries as those in

Results

At RWH, at total of 12 833 infants were born between January 2004 and May 2006, 584 of whom had a birth weight <1500 g. At NMH, 16 630 infants were born between August 2010 and May 2012, 221 of whom weighed <1500 g. Videos from 194 resuscitations were reviewed. Five infants in whom the exact time of birth could not be determined from recordings were excluded from the analysis; thus, a total of 189 videos (137 from RWH and 52 from NMH) were analyzed. The infants had a median gestational age 29

Discussion

First reported by Finer and coworkers,12, 13, 14 video recording of newborns for auditing, teaching, and research purposes has been used to assess many aspects of DR care.15, 16, 17, 18, 19, 20 We have determined the time taken to perform tasks in the DR in a large number of high-risk infants at 2 hospitals from prospectively collected high quality videos. Our study has limitations, however. We were unable to assess certain aspects of performance from the video recordings; for instance, we

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  • Cited by (0)

    Funded by the National Children's Research Center, Ireland; The Royal Women's Hospital, Melbourne; Murdoch Children's Research Institute, Melbourne; and National Health and Medical Research Council, Australia. The authors declare no conflicts of interest.

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