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Published on: January 12, 2018
Confidential enquiry into deaths due to prematurity
P H Cartlidge1, H P Jones, J H Stewart
1Department of Child Health, University of Wales College of Medicine, Cardiff, UK.
Insights
Neonatal respiratory distress syndrome (RDS) management was generally good, but thermal care and prompt surfactant administration require improvement. Ventilation management also showed common deficiencies in responding to infant needs.
Area of Science:
- Neonatology
- Pediatric Critical Care
Background:
- Neonatal respiratory distress syndrome (RDS) is a significant cause of mortality in premature infants.
- Effective management is crucial for improving outcomes in preterm neonates.
Purpose of the Study:
- To audit the management of neonatal respiratory distress syndrome (RDS) in a defined population.
- To identify areas for improvement in the care of premature infants with RDS.
Main Methods:
- Retrospective peer review of case notes for 49 infants born between 24-36 weeks gestation who died from prematurity in Wales in 1996.
- Assessment of key management aspects including delivery unit, neonatal intensive care, predelivery corticosteroids, resuscitation, thermal management, surfactant therapy, mechanical ventilation, and cardiovascular support.
Main Results:
- Most infants received care in specialized units, with high rates of indicated predelivery corticosteroids and satisfactory resuscitation.
- Thermal care on admission was suboptimal in 50% of infants, and early surfactant therapy was delayed in many cases.
- Mechanical ventilation management had deficiencies in 44% of cases, often due to poor anticipation and slow response to issues.
Conclusions:
- Neonatal RDS management is generally adequate, but thermal care and timely surfactant administration need enhancement.
- Improvements in anticipating and responding to ventilation challenges are necessary for better outcomes.
Abstract:
The aim of this study was to audit the management of neonatal respiratory distress syndrome (RDS) in a geographically defined population using a retrospective peer review of case notes. The subjects were 49 infants of 24-36 wk gestation with a birthweight >499 g, and dying as a consequence of prematurity at <1 y of age in Wales during 1996. Forty-four infants (90%) were delivered in a unit with staff experienced in the management of preterm birth. Of the 30 infants <30 weeks' gestation, 29 (97%) received neonatal intensive care on a (sub)regional unit. Predelivery corticosteroids were indicated in 34 cases and administered in 31 (91%). Resuscitation at birth was indicated in 47 infants and conducted satisfactorily in 42 (89%). Temperature on admission to the neonatal unit was not recorded in 7 infants; in the other 42 it was >35.5 degrees C in 21 (50%). Early surfactant therapy was administered to 31/34 (91%) infants still intubated 120 min after birth, but was given within 30 min to only 8 (24%). Mechanical ventilation was assessed in 41 infants and considered to be good in 23 (56%). Cardiovascular therapy was evaluated in 40 infants requiring active support and considered to be good in 31 (78%). We concluded that neonatal RDS was generally well managed, thermal care during resuscitation was poor, surfactant should be administered more promptly, and deficiencies in the management of ventilation were common and related mainly to poor anticipation and a slow response to problems.
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