Questionnaire on practices and priorities in neonatal care in Ireland

As part of a process of audit of neonatal practice, a questionnaire on clinical practice and priorities which need to be addressed was sent to all consultant neonatologists, and to a consultant paediatrician in all other units caring for newborn infants, in the Republic of Ireland. The response rate was 88% (22 out of 25 replied). Thirteen respondents specified greater than 24 weeks and/or greater than 500 grams as the criteria at which infants were resuscitated. Eleven routinely intubated very premature infants. Seven treated any infant intubated for respiratory distress syndrome with surfactant, and seven sometimes used prophylactic surfactant. Poor perfusion or low blood pressure was the most common criterion for volume expansion during the first hour, using albumen (15 of 22), fresh frozen plasma (10), whole blood (9), normal saline (20 and haemacell (1). Most (18 of 22) used steroids for established bronchopulmonary dysplasia. Oral feeds were generally begun "as soon as possible". Persistent foetal circulation was treated with various vasodilators, tolazoline (14 of 22), magnesium sulphate (8) and nitric oxide (4). The main local priorities noted are the need for more neonatally trained nursing and / or medical staff. Almost all respondents noted the need for a national neonatal transport system. While this summary reveals a considerable variation in clinical practice this variation reflects the lack of evidence on which to base clinical decision making. Where evidence exists from clinical trials considerable uniformity exists in clinical decision making and practice. This study highlights the need for continued audit of clinical practice and the essential role clinical research plays in informing decision making in practice.