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Neonatal resuscitation assessment: documentation and early paging must be improved!
Sophie Berglund1, Mikael Norman
1Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. sophie.berglund@ds.se
Insights
Neonatal resuscitation care has significant documentation flaws and delays in skilled personnel arrival, even in general obstetric populations. Improving documentation and early paging of experts are crucial for better infant outcomes.
Area of Science:
- Neonatal Resuscitation
- Obstetrics
- Perinatal Care
Background:
- Previous studies identified resuscitation flaws in medicolegal cases.
- Neonatal resuscitation quality in the general obstetric population was previously unevaluated.
Purpose of the Study:
- Evaluate neonatal resuscitation practices in a general obstetric population.
- Assess adherence to resuscitation guidelines in a setting with skilled birth attendance.
Main Methods:
- Observational study design.
- Included infants born in Stockholm County (2004-2006) with gestational age ≥33 weeks, planned vaginal delivery, normal cardiotocography, and Apgar score <7 at 5 minutes.
- Assessed adherence to neonatal resuscitation guidelines.
Main Results:
- Documentation was unsatisfactory for 45% of infants.
- Delayed initiation of resuscitation occurred in 48 cases due to late paging or pediatrician/neonatologist arrival.
- Unsatisfactory ventilation was noted in 15 cases due to delayed intubation or airway management.
Conclusions:
- Substandard neonatal resuscitation care extends beyond medicolegal cases.
- Improved documentation is essential for accurate evaluation of resuscitation quality.
- Earlier paging of skilled personnel and team/skills training in ventilation are recommended improvements.
Objective:
The authors had previously found flaws in resuscitation after severe neonatal asphyxia in cases selected on the grounds of suspected malpractice and financial compensation claims. The aim of the present study was to evaluate neonatal resuscitation in the general obstetric population in a setting with skilled attendance at birth.
Design:
Observational study.
Setting And Patients:
All infants born in the Stockholm County during 2004-2006 with a gestational age of ≥33 weeks, planned as vaginal delivery, with a normal cardiotocographic recording on admission to hospital and with an Apgar score of <7 at 5 min were included.
Main Outcome Measures:
Adherence to guidelines for neonatal resuscitation.
Results:
Documentation was unsatisfactory in 142 (45%) infants. Other important shortcomings identified were delayed initiation of extensive resuscitation due to late paging or late arrival of attending paediatrician/neonatologist (n=48), and unsatisfactory ventilation related to late intubation and late securing of free airway (n=15).
Conclusions:
Substandard care in neonatal resuscitation is not limited to cases of severe asphyxia related to claims for medical malpractice. The overall documentation of neonatal resuscitation needs to be much better to enable accurate and reliable evaluation. Obvious actions to improve standards of care include the paging of skilled personnel at an earlier stage in cases of complicated deliveries and team and skills training in neonatal ventilation.
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