Characterizing prehospital response to neonatal resuscitation

Area of Science:

• Emergency medicine
• Neonatal care
• Prehospital services

Background:

• The Neonatal Resuscitation Program (NRP) provides guidelines for initial newborn resuscitation.
• Effective prehospital resuscitation is critical for neonatal outcomes.
• Current adherence to NRP guidelines in the prehospital setting is not well-documented.

Purpose of the Study:

• To evaluate the performance of initial newborn resuscitation steps according to NRP guidelines in the prehospital setting.
• To identify areas for improvement in prehospital neonatal resuscitation.

Main Methods:

• An observational study involving 265 paramedics and EMTs from 45 EMS teams.
• Participants completed a baseline questionnaire on demographics, experience, and comfort with pediatric care.
• Technical performance of NRP steps was assessed via blinded video review of simulations.

Main Results:

• Only 16% of providers felt very comfortable caring for newborns.
• Timely initiation of drying (within 30s) was performed by 22%, stimulation by 18%, warming by 2%, and positive pressure ventilation (PPV) by 11%.
• Most providers (88%) used ventilation rates below NRP recommendations, and 96% exceeded recommended tidal volumes.

Conclusions:

• Initial NRP steps recommended for the first minute after birth are infrequently performed in a timely manner by prehospital providers.
• Significant opportunities exist to improve the quality and timeliness of prehospital newborn resuscitation.
• Further training and protocol refinement are needed to enhance NRP guideline adherence.