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The Feasibility and Impact of a Postresuscitation Care Protocol in the Well Baby Nursery

Andy J Reyes Santos1, Caroline Basta1, Kristen Allyson Ramones1

  • 1Department of Pediatrics, Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack Meridian Health Network, Hackensack, New Jersey.

American Journal of Perinatology
|April 4, 2023
PubMed

Insights

Implementing a postresuscitation care (PRC) protocol in the well baby nursery (WBN) is feasible and led to more neonatal intensive care unit (NICU) transfers. This enhanced monitoring may help identify infants needing higher levels of care after delivery room resuscitation.

Area of Science:

  • Neonatalogy
  • Pediatric Critical Care
  • Resuscitation Medicine

Background:

  • Infants undergoing delivery room (DR) resuscitation may experience delayed complications.
  • The Neonatal Resuscitation Program (NRP) recommends enhanced monitoring for these infants.
  • Well baby nurseries (WBNs) manage infants after DR resuscitation.

Purpose of the Study:

  • To evaluate if a postresuscitation care (PRC) protocol in the WBN improves identification of infants requiring neonatal intensive care unit (NICU) admission.
  • To assess the feasibility of implementing a standardized PRC protocol in the WBN.

Main Methods:

  • A retrospective and prospective cohort study was conducted.
  • The study involved 765 WBN admissions following DR resuscitation.
  • Infants received continuous positive airway pressure and/or positive pressure ventilation during DR resuscitation.

Main Results:

  • NICU transfers increased significantly after PRC protocol initiation (11.17% vs. 16.08%).
  • No significant difference in NICU transfer rates within the first 4 hours of life was observed (5.99% vs. 7.29%).
  • Respiratory distress remained the most common reason for NICU transfer in both pre-PRC and PRC groups.

Conclusions:

  • A PRC protocol in the WBN is feasible and associated with an increase in NICU transfers.
  • Delayed respiratory distress is a common morbidity in infants after apparent recovery from DR resuscitation.
  • Enhanced surveillance, as per NRP guidelines, is crucial for this infant population.
Abstract

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