UK neonatal resuscitation survey

Charles, E; Hunt, Katie; Murthy, Vadivelam; Harris, Christopher M.; Greenough, Anne

doi:10.1136/archdischild-2018-315526

Cited by 9 publications

(12 citation statements)

References 7 publications

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“…Surveys in Europe, 24 the US 14 and the UK 13 have examined neonatal resuscitation practices. Similar to this survey, some identified good compliance with their local guidelines, 13,24 whereas others identified inconsistencies 14 . Surveys also reflect changing practice over time; in 2004, 77% of respondents to a US survey initiated resuscitation in 100% oxygen, in line with standard practice at that time 14 .…”

Section: Discussionmentioning

confidence: 99%

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Neonatal Golden Hour: A survey of Australian and New Zealand Neonatal Network units' early stabilisation practices for very preterm infants

Hodgson

Owen

Lui

et al. 2021

J Paediatrics Child Health

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Aim To identify current ‘Golden Hour’ practices for initial stabilisation of very preterm infants <32 weeks' gestational age (GA) within tertiary neonatal intensive care units (NICUs) in the Australian and New Zealand Neonatal Network (ANZNN). Methods A 76‐question survey regarding delivery room (DR) and NICU stabilisation practices was distributed electronically to directors of tertiary perinatal NICUs in the ANZNN in January 2019. Responses were categorised into GA subgroups: 23–24, 25–27 and 28–31 weeks' GA. Results The response rate was 100% (24/24 units). Delayed cord clamping (DCC) was practised ‘always’ or ‘often’ by 21 units (88%). All units used oximetry to target oxygen saturations, and 23/24 (96%) commenced resuscitation in <40% oxygen. Ten units (42%) routinely used DR electrocardiography monitoring. CPAP was preferred as primary respiratory support in one‐third of units for infants born 23–24 weeks' GA, compared with 19 units (79%) at 25–27 weeks' GA and 23 units (96%) at 28–31 weeks' GA. DR skin‐to‐skin care was uncommon, particularly at lower GAs. Five units (21%) used minimally invasive surfactant therapy for non‐intubated infants at 23–24 weeks' GA, 13 units (54%) at 25–27 weeks' GA and 16 units (67%) at 28–31 weeks' GA. Conclusions Most Golden Hour stabilisation practices align with international guidelines. Consistency exists with respect to DCC, oxygen saturation targeting and primary CPAP use for infants 25 weeks' GA and above. Where evidence is less certain, practices vary across ANZNN NICUs. Time targets for stabilisation measures may help standardise practice for this population.

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Section: Discussionmentioning

confidence: 99%

“…International surveys have highlighted variation in early stabilisation practices for preterm infants, 13,14 resulting in quality improvement projects aiming to bundle and standardise Golden Hour practices, often using thermoregulation or glycaemic control as short‐term surrogates of effective early care 15,16 …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

Neonatal Golden Hour: A survey of Australian and New Zealand Neonatal Network units' early stabilisation practices for very preterm infants

Hodgson

Owen

Lui

et al. 2021

J Paediatrics Child Health

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“…It is well recognised that detection of exhaled CO 2 using a colorimetric device facilitates confirmation of tracheal tube placement in newborn babies, despite being subject to both false-positive and false-negative results, and this is recommended by international guidelines [2]. A recent survey of UK neonatal units reported routine use of CO 2 monitoring in 84-88% of neonatal intubations in the labour ward [3], considerably at odds with the reported availability of 'capnography' of between 18% and 48% in…”

Section: Paediatric Intensive Care and Neonatal Intensive Care Airwaymentioning

confidence: 99%

Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC‐NIC survey

et al. 2018

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We would like to comment on, and correct some misunderstandings in, the paper by Foy et al., which suggests that there are major gaps in optimal airway management in neonatal intensive care units (NICUs) in the UK, particularly lack of continuous waveform capnography and/or videolarygoscopy [1]. We are in full agreement with the NHS Improvement recommendation that undetected oesophageal intubation should be a 'Never Event', but note that detection of this event relates mostly to the use of capnography at intubation, rather than during ongoing ventilatory support.It is well recognised that detection of exhaled CO 2 using a colorimetric device facilitates confirmation of tracheal tube placement in newborn babies, despite being subject to both false-positive and false-negative results, and this is recommended by international guidelines [2]. A recent survey of UK neonatal units reported routine use of CO 2 monitoring in 84-88% of neonatal intubations in the labour ward [3], considerably at odds with the reported availability of 'capnography' of between 18% and 48% in Foy et al.'s paper. The phrase 'continuous waveform capnography' may not be one with which most staff working in a UK NICU will be familiar, and it is not clear from the paper whether the question regarding capnography was, or could have been, interpreted as including single use colorimetric CO 2 detector devices at neonatal intubation. Based on a single personal communication, Foy et al. state that capnography is 'routinely' used in 'many' neonatal transfers. This contradicts data presented in Fig. 2, but accords with a recent informal survey of 15 UK transport services, of which 13 routinely use capnography (personal communication -Dr A. Jackson). The transport neonatal population differs in several regards from the NICU population and continuous waveform capnography may be more useful in sedated babies, and when the environment means that the ventilator may not reliably produce flowgraphs. As acknowledged by Foy et al., there is no evidence of reduction in harm from intubation with the use of continuous waveform capnography in the NICU. Interpretation of continuous waveform capnography is likely to be complicated by the fast ventilator rates and short expiry time used in neonates, routine use of uncuffed tracheal tubes and the relatively large dead space in the smallest preterm infants. Most neonatal ventilators now incorporate flow graphs, with which neonatal nursing and medical staff are familiar, and which provide an opportunity to recognise accidental extubation. There has been no direct comparison of continuous waveform capnography and ventilator flow graphs in terms of efficacy and safety in ventilated preterm infants. Videolaryngoscopy has potential to facilitate teaching and practice of neonatal intubation [4] and videolaryngoscopes suitable for very preterm infants are now available. We anticipate therefore that availability of and (just as importantly) familiarity with videolaryngoscopy within UK neonatal units will continue to increase alt...

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“…Mactier et al. cite a survey abstract by Charles et al., date unknown, which reported ‘routine’ use of capnography (likely capnometry) during intubation in 81–88% of delivery suites . This survey was far less extensive than ours and had a lower response rate (83%).…”

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confidence: 62%