Presented at the Neonatal Society 2017 Summer Meeting.
Heathcote A1, Jones J, Clarke P
Neonatal Intensive Care Unit, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY
Background: Only a minority of babies needs extended resuscitation at birth. Resuscitations concerning babies who die or who survive with adverse outcomes are increasingly subject to medico-legal scrutiny. Yet international resuscitation guidelines currently offer no recommendations on expected timings by which practitioners should achieve potentially life-saving resuscitation interventions. Our aim was to describe real-life timings of key resuscitation milestones observed in an historical series of newborns who required full resuscitation at birth.
Methods: Retrospective case note review in our tertiary-level neonatal centre covering births in the 10-year period January 2006 to December 2015. Using neonatal and maternity databases, we identified all babies born with a 1-minute Apgar score of 0 who required full resuscitation in the delivery room. We pre-defined ‘full resuscitation’ as the need for positive pressure ventilation, cardiac compressions, and attempted emergency central venous access. We included all babies who were of birth gestational age ≥26 weeks and who were inborn. We interrogated their contemporaneous neonatal and maternal records for documented timings of key resuscitation milestones.
Results: Of 91 newborns identified in the study period with an Apgar score of 0 at 1 minute, 27 (30%) fulfilled all inclusion criteria. The table shows the timings of key resuscitation milestones as recorded in their medical records. Of the 27 babies, 9 (33%) showed no signs of life throughout and despite the resuscitation attempts, 8 (30%) were resuscitated but subsequently died in the NICU, and 10 (37%) survived to discharge. In four cases (15%), umbilical venous catheterisation proved difficult and adrenaline was first given via a peripheral vein (n=1), intraosseous device (n=1), or via endotracheal tube (n=2).
Table: Timing of key resuscitation milestones in neonates who required full resuscitation following birth
Conclusion: These data present timings of key resuscitation milestones in an historic series of prolonged newborn resuscitations that were conducted in the era of routine newborn life support training. Timings of important resuscitation events were often lacking in the contemporaneous documentation. The wide range of timings we present from real-life cases may prove useful to clinicians involved in medical negligence claims, and may provide a baseline for quality improvements in resuscitation training and medical documentation.
Corresponding author: adam.heathcote@doctors.org.uk