Relationship between oxygen saturation and the mode of oxygen delivery used in newborn resuscitation.

OBJECTIVE: To compare the rate of increase in oxygen saturation in babies receiving supplemental oxygen during resuscitation with those transitioning in room air. STUDY DESIGN: Prospective observational study. Infants were resuscitated with supplemental oxygen and continuous recording of preductal oxygen saturation was started immediately after birth. Oxygen saturation measurements from healthy newborns transitioned in room air were used for comparison. RESULT: A total of 186 infants were included--70 received supplemental oxygen and 116 were transitioned in room air. Compared with healthy infants transitioned in room air, infants receiving 100% oxygen by positive-pressure ventilation (PPV) did not differ significantly in the rate of increase in oxygen saturation (1.5% per minute, P=0.26), whereas infants receiving 100% free-flow oxygen had a significantly slower rate of increase in oxygen saturation (1.2% per minute, P=0.04). CONCLUSION: Babies receiving 100% oxygen by free flow had a slower increase in oxygen saturation compared with healthy infants transitioned in room air, whereas those receiving 100% oxygen by PPV had a similar increase in oxygen saturation compared with healthy infants transitioned in room air.

Evaluation of the effectiveness of the standardized neonatal resuscitation program.

OBJECTIVE: To determine if health care personnel trained in the Neonatal Resuscitation Program (NRP) used the NRP guidelines in the resuscitation of newborn babies. To determine differences between self-reporting and documentation of resuscitation in medical records. STUDY DESIGN: Using a validated questionnaire, individuals participating in resuscitation of newborns voluntarily phoned and answered questions on an Interactive Voice Response (IVR) system. The study was undertaken in level II hospitals in Southern Alberta with 7500 deliveries per year. RESULTS: Of the 5155 babies delivered during the study, 16% required resuscitation (bag and mask ventilation 10.6%, intubation for meconium or intermittent positive pressure ventilation, IPPV, 3.6%, cardiac massage, CM, 0.3%, epinephrine 0.1%, naloxone 6.9%). Of babies whose interventions could be assessed, bag and mask was correct in 99%, endotracheal intubation for IPPV in 100%, and CM in 100%. Only 75% of babies had meconium managed correctly and 92% had naloxone administered according to guidelines. There were more instances where IVR (48) reported a procedure, which was not charted versus charted and not reported by IVR (21). Educational needs identified by IVR included skills of resuscitation and NRP indications for management. CONCLUSION: Bag and mask ventilation and intubation for neonatal resuscitation are more common than previously reported. Management of the meconium-stained baby and use of naloxone require further education. Compared to charts, use of IVR system allows more complete documentation with rationale of interventions and identification of continuing educational needs.