Changes in resuscitation practice at birth

AIM

To investigate secular changes in neonatal resuscitation at birth.

METHODS

Single centre observational study of 17 890 infants born between May 1993 and April 1997. T-piece ventilation was introduced in April 1995.

OBSERVATIONS

Rates and modes of ventilatory resuscitation, early neonatal encephalopathy, neonatal convulsions, and meconium aspiration syndrome; 1 and 5 min Apgar scores; maternal age and method of delivery; paediatric attendance at delivery and resuscitation.

RESULTS

The rate of all forms of ventilatory resuscitation fell during the four year period from 11.0% to 8.9%. The rate of intubation fell from 2.4% to 1.2%. A reduced rate of intubation was seen at all gestations of 30 weeks and above. There was no difference in rates of relevant neonatal problems during the period except for a reduction in neonatal convulsions. The introduction of T-piece ventilation did not contribute to the reduction in intubation in a logistic regression model that included time trend.

CONCLUSION

A marked reduction in the rate of intubation was observed, without any reduction in the efficacy of resuscitation. This may reflect improvements and changing emphasis in resuscitation training.

Strategies for antenatal detection of Down's syndrome

AIM

To predict the effect of maternal serum screening and fetal echocardiography on the birth prevalence of Down's syndrome.

METHODS

The outcome of all Down's syndrome pregnancies in the Northern Health Region between 1985 and 1991 was retrospectively ascertained. The number and outcome of all Down's syndrome pregnancies were used to define a theoretical population which would exist in the absence of screening. Published reports were used to predict the effects of screening strategies.

RESULTS

Down's syndrome was identified in 412 pregnancies of which 315 (76%) resulted in live birth. A theoretical population with no antenatal screening would be expected to produce 31 stillbirths and 381 (92%) live births affected by Down's syndrome. In the same population a programme of maternal serum screening and fetal echocardiography would lead to 155 and 14 terminations, respectively, and when combined, would reduce affected live births to 229 (56%).

CONCLUSIONS

Even if maternal serum screening and fetal echocardiography achieve their predicted potential, around half of all pregnancies affected by Down's syndrome will result in live born babies.

Reappraisal of ultrasound imaging of neonatal intravascular catheters

Ultrasonography was successful in localising the tips of neonatal intravascular catheters and showed their precise relation to the cardiac chambers and major aortic branch vessels in 28 infants. Wherever adequate resources and training are available, this technique may provide a cheaper and non-invasive option, as well as giving additional information, than can be obtained from radiography.

Neonatal transport: safety and security

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