Post-resuscitative Care Outcomes in Neonates

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ESPR79
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Abstract: :

Background: The Neonatal Resuscitation Program (NRP) recommends that neonates who receive resuscitation in the delivery room (DR) with positive pressure ventilation (PPV) and/or continuous positive airway pressure (CPAP) should receive post-resuscitation care (PRC). However, specific guidelines for this care are lacking. Objective: To determine if a PRC protocol would result in more frequent and timely identification of complications requiring care in the NICU.  

Design/Methods: This was a single center retrospective (2015-2016) and prospective (2017-2018) cohort study performed in a level III perinatal referral center. During this time, there were 21,884 well nursery admissions. Starting in 2017, all well baby nursery (WBN) admissions who received DR resuscitation were monitored for a minimum of 3 hours with continuous pulse oximetry and heart rate monitoring, a blood glucose, and blood pressure as part of the PRC protocol. The primary outcomes were incidence of and time to NICU transfer. Details of pregnancy and labor & delivery course, neonatal characteristics, and NICU course were collected. Categorical variables were compared with chi-square and fisher's exact test and numerical variables were compared with unpaired t-test and Mann-Whitney sum test as appropriate.  

Results: There were 370 infants in retrospective cohort and 318 infants in prospective cohort.  In the retrospective cohort, 3.27% of nursery admissions received resuscitation compared with 3.77% in the prospective cohort. The median gestational age (38.93 wk [37.3-39.7] vs 39.0 wk [37.6-39.9], p=0.69), median birth weight (3205g [2815-3562] vs 3213g [2890-3511], p=0.89) and type of resuscitation (CPAP alone, 49.5% vs 54.4%, p=0.20) were similar between cohorts (Table 1). For the primary outcomes, there were no significant differences in incidence of NICU transfer (11.6% vs 15.4%, p=0.15) nor time to transfer (232 min [133-338] vs 271 min [165.5-454], p=0.28) (Table 1). In both groups, complications requiring NICU transfer were common, with respiratory distress being the most common indication (7.2% vs 10.7%, p=0.11) (Figure 1).

Conclusion(s): The PRC protocol did not result in more frequent or rapid recognition of complications that required NICU transfer. Prior to instituting the PRC protocol, our institutional practice was to monitor infants with mild respiratory distress in the WBN up to 4 hours on continuous pulse oximetry. This practice likely provided prompt detection of many infants requiring NICU transfer and prevented us from detecting the positive impacts of a PRC protocol. Although our institution-specific PRC protocol did not impact the recognition of neonatal morbidities requiring NICU care, significant neonatal morbidities were detected frequently in both cohorts. Increased surveillance is indicated for this high-risk population. The components and length of surveillance of PRC requires further investigation.

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Hackensack University Medical Center
Hackensack University Medical Center
Hackensack University Medical Center
Hackensack UMC

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