Neonatal/Infant Resuscitation
Neonatal/Infant Resuscitation 1
Haylee Rios, BS (she/her/hers)
Medical Student
University of the Incarnate Word School of Osteopathic Medicine
San antonio, Texas, United States
The Neonatal Resuscitation Program (NRP) provides an evidenced based approach to the care and resuscitation of newborns at birth and has issued eight editions to date. When an infant requires resuscitation, the details of these interventions should be recorded in a resuscitation or code sheet. Accurate event recording is critical for both medicolegal purposes and later debriefing and quality improvement. However, no clear standards exist regarding what NRP data elements should be documented on these records.
Objective:
We sought to collect and compare the code sheets utilized in the delivery room during neonatal resuscitation.
Design/Methods:
We solicited delivery room code sheets from NICUs through Twitter and the Pediatrix Neonatal Forum. The NRP resuscitation algorithm was broken down into individual steps and specific data elements needed to record these steps coded into a spreadsheet (Figure 1). We analyzed each code sheet for the presence or absence of each data element.
Results:
A total of 56 distinct delivery room code sheets were collected and analyzed. All levels of NICU were represented (29 from Level 4 NICUs, 25 Level from 3, and 2 from Level 2 NICUs. The data elements most often collected included endotracheal tube placement (52, 93%), time of epinephrine administration (52, 93%), heart rate (51, 91%), chest compressions (51, 91%), and time of chest compressions (51, 91%). The data elements least often collected included gestational age (2, 4%), time of ECG lead placement (3, 5%), and rate of chest compressions (4, 7%, Figure 2). Overall, discreet locations to record medication data elements appeared most, followed by circulation data elements and least commonly breathing data elements.
Conclusion(s):
No standard currently exists for layout of delivery room resuscitation code sheets. Variations in collected data cross hospital sites may lead to long-term challenges in improving quality of care and outcomes across disparate hospitals and regions. While discrete data is more commonly collected for infants who require circulatory and medication support, basic evaluation and breathing elements are inconsistently collected. Recommendations from the NRP for essential data elements to collect when conducting neonatal resuscitation may lead to improved consistency across sites.
