91 - Delivery Room Resuscitation Practice in the US: A National Survey

Poster Number: 91
Publication Number: 91.438

Heidi M. Herrick, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Charlotte Cecarelli, University of Pennsylvania School of Nursing, Philadelphia, PA, United States; Claire E. Fishman, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Louise S. Owen, Royal Women's Hospital, Melbourne, Melbourne, Victoria, Australia; Elizabeth Foglia, Perelman School of Medicine at the University of Pennsylvania, Swarthmore, PA, United States

Background: Despite dissemination of national neonatal resuscitation guidelines, prior observational studies, including a 2004 survey, demonstrated significant variation in delivery room (DR) resuscitation practice in the US. Ongoing updates to resuscitation guidelines reflect advancements in DR science and equipment. A contemporary assessment of DR practice in the US is needed.

Objective: To characterize current DR resuscitation systems, equipment, and practice in the US.

Design/Methods: We developed a survey with 6 domains: hospital characteristics, resuscitation space, and DR staffing, equipment, practice, and reporting. Questions were modified when asked to either Level 2 or Level 3/4 centers, the latter included questions about preterm infant ( < 32 weeks gestational age [GA]) resuscitation practices. Staffing questions for 24-week GA deliveries were used to identify typical team composition. All questions referred to infants born to COVID negative mothers. Potential delivery hospitals were identified in 2020 using the American Academy of Pediatrics Neonatal Intensive Care Unit search tool. Each hospital was called to confirm delivery hospital status, and medical director email address was obtained online or by phone. Surveys were distributed via email to all identified medical directors at confirmed delivery hospitals and resent up to 5 times.

Results: We distributed the survey to 777 hospitals from 3/21-6/21 with a 35% response rate (269 hospitals). Respondent hospitals included 28 Level 2 (Table 1), 173 Level 3, and 68 Level 4. Table 2 shows Level 3 and 4 hospital characteristics; 90% report neonatal attending presence at a 24-week night delivery, while 50% have 24-hour in-house attending coverage. Table 3 shows Level 3 and 4 preterm resuscitation practices; 91% report delayed cord clamping. Almost all (95%) level 3 and 4 hospitals have a thermoregulation protocol. Approximately 90% of Level 3 and 4 hospitals use a T-piece to initiate respiratory support, 30% empirically intubate infants below a certain GA, and 8% start preterm resuscitations with a fraction of inspired oxygen (FiO2) >30%. Conclusion(s): We report contemporary DR resuscitation practices across 269 US delivery hospitals. Resuscitation team composition for preterm infants appears uniform, but half of level 3 and 4 hospitals do not have a neonatologist present in-house overnight. We found substantial differences in the equipment used for preterm infants compared with the previously published national survey in 2004. These findings provide important insights of how neonatal resuscitation guidelines are implemented into practice across the US.
Table 1: Hospital Characteristics, Staffing Models, and Transfer Facilities for Level 2 Hospitals (Nf28)NICU= Neonatal Intensive Care Unit
Table 2: Hospital Characteristics, Resuscitation Space, and Staffing Models for Level 3 & 4 Hospitals (Nf241)*Includes Nurse Practitioners, Physician Assistants, and Pediatric Hospitalists
VLBWs= Very Low Birth Weight Infants ( < 1500 grams), ELBWs= Extremely Low Birth Weight Infants ( < 1000 grams),
L&D= Labor and Delivery, OR= Operating Room, NICU= Neonatal Intensive Care Unit, GA= Gestational Age,
IQR= Interquartile Range