title: A prospective clinical audit of neonatal resuscitation practices in Canada.
abstract: OBJECTIVE
  This is a prospective audit to determine the frequency of resuscitation interventions in the clinical setting and to compare self-reports of clinical performance with the existing Neonatal Resuscitation Program (NRP) and Canadian National Guidelines for Neonatal Resuscitation.
  
  
  METHODS
  Fifty-six level I, II, and III hospitals in Canada participated. Any infant requiring resuscitation, as defined by the need for at least positive pressure ventilation (PPV), was eligible for inclusion (n = 783 resuscitations).
  
  
  METHODS
  A prospective self-report audit was chosen and data were collected over a 6-month period in 1998. The audit focused on the use of PPV, intubation, chest compressions, free-flow oxygen, or medications during the resuscitation. The infant's temperature at the end of resuscitation was also noted. The data were analyzed with descriptive statistics. The composition of the resuscitation team and their NRP certification status were recorded.
  
  
  RESULTS
  The need for resuscitation was not anticipated in 76% of the cases (596 of 783). Errors in the sequencing of care, such as delays in initiating PPV, provision of chest compressions before or without establishing an airway and ventilatory support, and administering naloxone before PPV, were reported. Resuscitations attended by a team of NRP certified providers had improved sequencing when compared with those in which only some individual providers were certified. Chest compressions were provided in 8% of the cases (65 of 783). Medications were used in 14% (113/783) of all cases. Providers in level I hospitals performed chest compressions more frequently than those in level II and III settings. At the end of the resuscitation, 27% of the infants were hypothermic (142 of 520), and 25% were hyperthermic (128 of 520). Overall, 52% were out of the normal neutral range.
  
  
  CONCLUSIONS
  Clear differences between the NRP guidelines and actual clinical practice were shown. A high rate of unanticipated resuscitations, delivery room medications, and chest compressions was described. Postresuscitation hypothermia or hyperthermia were common. Improved sequencing was noted when the entire resuscitation team was NRP certified. Certification in NRP does not assure competency, nor does it ensure compliance with established standards of care.
authors.affiliation: Perinatal Partnership Program of Eastern and Southeastern Ontario, Ottawa, Ontario, Canada. mitchela@kgh.kari.net
authors.forename: Ann
authors.initials: A
authors.lastname: Mitchell
authors.forename: Patricia
authors.initials: P
authors.lastname: Niday
authors.forename: Jill
authors.initials: J
authors.lastname: Boulton
authors.forename: Graham
authors.initials: G
authors.lastname: Chance
authors.forename: Corinne
authors.initials: C
authors.lastname: Dulberg
mesh_terms: D002170:Canada; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D003696:Delivery Rooms / Q000592:standards; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards* / Q000706:statistics & numerical data; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012107:Research Design; D012151:Resuscitation / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires