title: Dedicated neonatal retrieval teams improve delivery room resuscitation of outborn premature infants.
abstract: BACKGROUND
  Morbidity related to ineffective resuscitation and stabilization of premature infants is increased when delivery occurs outside tertiary perinatal centers. The regional neonatal transport team received extensive training to expand their scope of practice to include delivery room resuscitation allowing them to attend high-risk deliveries in community hospitals when maternal transfer was not possible.
  
  
  OBJECTIVE
  Compare the resuscitation and stabilization of premature infants when a specialized neonatal retrieval team (SNRT) is in attendance at delivery with immediate resuscitation and stabilization performed by the referral hospital team (RHT).
  
  
  METHODS
  We assessed the impact of a specially trained neonatal transport team by comparing the initial resuscitation process, airway and vascular access skills, illness severity and patient stabilization in both groups.
  
  
  RESULTS
  Neonates resuscitated by the RHT were more likely to receive oxygen, mask CPAP, bag and mask ventilation and cardiac compressions for a significantly longer time period. Neonates resuscitated by the SNRT were intubated more promptly (8.5 minutes {1 to 22} vs 16 minutes {1 to 90}, p=0.035) following a fewer number of attempts. The endotracheal tube was correctly positioned on radiological assessment in 72% of cases in the SNRT group vs 38.1% in the RHT group (p<0.001). Many neonates had no vascular access (31%) and were profoundly hypothermic (38.5%) on arrival of the SNRT. Although there was no significant difference in maximum FiO(2) or oxygenation index, babies with respiratory distress syndrome resuscitated by the RHT were less likely to receive surfactant therapy (76.6 vs 34.4%, p=0.001). There was no difference in transport-related mortality between the groups
  
  
  CONCLUSIONS
  The presence of a highly skilled transport team at a high-risk preterm delivery improves the quality of neonatal resuscitation by increasing intubation success rates and achieving earlier vascular access. Neonates resuscitated by dedicated neonatal retrieval teams were less likely to become significantly hypothermic. Although the severity of RDS was similar neonates in the RHT were less likely to receive surfactant.
authors.affiliation: Acute Care Transport Services, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: P J
authors.initials: PJ
authors.lastname: McNamara
authors.forename: W
authors.initials: W
authors.lastname: Mak
authors.forename: H E
authors.initials: HE
authors.lastname: Whyte
mesh_terms: D000704:Analysis of Variance; D002983:Clinical Competence; D003696:Delivery Rooms; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D008423:Maternal Age; D017283:Neonatal Nursing / Q000458:organization & administration; D009359:Neonatology / Q000379:methods; D009864:Ontario; D010348:Patient Care Team / Q000458:organization & administration*; D011247:Pregnancy; D011336:Probability; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012151:Resuscitation / Q000592:standards* / Q000639:trends; D018570:Risk Assessment; D012308:Risk Management / Q000458:organization & administration; D015996:Survival Rate; D017749:Total Quality Management; D014505:Urban Population