The development and implementation of a multidisciplinary neonatal resuscitation team in a Canadian perinatal centre.
OBJECTIVE
To describe the implementation of a multidisciplinary neonatal resuscitation team (NRT) at a Canadian tertiary perinatal centre.


METHODS
In February 2002, the primary role of neonatal resuscitation was transferred from attending physicians (on-call off-site) to a NRT (consisting of a neonatal intensive care nurse, a respiratory therapist, and, when available, a resident, clinical associate (supervised licensed physician), or nurse practitioner). The NRT attended moderate- and high-risk deliveries (in the latter case, accompanied by a neonatologist). Normal, low-risk deliveries remained the responsibility of caseroom (delivery room) staff, assisted by the NRT when concerns arose. A prospective assessment was performed of resuscitation requirements and outcomes.


RESULTS
: Over 24 months, the NRT attended 2944 (64.5%) out of 4565 deliveries. The NRT attended 2497 moderate-risk deliveries, providing positive pressure ventilation (in 15.7% of cases), chest compressions (0.1%), and epinephrine (adrenaline) (0.08%). There were no neonatal deaths or morbidities related to resuscitation in this cohort. A small, but significant, proportion of babies with no identifiable risk factors required resuscitation by caseroom staff (in most cases with brief periods of positive pressure ventilation).


CONCLUSIONS
Assignment of level of risk provides a safe means of delivering neonatal resuscitation services, facilitating NRT attendance at the majority of deliveries that required resuscitation. A NRT can perform safely and effectively in a tertiary perinatal centre with off-site support from experienced neonatal staff at high-risk deliveries only. Caseroom (delivery room) staff should continue to be trained in neonatal resuscitation.
Aziz
Khalid
K
Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St. John's NL, Canada A1B 3V6. kaziz@mun.ca
Chadwick
Mairi
M
Downton
Geoff
G
Baker
Mary
M
Andrews
Wayne
W
D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards; D016009:Chi-Square Distribution; D002983:Clinical Competence / Q000592:standards; D003696:Delivery Rooms / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards* / Q000706:statistics & numerical data; D009523:Newfoundland and Labrador; D010348:Patient Care Team / Q000592:standards*; D012151:Resuscitation / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data