Effects of a course in neonatal resuscitation--evaluation of an educational intervention on the standard of neonatal resuscitation.
BACKGROUND
Appropriate assessment and resuscitation is an important part of neonatal care provided during the first minutes of life. Midwifery and junior medical staff are often in the frontline of neonatal resuscitation. Appropriate education and training of midwifery staff is therefore essential if the standard of care delivered to babies in the delivery suite is to be improved and maintained. Evaluation of any such educational interventions is necessary to assess their effectiveness.


OBJECTIVE
To assess the effect of a course in neonatal resuscitation introduced in 1995 aimed at midwifery staff, on the standard of care provided to babies immediately after birth. Prior to this, training in neonatal resuscitation was largely theoretical.


METHODS
Naturalistic design observational study conducted in a maternity unit with a tertiary neonatal intensive care unit in the North of England. We compared two groups of babies born before and after the course was introduced. Use of naloxone in the delivery suite and appropriateness of its use, and temperature on admission to neonatal intensive care unit were used as proxy markers for standard of care and compared in the two groups. We also looked at the use of mask intermittent positive pressure ventilation (IPPV) and tracheal intubation in the delivery suite.


RESULTS
Use of naloxone fell dramatically from 13.2% of all babies born in 1994 to 0.5% in 2003. Inappropriate use of naloxone before other resuscitation measures were initiated declined from 75% of babies given naloxone in 1994 to 10% in 2003. The incidence of hypothermia (<35 degrees C) on admission to neonatal unit declined from 9% of all admissions to 2.3% in 2003. There was a trend towards increased use of mask ventilation in the delivery suite with a corresponding trend towards less tracheal intubation.


CONCLUSIONS
We have shown that the intervention has been related temporally to an improvement in the quality of care delivered by midwifery staff to newborn babies. Practical courses in neonatal resuscitation can contribute to improvements in the quality of care provided to babies immediately after birth. These courses are more effective than theoretical teaching alone.
Singh
Jaideep
J
Neonatal Directorate, The James Cook University Hospital, Middlesbrough TS4 3BW, UK. jaideep.singh@ncl.ac.uk
Santosh
Sanuja
S
Wyllie
J P
JP
Mellon
A
A
D004363:Drug Utilization / Q000639:trends; D004739:England / Q000453:epidemiology; D006801:Humans; D007035:Hypothermia / Q000453:epidemiology; D015994:Incidence; D007231:Infant, Newborn; D007318:Inservice Training; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008397:Masks; D008880:Midwifery / Q000193:education*; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D010343:Patient Admission; D011175:Positive-Pressure Respiration / Q000295:instrumentation / Q000706:statistics & numerical data; D012151:Resuscitation / Q000193:education*; D012189:Retrospective Studies
D009292:Narcotic Antagonists; D009270:Naloxone