Factors associated with fall in neonatal intubation rates in the United Kingdom--prospective study.
OBJECTIVE
To investigate the trend of neonatal resuscitation by intubation or mask ventilation over time and to assess its association with changes in prevalence of caesarean section and use of general anaesthesia in labour.


METHODS
All women booking pregnancy at any of 15 maternity units, analysed using logistic regression.


METHODS
Prospective study.


METHODS
UK hospital-based maternity units (15 centres).


METHODS
A total of 221,322 first singleton births of babies weighing 200 g or more in the St Mary's Maternity Information System cohort, 1988-2000, covering the North West Thames area of London.


METHODS
Prevalence of intermittent positive-pressure ventilation (IPPV) (by intubation or mask) by calendar year.


RESULTS
Overall use of IPPV decreased markedly (two-sided P<0.01) over the course of the study, and this decrease was evident by all modes of delivery. Adjusted mean prevalence of intubated IPPV decreased from 0.51% (95% CI 0.44-0.58) in 1988 to 0.07% (95% CI 0.06-0.09) in 2000. There was a similar decrease in the prevalence of IPPV by mask. However, despite substantial increases in prevalence of caesarean sections and reductions in the use of general anaesthesia over the course of the study, adjusting for these variables made little difference to the temporal trends in intubation or use of mask ventilation.


CONCLUSIONS
There has been a marked reduction in the prevalence of infants given resuscitation by positive-pressure ventilation that cannot be explained by changes in the prevalence of caesarean section or use of general anaesthesia in labour.
Little
M P
MP
Department of Epidemiology and Public Health, Imperial College Faculty of Medicine, St Mary's Campus, and Paediatric Department, St Mary's Hospital, London, UK. mark.little@imperial.ac.uk
Järvelin
M-R
MR
Neasham
D E
DE
Lissauer
T
T
Steer
P J
PJ
D000773:Anesthesia, Obstetrical / Q000639:trends; D002585:Cesarean Section / Q000639:trends; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007440:Intubation / Q000639:trends*; D017214:Laryngeal Masks / Q000639:trends; D008131:London; D018743:Perinatal Care / Q000639:trends*; D011175:Positive-Pressure Respiration / Q000639:trends; D011247:Pregnancy; D011446:Prospective Studies; D012151:Resuscitation / Q000639:trends*