title: Practice variation in initial management and transfer thresholds for infants with respiratory distress in Australian hospitals. Who should write the guidelines?
abstract: OBJECTIVE
  In Australian hospitals: (i) to identify current practices in the initial oxygen management of infants with respiratory distress; (ii) to identify factors important in deciding to transfer an infant; and (iii) to identify thresholds for transfer.
  
  
  METHODS
  All Australian hospitals with: >200 registered deliveries, a special care unit (SCU) or neonatal intensive care unit (NICU), and at least one paediatrician were surveyed in 2004 (n=176). The questionnaire sought information on the initial oxygen management and factors important in deciding to transfer. Three scenarios were also used to identify thresholds for pH, carbon dioxide and oxygen levels at which transfer should occur. Responses from SCU were compared with those from NICU.
  
  
  RESULTS
  15/19 (79%) NICUs and 118/157 (75%) SCUs responded. Initial oxygen management varies widely among SCUs and NICUs. NICUs set significantly lower saturation (SaO(2)) targets in two of the three scenarios. NICUs are statistically significantly more likely to regard 'Medical Staff Experience' and 'Time to Nearest NICU' as important compared with SCUs (P<0.05). NICUs would 'Probably' and 'Definitely Transfer' infants at significantly lower oxygen levels in all three cases (P<0.05). SCUs are significantly less likely to transfer babies with pH of <7.25 compared with NICUs. There was no difference between the centres for CO(2) level.
  
  
  CONCLUSIONS
  The wide variation that exists between nurseries in the initial management of infants with respiratory distress and in the thresholds for transfer strongly suggests the need for the development of practice guidelines.
authors.affiliation: Northern Sydney Central Coast Area Health Service, Gosford Hospital, Gosford, NSW, Australia. abuckmaster@nsccahs.health.nsw.gov.au
authors.forename: Adam G
authors.initials: AG
authors.lastname: Buckmaster
authors.forename: Ian M R
authors.initials: IM
authors.lastname: Wright
authors.forename: Gaston
authors.initials: G
authors.lastname: Arnolda
authors.forename: David J
authors.initials: DJ
authors.lastname: Henderson-Smart
mesh_terms: D001315:Australia; D003657:Decision Making; D005260:Female; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal; D008297:Male; D009725:Nurseries, Hospital; D010102:Oxygen Inhalation Therapy; D010360:Patient Transfer; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012107:Research Design; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors