title: Nurse-led newborn resuscitation in an urban neonatal unit.
abstract: OBJECTIVE
  To determine the safety and efficacy of neonatal nurses attending at-risk deliveries.
  
  
  METHODS
  An audit of 2 years of delivery attendance by neonatal nurses at an urban hospital. Attendance also by a paediatrician if expected birth weight <2 kg, gestation < 35 weeks, twin pregnancy, foetal distress or any anomaly anticipated to seriously affect the newborn's health.
  
  
  RESULTS
  About 3021 deliveries were attended, 2228 (74%) by a neonatal nurse, 776 (25%) by a neonatal nurse and a paediatrician and 17 (1%) by a paediatrician. Twenty-three children required intermittent positive pressure ventilation via endotracheal tube and/or cardiac massage. All but five of these were deliveries where both a neonatal nurse and a paediatrician were present. Three of these five deliveries had foetal tachycardia. There were 33 deliveries managed by the neonatal nurse alone where the 1-min Apgar was three or less. All achieved a 10-min Apgar of seven or greater. Over the study interval, the proportion of deliveries attended only by a neonatal nurse increased and intensity of resuscitation administered decreased.
  
  
  CONCLUSIONS
  Appropriately trained neonatal nurses can safely resuscitate newborns. Addition of foetal tachycardia to the indications for paediatrician attendance identifies infants likely to require more resuscitation.
authors.affiliation: Special Care Baby Unit, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Donna
authors.initials: D
authors.lastname: Neal
authors.forename: Danny
authors.initials: D
authors.lastname: Stewart
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Grant