Neonatal resuscitation assessment: documentation and early paging must be improved!
OBJECTIVE
The authors had previously found flaws in resuscitation after severe neonatal asphyxia in cases selected on the grounds of suspected malpractice and financial compensation claims. The aim of the present study was to evaluate neonatal resuscitation in the general obstetric population in a setting with skilled attendance at birth.


METHODS
Observational study.


METHODS
All infants born in the Stockholm County during 2004-2006 with a gestational age of ≥33 weeks, planned as vaginal delivery, with a normal cardiotocographic recording on admission to hospital and with an Apgar score of <7 at 5 min were included.


METHODS
Adherence to guidelines for neonatal resuscitation.


RESULTS
Documentation was unsatisfactory in 142 (45%) infants. Other important shortcomings identified were delayed initiation of extensive resuscitation due to late paging or late arrival of attending paediatrician/neonatologist (n=48), and unsatisfactory ventilation related to late intubation and late securing of free airway (n=15).


CONCLUSIONS
Substandard care in neonatal resuscitation is not limited to cases of severe asphyxia related to claims for medical malpractice. The overall documentation of neonatal resuscitation needs to be much better to enable accurate and reliable evaluation. Obvious actions to improve standards of care include the paging of skilled personnel at an earlier stage in cases of complicated deliveries and team and skills training in neonatal ventilation.
Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. sophie.berglund@ds.se
Sophie
S
Berglund
Mikael
M
Norman
D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D002983:Clinical Competence; D004282:Documentation / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006747:Hospital Communication Systems / Q000592:standards; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records / Q000592:standards*; D018743:Perinatal Care / Q000379:methods / Q000592:standards*; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D011787:Quality of Health Care; D013548:Sweden