Potentially avoidable neonatal retrievals in New South Wales: a retrospective analysis.
OBJECTIVE
To identify areas for improvement in outcomes in retrieved newborns by reviewing newborn retrieval activity and evaluating potentially avoidable retrievals from each referring hospital stratified by the level of service delivery over the study period.


METHODS
A retrospective analysis of newborn retrievals from 1 January 2006 to 31 December 2009.


METHODS
Newborn and Paediatric Emergency Transport Service (NETS).


METHODS
Newborns less than 72 hours old retrieved by NETS in the study period. Each retrieval was classified as potentially avoidable, unavoidable or unclassified, based on predefined criteria.


METHODS
Newborn retrieval rates (per 10,000 live births) and potentially avoidable retrievals for each referring hospital level and overall.


RESULTS
There were 2494 newborn retrievals over the study period, with an annual mean of 623 total and 30 potentially avoidable retrievals. There was a reduction in the potentially avoidable retrieval rate (per 10,000 live births) over the study period (from 3.9 in 2006 and 4.2 in 2007 to 2.2 in 2008 and 2.3 in 2009) despite an increase in the total retrieval rate over the same time. Discretionary caesarean, defined as elective (pre-labour) caesarean section without documented fetal or maternal indications before 39 completed weeks of gestation, accounted for two-thirds of the potentially avoidable retrievals.


CONCLUSIONS
Potentially avoidable retrievals were a small but significant proportion and are becoming less frequent. Discretionary caesarean is the most common cause of potentially avoidable retrieval. Strict implementation of the elective caesarean section policy directive has the potential to reduce morbidity and the costs related to retrieval.
Royal Prince Alfred Hospital Newborn Care, Sydney, NSW, Australia. hpop8785@uni.sydney.edu.au.
Himanshu P
HP
Popat
Newborn and Paediatric Emergency Transport Service, Sydney Children's Hospital Network, Sydney, NSW, Australia.
Margaret
M
Wall
Newborn and Paediatric Emergency Transport Service, Sydney Children's Hospital Network, Sydney, NSW, Australia.
Kathryn A
KA
Browning Carmo
Newborn and Paediatric Emergency Transport Service, Sydney Children's Hospital Network, Sydney, NSW, Australia.
Andrew
A
Berry
D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000628:therapy*; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data*; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000592:standards / Q000706:statistics & numerical data*