title: Neonatal outcomes after introduction of a national intrapartum fetal surveillance education program: a retrospective cohort study.
abstract: OBJECTIVE
  To determine the impact of a multidisciplinary fetal surveillance education program (FSEP) on term neonatal outcomes.
  
  
  METHODS
  A retrospective cohort study of term neonatal outcomes before (1998-2004) and after (2005-2010) introduction of a FSEP. Clinical data was collected for all term infants admitted to a neonatal intensive care unit (NICU) in Australia between 1998 and 2010. Infants with congenital abnormalities were excluded. Neonatal mortality and severe neonatal morbidity (admission to a NICU, respiratory support, hypoxic encephalopathy) were compared before and after the FSEP was introduced. The rates of operative delivery during this time were assessed.
  
  
  RESULTS
  There were 3 512 596 live term births between 1998 and 2010. The intrapartum hypoxic death rate at term decreased from 2.02 to 1.07 per 10 000 total births. More neonates were admitted to NICU after 2005 (10.6 versus 14.6 per 10 000 live births), however fewer babies admitted to the neonatal unit had Apgar scores < 5 at five minutes (55.1-45.5%, RR 0.82, 95% CI 0.7-0.87); and rates of hypoxic ischemic encephalopathy fell from 36% to 30% (RR 0.83, 95% CI 0.76-0.90). There was no increase in rates of emergency in labour caesarean sections (11.7% pre versus 11.1% post, RR 0.95, 95% CI 0.95-0.96).
  
  
  CONCLUSIONS
  Introduction of a national FSEP was associated with increased neonatal admissions but a reduction in intrapartum hypoxia, without increasing emergency caesarean section rates.
authors.affiliation: a Department of Obstetrics and Gynaecology , Mercy Hospital for Women , Heidelberg , Victoria , Australia.
authors.forename: L D
authors.initials: LD
authors.lastname: Brown
authors.affiliation: a Department of Obstetrics and Gynaecology , Mercy Hospital for Women , Heidelberg , Victoria , Australia.|b Department of Obstetrics and Gynaecology , University of Melbourne, Mercy Hospital for Women , Heidelberg , Victoria , Australia , and.
authors.forename: M
authors.initials: M
authors.lastname: Permezel
authors.affiliation: c On behalf of the Australian and New Zealand Neonatal Network , Lismore , NSW , Australia.
authors.forename: J R
authors.initials: JR
authors.lastname: Holberton
authors.affiliation: b Department of Obstetrics and Gynaecology , University of Melbourne, Mercy Hospital for Women , Heidelberg , Victoria , Australia , and.
authors.forename: C L
authors.initials: CL
authors.lastname: Whitehead
mesh_terms: D001034:Apgar Score; D001315:Australia / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005311:Fetal Hypoxia / Q000175:diagnosis* / Q000517:prevention & control; D005323:Fetal Monitoring / Q000379:methods*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods; D007743:Labor, Obstetric; D010500:Perinatology / Q000193:education*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
keywords: Fetal monitoring; hypoxic ischemic encephalopathy; intrapartum; neonatal outcome