Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. e164-e175 (doi:10.1542/10.1542/peds.2005-0936)

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A Survey of Delivery Room Resuscitation Practices in the United States

Tina A. Leone, MD, Wade Rich, RRT and Neil N. Finer, MD

Department of Pediatrics, Division of Neonatology, University of California, San Diego, San Diego, California

Objective. To determine current resuscitation practices of neonatologists in the United States.

METHODS. A 15-question survey was developed and mailed to neonatal directors in May 2004.

ELRESULTS. Of the total of 797 surveys mailed, 84 were returned undeliverable or unanswered and 450 were returned completed (63% response rate). Respondents were mainly (70%) from level III NICUs. Most programs resuscitate newborns in the delivery room (83%), rather than in a separate room. The number and background of individuals attending deliveries vary greatly, with 31% of programs having <3 individuals attending deliveries. Flow-inflating bags are most commonly used (51%), followed by self-inflating bags (40%) and T-piece resuscitators (14%). Pulse oximeters are used during resuscitation by 52% of programs, and 23% of respondents indicated that there was a useful signal within 1 minute after application. Blenders are available for 42% of programs, of which 77% use pure oxygen for the initial resuscitation and 68% use oximeters to alter the fraction of inspired oxygen. Thirty-two percent of programs use carbon dioxide detectors to confirm intubation, 48% routinely and 43% when there is difficulty confirming intubation. Preterm infants are wrapped with plastic wrap to prevent heat loss in 29% of programs, of which 77% dry the infant before wrap application. A majority of programs (76%) attempt to provide continuous positive airway pressure or positive end expiratory pressure (PEEP) during resuscitation, most commonly with a flow-inflating bag (58%), followed by a self-inflating bag with PEEP valve (19%) and T-piece resuscitator (16%). A level of 5 cm H₂O is used by 55% of programs.

CONCLUSIONS. Substantial variations exist in neonatal resuscitation practices, some of which are not addressed in standard guidelines. Future guidelines should include recommendations regarding the use of blenders, oximeters, continuous positive airway pressure/PEEP, and plastic wrap during resuscitation.

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Key Words: neonatal resuscitation • survey • practice variation • delivery room

Abbreviations: NRP—Neonatal Resuscitation Program • PEEP—positive end expiratory pressure • CPAP—continuous positive airway pressure • PPV—positive pressure ventilation • ELBW—extremely low birth weight

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Accepted Jul 29, 2005.

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