114 The Development and Audit of a Multidisciplinary Neonatal Resuscitation Team at a Tertiary Perinatal Centre

This study describes the performance and risk management of a multidisciplinary NRT at a tertiary perinatal centre.

The interdisciplinary nature of the Neonatal Resuscitation Program has stimulated development of neonatal resuscitation teams (NRTs).

In May 2001, the training and preceptorship of an NRT was instituted at the newly-built regional perinatal centre in St. John's, Newfoundland and Labrador. In February 2002 the role of neonatal resuscitation was transferred from attending pediatricians/neonatologists to a NRT which consisted of a neonatal nurse, a respiratory therapist, and, when available, a resident or nurse practitioner. Criteria for levels of risk were established, mandating NRT attendance at moderate- and high-risk deliveries (in the latter case, accompanied by a neonatologist). Low-risk deliveries remained the responsibility of caseroom staff, assisted by the NRT when concerns arose. Liberal thresholds for risk were required to satisfy obstetrical concerns. NRT activity was prospectively audited for 18 months.

During this time the NRT attended 2370 (64.3%) out of 3684 deliveries. 98% of attendances were in advance of delivery. Table 1 demonstrates the demographics of this population, with resuscitation interventions and outcomes. There were no neonatal deaths or morbidities related to resuscitation in the low- or moderate-risk groups. Neonatologists were not notified for 82 (29%) high-risk deliveries. In 72 cases the NRT felt designation of high-risk was inappropriate. The remaining 10 cases resulted in a redefining of high-risk criteria and reinforcement of communication strategies.

A NRT can perform effectively in a tertiary centre with support from experienced pediatric staff at high-risk deliveries only. Categorization of deliveries into level of risk provides a safe and efficient means of delivering neonatal resuscitation services.