Changes in resuscitation practice at birth

The investigators, in the course of an ongoing monitoring program, prospectively collected information on neonatal resuscitation covering 17,885 infants born in a 4-year period in 1993 through 1997. In early 1995, T-piece circuits and facemasks were introduced in the maternity unit, and all medical and midwifery staff received practical training in their use. After 6 months, the previously used 500-mL self-inflating bags and masks were removed. Mean maternal age increased by approximately 6 months during the period under study. Forceps deliveries and cesarean sections (elective and emergency) declined significantly, whereas ventouse extractions and vaginal deliveries through meconium increased. Although medical staff electively attended progressively fewer deliveries during the 4-year study period, the number of infants seen after delivery by a pediatrician did not change significantly. Rates of early neonatal encephalopathy and meconium aspiration syndrome did not change significantly, but neonatal convulsions became markedly less frequent. The intubation rate fell significantly throughout the study period. The crude rate of endotracheal intubation fell 51%, and that of ventilatory resuscitation by any method decreased from 11% to 8.9%. The proportion of infants who received ventilatory support at birth but were not intubated rose from 76% to 86%. Intubation rates declined for infants of 30 weeks gestation and above. Rates of mask ventilation and intubation were 3.7% and 0.6%, respectively, for infants born by normal vaginal delivery. In contrast, 8.3% of infants born by elective cesarean section and 19.1% of those born by emergency section received mask ventilation. There was no independent association between the advent of T-piece ventilation and a lower intubation rate. No consistent change in 5-minute Apgar scores was evident during the period under review. Intubation rates fell substantially in this population with no decline in neonatal status. T-piece ventilation appears to be an effective and safe alternative to bag-valve-mask ventilation for resuscitating newborn infants. Education in the use of noninvasive airway support could help account for declining rates of intubation.