Reduction of intubation rate during newborn resuscitationafter transition from self-inflating bag to T-piece resuscitator: A quality improvement project
- Author:
Khuen Foong Ng
;
Pauline Poh Ling Choo
;
Umathevi Paramasivam
;
Shahrul Aiman Soelar
- Publication Type:Journal Article
- Keywords:
Quality improvement;
self-inflating bag;
T-piece resuscitator;
intubation rate;
newborn resuscitation
- MeSH:
Infant, Newborn
- From:
The Medical Journal of Malaysia
2015;70(4):228-231
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: T-piece resuscitator (TPR) has many
advantages compared to self-inflating bag (SIB). Early
Continuous Positive Airway Pressure (CPAP) during
newborn resuscitation (NR) with TPR at delivery can reduce
intubation rate.
Methods: We speculated that the intubation rate at delivery
room was high because SIB had always been used during
NR and this can be improved with TPR. Intubation rate of
newborn <24 hours of life was deemed high if >50%. An audit
was carried out in June 2010 to verify this problem using a
check sheet.
Results: 25 neonates without major congenital anomalies
who required NR with SIB at delivery were included.
Intubation rate of babies <24 hours of life when SIB was
used was 68%. Post-intervention audit (August to November
2010) on 25 newborns showed that the intubation rate within
24 hours dropped to 8% when TPR was used. Proportion of
intubated babies reduced from 48.3% (2008-2009) to 35.1%
(2011-2012), odds ratio 0.58 (95% CI 0.49-0.68). Proportion of
neonates on CPAP increased from 63.5% (2008-2009) to
81.0% (2011-2012), odds ratio 2.44 (95% CI 2.03-2.93). Mean
ventilation days fell to below 4 days after 2010. Since then,
all delivery standbys were accompanied by TPR and it was
used for all NR regardless of settings. There was decline in
intubation rate secondary to early provision of CPAP with
TPR during NR. Mean ventilation days, mortality and length
of NICU stay were reduced.
Conclusion: This practice should be adopted by all hospitals
in the country to achieve Millennium Development Goal 4
(2/3 decline of under 5 mortality rate) by 2015.
- Full text:P020150908396674967356.pdf
