The Feasibility and Impact of a Postresuscitation Care Protocol in the Well Baby Nursery

Abstract

Objective: Determine if a post-resuscitation care (PRC) protocol in the well baby nursery (WBN) would improve identification of infants requiring NICU (Neonatal Intensive Care Unit) admission. Study design: This is a retrospective and prospective cohort study of a PRC protocol in 765 WBN admissions after delivery room (DR) resuscitation with continuous positive airway pressure (CPAP) and/or positive pressure ventilation (PPV). Results: After protocol initiation, NICU transfers during the birth hospitalization increased significantly (11.17% vs 16.08%, p<0.05). There was no difference in incidence of NICU transfer (5.99% vs 7.29%, pre-PRC vs PRC, p=0.47) during the first four hours of life during protocol administration. Respiratory distress was the most common indication for NICU transfer in both cohorts (7.90% vs 11.81%, p=0.09, pre-PRC vs PRC). Non-invasive positive pressure and/or high flow nasal cannula (5.72% vs 9.55%, p=0.06, pre-PRC vs PRC) were routinely administered in the NICU to transferred infants. Conclusions: After apparent recovery from DR resuscitation WBN admissions experience significant risk of complications requiring NICU transfer, supporting NRP recommendation for enhanced monitoring. In our study, we demonstrated the feasibility of standardized PRC protocol in the WBN. NICU transfers increased after initiation of a PRC protocol, however, further studies are needed to confirm possible benefits of this PRC protocol in improving identification of infants requiring a higher level of care.