Neonatal resuscitation in community hospitals: a regional-based, team-oriented training program coordinated by the tertiary center

Article Abstract:

When newborns are born in a community hospital and require additional intensive care, they are transferred to high-risk care units in other hospitals. Often problems arise before the transfer can be made. Community hospitals must be prepared for complicated resuscitations that utilize methods of artificial breathing and chest compressions in order to keep patients alive. Most often the pediatrician is the only one experienced in newborn resuscitation, and at community hospitals, he may not be present at every delivery. An increasing number of malpractice suits arising out of obstetrical complications may cite inadequate resuscitation attempts as a cause of poor infant outcome. Since round-the-clock pediatric coverage is difficult in community hospital settings, the development of nonphysician resuscitation teams is suggested. A pilot program incorporating a team approach was developed between a tertiary (high-risk care) hospital and seven community hospitals. The 'code pink' team including physician and nonphysician members would be on duty 24 hours a day. They were taught a specific protocol to be followed in the event a 'code pink' resuscitation was required. Members were taught as a group and individually, at the tertiary care hospital and then at the community hospital where 'code pink' drills were periodically practiced. Problems encountered included interpretation of the 'code pink' call, assigning roles to team members, scheduling problems for small numbers of staff, storage of resuscitation equipment and evaluation of resuscitation audits.

Study and teaching, Pediatrics, Cardiopulmonary resuscitation, Resuscitation, CPR (First aid) for children

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Use of labor-delivery-recovery room in an urban tertiary care hospital

Article Abstract:

The initiation of 'birthing rooms', which provide a more home-like setting for labor and delivery, prompted speculation that many mothers would require transfer to more conventional operative-type delivery rooms because of complications. An evaluation of birthing rooms, more properly referred to as labor-delivery-recovery rooms, at the 1,000 bed Tampa General Hospital revealed that the rate of transfer to a traditional operative delivery room for vaginal delivery was 3.8 percent. There were 7,447 deliveries between May 1986 and August 1987; 6,181 were vaginal deliveries. Of the vaginal births that took place in an operative delivery room, 28 percent, the largest group, were transferred because of 'ominous' fetal heart tracings. Women with known twin gestations accounted for 19 percent of the transfers. Prolonged second stage of labor accounted for 18 percent of the mothers transferred, and 11 percent were simply the result of labor-delivery-recovery rooms being unavailable. Other reasons for transfer included breech presentation, maternal complications, and known or suspected fetal abnormalities. The use of labor-delivery-recovery rooms eliminated the occasionally clumsy transfer of women from labor rooms to delivery rooms, and permitted 96.2 percent of women delivering their babies vaginally, regardless of risk status, to be in a pleasant and safe home-like environment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Labor (Obstetrics), Natural childbirth, Alternative birthing centers, Birthing centers

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Assiociation between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia

Article Abstract:

A pH less than 7 in umbilical artery blood is an indicator of a potentially serious illness in newborn babies. In a study of 93 newborn infants, a pH less than 7 was linked to seizures, intrauterine growth restriction, encephalopathy and the need for CPR and mechanical ventilation.

Hydrogen-ion concentration, Acid-base imbalances, Acid-base imbalance

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