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Confidential enquiry into deaths due to prematurity
Author(s) -
Cartlidge PHT,
Jones HP,
Stewart JH,
Drayton MR,
Ferguson DS,
Matthes JWA,
Minchom PE,
Moorcraft J
Publication year - 1999
Publication title -
acta pædiatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/j.1651-2227.1999.tb01086.x
Subject(s) - medicine , respiratory distress , neonatal intensive care unit , neonatal resuscitation , gestation , pediatrics , mechanical ventilation , resuscitation , population , neonatal respiratory distress syndrome , surfactant therapy , retrospective cohort study , birth weight , gestational age , pregnancy , emergency medicine , anesthesia , surgery , environmental health , biology , genetics
The aim of this study was to audit the management of neonatal respiratory distress syndrome (RDS) in a geographically defined population using a retrospective peer review of case notes. The subjects were 49 infants of 24–36 wk gestation with a birthweight > 499 g, and dying as a consequence of prematurity at <1 y of age in Wales during 1996. Forty‐four infants (90%) were delivered in a unit with staff experienced in the management of preterm birth. Of the 30 infants <30 weeks'gestation, 29 (97%) received neonatal intensive care on a (sub)regional unit. Predelivery corticosteroids were indicated in 34 cases and administered in 31 (91%). Resuscitation at birth was indicated in 47 infants and conducted satisfactorily in 42 (89%). Temperature on admission to the neonatal unit was not recorded in 7 infants; in the other 42 it was >35.5°C in 21 (50%). Early surfactant therapy was administered to 31/34 (91%) infants still intubated 120 min after birth, but was given within 30 min to only 8 (24%). Mechanical ventilation was assessed in 41 infants and considered to be good in 23 (56%). Cardiovascular therapy was evaluated in 40 infants requiring active support and considered to be good in 31 (78%). We concluded that neonatal RDS was generally well managed, thermal care during resuscitation was poor, surfactant should be administered more promptly, and deficiencies in the management of ventilation were common and related mainly to poor anticipation and a slow response to problems.