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Incidence of Newborn Stabilization and Resuscitation Measures and Guideline Compliance during the First Minutes of Life in Norway

Background: Most newborns manage the transition from intra- to extrauterine life without interventions, yet neonatal morbidity caused by failure of transition remains an important health problem. Objective: To determine the incidence of neonatal stabilization and resuscitation measures and guideline compliance during the first minutes after birth. Methods: This is a prospective, observational study of all births in three Norwegian hospitals. All interventions performed, including suctioning, use of pulse oximetry, continuous positive airway pressure (CPAP), positive pressure ventilation (PPV), supplemental oxygen, intubation, and administration of drugs, were registered at every on-call team shift during the study period. Results: A total of 1,507 live-born infants were included, of whom 264 (18%) were brought to the resuscitation crib. Oropharyngeal suctioning was performed in 77 (5%), deep blind suctioning was carried out in 10 (1%) and 84 (6%) were monitored using pulse oximetry. PPV was provided in 58 cases (4%) - 8 (21%) of <34 weeks and 50 (3%) of ≥34 weeks of gestation. Sustained inflation is not routinely used in these departments. CPAP (without PPV) was provided in 17 cases (1%) - 4 (0.3%) were intubated and ventilated through the endotracheal tube. Supplemental oxygen was given to 39 infants (3%) - 9 without pulse oximetry monitoring. The median (interquartile range) birth weight and gestational age of the newborns requiring PPV and/or CPAP were 3,220 g (2,643-3,858) and 39 weeks (37-41), respectively. Conclusion: In this study, the need for resuscitation and/or stabilization measures was commonly considered, and 4% of all newborns received PPV. Despite strong guideline emphasis on the use of pulse oximetry to guide oxygen administration, many infants received oxygen treatment without pulse oximetry monitoring.