Potentially avoidable neonatal retrievals in New South Wales: a retrospective analysis.

OBJECTIVE: To identify areas for improvement in outcomes in retrieved newborns by reviewing newborn retrieval activity and evaluating potentially avoidable retrievals from each referring hospital stratified by the level of service delivery over the study period. DESIGN: A retrospective analysis of newborn retrievals from 1 January 2006 to 31 December 2009. SETTING: Newborn and Paediatric Emergency Transport Service (NETS). PARTICIPANTS: Newborns less than 72 hours old retrieved by NETS in the study period. Each retrieval was classified as potentially avoidable, unavoidable or unclassified, based on predefined criteria. MAIN OUTCOME MEASURES: Newborn retrieval rates (per 10,000 live births) and potentially avoidable retrievals for each referring hospital level and overall. RESULTS: There were 2494 newborn retrievals over the study period, with an annual mean of 623 total and 30 potentially avoidable retrievals. There was a reduction in the potentially avoidable retrieval rate (per 10,000 live births) over the study period (from 3.9 in 2006 and 4.2 in 2007 to 2.2 in 2008 and 2.3 in 2009) despite an increase in the total retrieval rate over the same time. Discretionary caesarean, defined as elective (pre-labour) caesarean section without documented fetal or maternal indications before 39 completed weeks of gestation, accounted for two-thirds of the potentially avoidable retrievals. CONCLUSIONS: Potentially avoidable retrievals were a small but significant proportion and are becoming less frequent. Discretionary caesarean is the most common cause of potentially avoidable retrieval. Strict implementation of the elective caesarean section policy directive has the potential to reduce morbidity and the costs related to retrieval.

Endobronchial polyp in a neonate.

Respiratory distress in the neonate with collapse/hyperinflation of the lung can be because of a number of causes, which includes extraluminal, parenchymal and endobronchial lesions. Endobronchial tumour and polyps as the cause of collapse/hyperinflation in newborns are quite rare. We report a case of preterm newborn with respiratory distress secondary to endobronchial inflammatory granuloma and discuss the relevant issues in diagnosis and management.