Decreasing delivery room intubations: A quality improvement project.

AIM: The delivery room intubation rate for babies born less than 32 weeks postmenstrual age (PMA) at the Mater Mothers' Hospital in 2017 was 51%. Delivery room intubation of preterm infants may be associated with an increased risk of developing bronchopulmonary dysplasia. This quality improvement project aimed to decrease the rate of delivery room intubation for infants born less than 32 weeks PMA. METHODS: A quality improvement process using the evidence-based practice for improving quality framework and Plan-Do-Study-Act cycles was undertaken from October 2018 to December 2019. Commencing bubble continuous positive airway pressure for initial resuscitation in the delivery room was the principal change idea. RESULTS: The delivery room intubation rate for infants born less than 32 weeks PMA before the commencement of this project was 48% (cohort 1, n = 221). There was a significant decrease in the rate to 37.2% while the project was being conducted (cohort 2, n = 277) and a further significant reduction to 28.2% after introducing bubble continuous positive airway pressure in the delivery room (cohort 3, n = 202). There was a significant improvement in admission temperatures and a significant decrease in mortality rate between cohort 1 and cohort 2 but not between cohort 2 and cohort 3. There was no change in the rate of discharge home on oxygen between cohorts. CONCLUSIONS: This quality improvement project led to a significantly decreased delivery room intubation rate in infants born less than 32 weeks PMA. There was no evidence of any adverse outcomes with this approach.

Ectopic Intralaryngo-Tracheal Thyroid Tissue Causing Neonatal Death.

INTRODUCTION: Ectopic thyroid tissue can be found anywhere along the embryologic path of thyroid descent. Intralaryngo-tracheal thyroid tissue is the least common site of ectopia and can present with upper airways obstruction. Its presentation in the neonate is exceptional. CASE REPORT: We describe a term female neonate with subglottic thyroid tissue causing near-total occlusion of the larynx, which led to upper airways obstruction and neonatal death. CONCLUSION: This emphasizes the importance of considering intralaryngo-tracheal tumors as a cause of acute and otherwise unexplainable respiratory distress immediately after birth. The cause of this neonatal death would not have been elucidated without careful autopsy examination.

Time-to-delivery after maternal transfer to a tertiary perinatal centre.

OBJECTIVES: To determine, in women transferred antenatally for acute admission with high risk pregnancies, the numbers who deliver, the average time from transfer to delivery, and whether the reason for transfer influences the time-to-delivery. METHODS: A retrospective analysis of time-to-delivery was performed in a population of women transferred to the Royal Brisbane and Women's Hospital, QLD. Data were obtained from the hospital obstetric, neonatal, and admission databases. RESULTS: A total of 941 women were transferred antenatally with high risk pregnancies where delivery was deemed potentially imminent. Of these 821 (87%) delivered at RBWH. The remaining 120 women (13%) were discharged prior to delivery and then delivered elsewhere. Of the 821 maternal transfers that delivered, the median time to delivery was 24.4 hrs. There were 43% who delivered within 24 hours of admission and 29% who either delivered after 7 days or delivered elsewhere. Most transfers for fetal abnormality delivered in the first 24 hours while most transfers for antepartum haemorrhage and preterm prelabour membrane rupture delivered beyond 24 hours. CONCLUSION: There are significant differences in time-to-delivery following transfer depending on the reason for transfer and many infants transferred in utero will not deliver imminently.