Factors associated with fall in neonatal intubation rates in the United Kingdom – prospective study

Abstract

To investigate the trend of neonatal resuscitation by intubation or mask ventilation over time and to assess its association with changes in prevalence of caesarean section and use of general anaesthesia in labour. All women booking pregnancy at any of 15 maternity units, analysed using logistic regression. Prospective study. UK hospital-based maternity units (15 centres). A total of 221,322 first singleton births of babies weighing 200 g or more in the St Mary's Maternity Information System cohort, 1988-2000, covering the North West Thames area of London. Prevalence of intermittent positive-pressure ventilation (IPPV) (by intubation or mask) by calendar year. Overall use of IPPV decreased markedly (two-sided P<0.01) over the course of the study, and this decrease was evident by all modes of delivery. Adjusted mean prevalence of intubated IPPV decreased from 0.51% (95% CI 0.44-0.58) in 1988 to 0.07% (95% CI 0.06-0.09) in 2000. There was a similar decrease in the prevalence of IPPV by mask. However, despite substantial increases in prevalence of caesarean sections and reductions in the use of general anaesthesia over the course of the study, adjusting for these variables made little difference to the temporal trends in intubation or use of mask ventilation. There has been a marked reduction in the prevalence of infants given resuscitation by positive-pressure ventilation that cannot be explained by changes in the prevalence of caesarean section or use of general anaesthesia in labour.