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Objective The objective of this study is to determine if a postresuscitation care (PRC) protocol in the well baby nursery (WBN) would improve identification of infants requiring neonatal intensive care unit (NICU) admission.

Study Design This is a retrospective and prospective cohort study of a PRC protocol in 765 WBN admissions after delivery room (DR) resuscitation with continuous positive airway pressure and/or positive pressure ventilation.

Results After protocol initiation, NICU transfers during the birth hospitalization increased significantly (11.17 vs. 16.08%, p < 0.05). There was no difference in incidence of NICU transfer (5.99 vs. 7.29%, pre-PRC vs. PRC, p = 0.47) during the first 4 hours of life during protocol administration. Respiratory distress was the most common indication for NICU transfer in both cohorts (7.90 vs. 11.81%, p = 0.09, pre-PRC vs. PRC). Noninvasive positive pressure and/or high-flow nasal cannula (5.72 vs. 9.55%, p = 0.06, pre-PRC vs. PRC) were routinely administered in the NICU to transferred infants.

Conclusion After apparent recovery from DR resuscitation, WBN admissions experience significant risk of complications requiring NICU transfer, supporting Neonatal Resuscitation Program recommendation for enhanced monitoring. In our study, we demonstrated the feasibility of standardized PRC protocol in the WBN. NICU transfers increased after initiation of a PRC protocol; however, further studies are needed to confirm possible benefits of this PRC protocol in improving identification of infants requiring a higher level of care.

Key Points

A PRC protocol in WBN is feasible and associated with increased NICU transfer.

Despite initial apparent recovery, delayed presentation of respiratory distress is a frequent morbidity.

Increased surveillance as recommended by Neonatal Resuscitation Program is indicated in this population.

Keywords resuscitation - postresuscitation care - complications - term neonate - late preterm neonate - continuous positive airway pressure - positive pressure ventilation Publication History

Received: 04 November 2022

Accepted: 30 March 2023

Accepted Manuscript online:
04 April 2023

Article published online:
11 May 2023

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