Confidential enquiry into deaths due to prematurity

The aim of this study was to audit the management of neonatal respiratory d istress syndrome (RDS) in a geographically defined population using a retro spective peer review of case notes. The subjects were 49 infants of 24-36 w k gestation with a birthweight >499 g, and dying as a consequence of premat urity at <1 y of age in Wales during 1996. Forty four infants (90%) were de livered in a unit with staff experienced in the management of preterm birth . Of the 30 infants <30 weeks' gestation, 29 (97%) received neonatal intens ive care on a (sub)regional unit. Pre-delivery corticosteroids were indicat ed in 34 cases and administered in 31 (91%). Resuscitation at birth was ind icated in 47 infants and conducted satisfactorily in 42 (89%). Temperature on admission to the neonatal unit was not recorded in 7 infants; in the oth er 42 it was greater than or equal to 35.5 degrees C in 21 (50%). Early sur factant therapy was administered to 31/34 (91%) infants still intubated 120 min after birth, but was given within 30 min to only 8 (24%). Mechanical v entilation was assessed in 41 infants and considered to be good in 23 (56%) . Cardiovascular therapy was evaluated in 40 infants requiring active suppo rt and considered to be good in 31 (78%). We concluded that neonatal RDS wa s generally well managed, thermal care during resuscitation was poor, surfa ctant should be administered more promptly, and deficiencies in the managem ent of ventilation were common and related mainly to poor anticipation and a slow response to problems.