The most appropriate place for the delivery of a very low birthweight (VLBW) infant is in a hospital qualified to care for high risk neonates. The reality is that with regularity, these fragile infants will be born in community hospitals lacking neonatal intensive care services. Current Neonatal Resuscitation Program (NRP) standards for managing VLBW infants are directed at facilities that electively deliver preterm infants. However, to give these babies the best start, it is important for Level I obstetric facilities to strive to incorporate current resuscitation recommendations into their practice. The recommended care is more likely to be implemented if it can be done in an efficient and cost-effective manner.

Problem-Solving Methods:

A multidisciplinary approach was taken to develop cost-effective methods for staff to provide evidence-based resuscitation care to the VLBW infants born in a community Level I obstetric unit. Specifically, the titration of blended oxygen using pulse oximetry in the delivery room, use of measures to enhance thermoregulation, and use of a pressure monitoring device during ventilation were addressed. A biomedical engineer, respiratory therapist, and advanced practice nurse contributed to the formulation of creative applications to fulfill the resuscitation recommendations. Education was provided for the healthcare team to understand the recommendations and incorporate the new equipment and supplies into the resuscitation of VLBW infants.

Findings:

The creation of a portable equipment station enabled the facility to save approximately $2200 per delivery room in capital equipment expense. Additional modest savings per patient were accomplished by use of a standard food grade zip bag and homemade hats rather than purchasing the commercially available products. Selection of a new resuscitation bag with a built in manometer netted no change in cost. Lessons learned included:  the need to secure the portable pulse oximeter to prevent theft; the portable equipment station on rolling wheels was easily misplaced in the department impacting its use; the packaging together of supplies for a VLBW delivery did facilitate the use of the supplies by care providers; there was a poor response rate for completion of the quality improvement form; and the staff could use further hands-on practice with the equipment and techniques in the form of mock resuscitations on the unit.

Conclusion:

Success was achieved in the incorporation of evidenced-based guidelines for the resuscitation of VLBW infants with a reasonably low outlay of capital funds. The approach is cost-effective, sustainable, and can be duplicated in other organizations.