Resuscitative Efforts by Emergency Medical Services for Neonates Within the First Six Hours of Life: A Nationwide Cross-Sectional Analysis.

Objective: The purpose of this study was to describe the prehospital care for neonatal resuscitations (age <6 h) encountered by emergency medical services (EMS) in the United States.

Methods: We conducted a cross-sectional analysis of EMS patient care records in the 2018 and 2019 National EMS Information System Public Release Version 3.4 data sets. We included EMS activations related to a 9-1-1 scene response for patients <6 hours old with evidence of resuscitative efforts or an out-of-hospital cardiac arrest. We examined patient, community, emergency response, and clinical characteristics using descriptive statistics.

Results: A total of 580 EMS encounters were included, of which 184 (31.7%) involved out-of-hospital cardiac arrest. Median patient age was 30 minutes (IQR: 5 to 60). Most responses were by advanced life support (93.1%), and median total prehospital time was 32.8 minutes (IQR: 24.0 to 45.9). The majority of encounters took place in a private residence (73.3%) in an urban setting (83.2%). The patient was left on scene in 3.1% of encounters, and all others were transported to the hospital. Basic airway management was most often required (74.3%), oxygen was delivered in 43.5% of cases, and advanced airway management was performed in 5.7% of encounters. Field delivery was performed in 20.5% of encounters, and compressions/defibrillation were performed in 21.2% of cases.

Conclusion: Prehospital neonatal resuscitation by EMS is uncommon but often requires advanced interventions rarely performed by EMS on newborn patients. These findings have important implications for EMS training and education, including the development of protocols, training programs, and other preparedness innovations for neonatal resuscitation specific to the prehospital setting.