Aim To perform a service assessment of neonatal morbidity and mortality and the financial implications for a local neonatal unit from Lucas’ Category one caesarean sections.
Methods Using local online systems; ICE and BadgerNet, all Category one sections were identified between April 1st 2012 and March 31st 2014. Once identified a number of observations were looked into including the indications for each section, the improvement of Apgar scores, the number admitted to the neonatal unit, levels of organ support, neonates requiring follow up and the financial impact of looking after this patient population.
Results 295 patients were identified from the method used including 3 mortalities; interestingly 29 (9.8%) were performed post 42 weeks of gestation. 62% of sections identified were performed due to foetal distress a proportion consistent with McIlwaine et al’s audit results. Reassuringly raw statistics below showed improvement of Apgar scores; 89% scoring 9 or 10 at Ten minutes vs 54% at One minute. 76 (26%) of neonates were admitted to the neonatal unit for further management, of these one-third had stays of less than 3 days whilst 29% remained in for at least 15 days; mean length 13.75 days (median 7, range 74). The most common organ system requiring support was respiratory with 62% requiring this; metabolic and neurological support was also provided to a third of patients. Finally two-thirds of admitted neonates required no follow up. The financial cost to the department in caring for these neonates was calculated as £550,400.
Conclusion Overall 1 in 16 patients required some degree of follow up from neonatology after discharge. Three action points have been developed; firstly the formation of a perinatal dashboard locally or even regionally. The second being a project covering the south west regional looking into short-term morbidity and mortality of the same population group. Finally, to promote more in-depth research into the outcomes of neonates from category one sections where the literature demonstrates little or no work within this field. A prospective-cohort study would be the most appropriate design model for this project.
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