1. First Hour of Care Claire O’Mara Lead Nurse/Innovation Lead EoE Neonatal ODN.

2. Demographics. 75 Babies from Level 3 199 Babies from Level 2 77 Babies from Level 1

3. 4 Care Bundles. Thermoregulation Respiratory Circulation General

4. Thermoregulation. < 26 46.7% temperature < 36.5° 35+ 22.6% temperature < 36.5° Hat applied YES in 55%, NO 35.9% Use of plastic bags < 30 gestation - level 3, 100% compliant - level 1-2, 90.6% compliant

5. Respiratory Oxygen/Air blender available; - 93.4% Yes - 6.6% No Poor documentation in all gestations of % of oxygen used to initiate stabilisation/resus. Use of saturation monitoring; -< 26, 20% did not use -35 +, 70% did not use

6. Respiratory cont... Use of PEEP Dose of Surfactant 200mg/kg Prescribing of caffeine within 1 st 24 hours - < 26 37% No - 31-34+6 82% No

7. Circulation. < 26, 27% had no fluids in the 1 st hour Antibiotics < 26, 37% had not received in the 1 st hour 35+, 35% had not received in the 1 st hour

8. General Delayed cord clamping not practised/monitored in > 80-90% of our units Poor documentation around parent antenatal counselling. < 26, 43% not shown to parents before being transferred, 17% not documented 31-34+6, 27% not shown, 7% not documented

9. General cont.... Use of Antenatal Steroids - <26, 30% received no steroids - 31-34+6, 23% received no steroids Magnesium Sulphate - < 26, 73% not received - 26-30+6, 80% not received

10. Summary. As a Network we are performing ‘well’ but we could do better !! Basic mistakes occur in all gestational ranges in all levels of NICU Simple timely actions have good evidence base for reducing mortality and morbidity. (early fluids, delayed cord clamping, early antibiotics, optimal respiratory management)