553 - Identifying Gaps in Neonatal Stabilization and Resuscitation at Community Emergency Departments in Texas

Publication Number: 3534.553

Khawar Nawaz, University of Texas Southwestern Medical School, Dallas, Texas, TX, United States; Gabriela Ocampo, University of Texas Southwestern Medical School, North Richland Hills, TX, United States; Rita Dadiz, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Noorjahan Ali, University of Texas Southwestern Medical School, Dallas, TX, United States; Shalini Ramachandran, UTSW, Dallas, TX, United States

Background: Nearly one million pediatric emergency department (ED) visits occur annually in the United States, with approximately 85% presenting to community EDs (CEDs). Neonates often present with time-sensitive, high-acuity conditions requiring prompt recognition and stabilization. Although the National Pediatric Readiness Project establishes standards for pediatric emergency preparedness, limited data exist regarding neonatal-specific readiness in CEDs. Assessing the current state of neonatal training and resources is essential to inform targeted quality improvement efforts.

Objective: To (1) describe the frequency and characteristics of neonatal visits to Texas CEDs; (2) assess the availability of neonatal stabilization and resuscitation training and equipment; and (3) evaluate the feasibility and acceptability of a neonatal emergency reference tool for CED providers.

Design/Methods: A statewide cross-sectional needs assessment was conducted among emergency physicians practicing in Texas CEDs. A survey was developed using the Delphi method, refined through expert review, pilot tested, and distributed via REDCap. Collected data included CED demographics, neonatal visit volume, resuscitation frequency, staff training frequency and modality, and resource/equipment availability for neonatal emergencies. Descriptive analyses were performed to identify gaps and areas of need.

Results: The survey achieved a 40% response rate. Over 50% of responding CEDs reported being greater than 25 miles from the nearest pediatric ED, and approximately 50% reported managing more than five neonatal visits per day. Fewer than 75% of respondents reported consistent access to essential neonatal stabilization equipment (e.g., hat, warmer, bag-mask ventilation). Figure 1. Approximately 30% of CEDs require Neonatal Resuscitation Program training. Less than 70% received annual or less frequent didactic or simulation-based neonatal emergency training. Figure 2. Encouragingly, 80% expressed both interest in and perceived feasibility of additional neonatal stabilization and resuscitation education. Figure 3.

Conclusion(s): This statewide assessment identifies significant gaps in neonatal emergency preparedness across Texas community EDs, including limited access to essential equipment and infrequent neonatal-specific training. These findings highlight opportunities for statewide collaboration to enhance neonatal readiness through targeted educational initiatives and implementation of standardized resource tools to improve neonatal outcomes in community settings.

Figure 1 -Availability of equipment for neonatal stabilization and resuscitation


Figure 2: Frequency of education (didactic and/or simulation) on neonatal emergencies, stabilization and resuscitation.


Figure 3: Acceptability and feasibility of responders on education and training on neonatal emergencies management