Recurring concern
Inadequate competence in neonatal resuscitation
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Request correctionFirst reported 21 Apr 2015•Latest report 10 Feb 2025
What this concern includes
Includes failures of neonatal-resuscitation competence arrangements, including insufficient clinical exposure, training, simulation, supervised practice, refresher provision, competence assessment or assurance for paediatricians, neonatal clinicians and other staff expected to perform or support neonatal resuscitation.
Not included
- Excludes adult or general resuscitation competence concerns where neonatal resuscitation is not materially involved.
- Excludes generic first-aid, emergency-response or staff-training deficiencies without a direct neonatal-resuscitation connection.
- Excludes shortages or unavailability of neonatal resuscitation equipment where clinician competence is not the deficient control.
- Excludes failures in neonatal diagnosis, treatment or referral that do not concern competence to perform or support neonatal resuscitation.
- Reports
- 5
- Individual concerns
- 6
- Date range
- 2015–2025
- Stated actions
- 12
Distinct published reports
A report can raise multiple concerns
First to latest report issue date
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
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Concerns raised1
Lack of compulsory direct observed training for paediatric middle grades performing neonatal intubation
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
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Action
Provide neonatal airway management training through Progress+ neonatology placements.
Stated by Royal College of Paediatrics and Child Health -
Action
Strengthen the Progress+ curriculum's neonatal airway capabilities, emphasizing non-invasive airway management and specialty-level safe intubation and difficult-airway management.
Stated by Royal College of Paediatrics and Child Health -
Action
Develop a neonatal airway safety standard with BAPM addressing skills maintenance and ongoing training.
Stated by Royal College of Paediatrics and Child Health
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Action
Signpost members to the neonatal airway safety standard and its skills-maintenance resources.
Stated by Royal College of Paediatrics and Child Health
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
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Position
Removing mandatory neonatal intubation DOPS does not necessarily increase risk because non-invasive airway management is safer and the former DOPS provided false reassurance.
Stated by Royal College of Paediatrics and Child Health
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Position
Operational delivery networks are responsible for supporting airway and resuscitation skill maintenance across neonatal units, particularly where skills are infrequently used.
Stated by Royal College of Paediatrics and Child Health
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Concerns raised2
Reduction in paediatric middle grades' practical experience in neonatal resuscitation
Lower level of consultant general paediatricians' experience in complex neonatal resuscitation
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
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Action
Require all core trainees to spend time in a neonatal setting during training.
Stated by Royal College of Paediatrics and Child Health -
Action
Use a formal supervisor assessment to confirm trainee readiness for tier 2 rota work.
Stated by Royal College of Paediatrics and Child Health -
Action
Require general paediatric specialty trainees to spend time in a neonatal setting.
Stated by Royal College of Paediatrics and Child Health
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Action
Maintain mandatory specialty-level capabilities for neonatal resuscitation and airway management.
Stated by Royal College of Paediatrics and Child Health
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
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Position
Specific mandatory neonatal placements are unnecessary because capabilities can be acquired in most settings, with all trainees spending time in a neonatal setting.
Stated by Royal College of Paediatrics and Child Health
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Position
Mandatory non-invasive airway skills, readiness assessment, consultant support and current Newborn Life Support status provide safe preparation for neonatal resuscitation.
Stated by Royal College of Paediatrics and Child Health
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Concerns raised1
Lack of training on blood transfusion during neonatal resuscitation
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
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Action
Adopt a low threshold for blood transfusion during resuscitation, preferring blood boluses over fluids in line with 2021 NLS guidance.
Stated by North West Anglia NHS Foundation Trust
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Concerns raised1
Inadequate neonatal resuscitation training
This report raised 19 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
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Position
The Trust is responsible for setting out and implementing actions to address the identified maternity-service safety risks.
Stated by Department of Health and Social Care
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Concerns raised1
Failure to provide further support to midwives without experience in newborn resuscitation
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concernsEach statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
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Action
Require all employed midwives to complete annual neonatal resuscitation theory and simulation training under accredited trainers.
Stated by Bedford Hospital -
Action
Provide new starter midwives with a structured orientation period, nominated preceptor and managerial and supervisory support tailored to learning needs.
Stated by Bedford Hospital -
Action
Risk-assess case complexity at handover and throughout each shift, allocate women according to staff experience and competence, and record four-hourly reviews.
Stated by Bedford Hospital
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
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Position
Existing training, orientation, supervision and emergency support systems sufficiently address risks from limited hands-on neonatal resuscitation experience.
Stated by Bedford Hospital
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Position
A second person is not required at birth; midwives must request support when clinically necessary, with assistance available through existing arrangements.
Stated by Bedford Hospital
Data last updated 7 September 2026