Background Approximately 1% of newborns (NB) require advanced resuscitation (AR) [intubation (ET), and/or chest compression (CC) and/or medication (ME)] at birth. The NRP recommends checking risk factors maternal (MF), intrapartum (IF) and fetal (FF) before each birth (evidence level of expert recommendation) but the need for a team with advanced skills after risk factors have been identified remains undetermined. This imprecision leads to underprovision of expertise which is unsafe or costly overprovision of expertise.
Objective To evaluate the relationship of RF and the need for AR in NB ≥34 w gestational age (GA).
Design/methods Prospective, case-controlled study conducted in 16 sites (ARG, CHL, USA and BRA) during 18 months. DR management followed NRP guidelines. Eligible cases were NB ≥34 w GA receiving AR at birth and the 4 consecutive NB not requiring AR were selected as controls for the study. Exclusion criteria: prenatal diagnosis of major congenital malformations. Univariate analysis and multivariate logistic regression (MLR) were used to estimate OR and the associated 95% CI.
Results From 61,593 deliveries, 58,429 NB were ≥34w GA (95%). Out of 219 NB receiving AR (0.37%), 23 were excluded, resulting in 196 cases and 784 controls. We found 21 RF statistically associated with AR. The MLR correctly classified 87% of the observations.
Conclusion NB of pregnant women presenting the following RF: GA < 37, EC, MFL, CC, FB, AP, MSAF, ECS, Ga and PROM (Premature rupture of membranes) >18 h have an increased need of Advanced Resuscitation (AR). Team trained to should be present at the delivery for pregnant women with the above risk factors.
MLR to AR