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PS-225 Risk Factors (rf) Associated With Advanced Neonatal Resuscitation In = 34 W Ga Newborns: A Multicenter, Prospective, Case-controlled Study. The Advanced Neonatal Resuscitation (anr) Study
  1. JP Berazategui1,
  2. A Aguilar2,
  3. M Escobedo3,
  4. F Althabe4,
  5. R Ginsburg5,
  6. F De Almeida5,
  7. G Albornoz6,
  8. F Saker7,
  9. MG Puig8,
  10. D Amado9,
  11. M Valera10,
  12. E Szyld4
  1. 1Maternal and Infant, FUNDASAMIN / Hospital Universitario Austral, Pilar - Derqui, Argentina
  2. 2Maternal and Infant, FUNDASAMIN (Fundacion Para La Salud Materno Infantil), Buenos Aires, Argentina
  3. 3Maternal and Infant, University of Oklahoma, Oklahoma, USA
  4. 4Maternal and Infant, IECS Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
  5. 5Maternal and Infant, Escola P. de Medicina da Universidade F. de Sao Paulo, Sao Paulo, Brazil
  6. 6Maternal and Infant, Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina
  7. 7Maternal and Infant, Cleveland Clinic, Cleveland, USA
  8. 8Maternal and Infant, Maternidad Martin, Rosario, Argentina
  9. 9Maternal and Infant, Maternidad NS de la Merced, Tucuman, Argentina
  10. 10Maternal and Infant, Hospital Feernandez, Buenos Aires, Argentina


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.


Abstract PS-225 Table 1

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