title: Do We Need an Intubation-Skilled Person at All High-Risk Deliveries?
abstract: OBJECTIVE
  To evaluate the significance and predictive value of each of the Neonatal Resuscitation Program (NRP)-listed ante- and intrapartum risk factors for the need of neonatal intubation at birth.
  
  
  METHODS
  In this population-based study, perinatal data of all infants born at ≥ 35 weeks gestation in the province of Nova Scotia between 1994 and 2014, were identified and reviewed from the Nova Scotia Atlee Database. The frequency of occurrence of risk factors, incidence of neonatal intubation at birth, and its relationship with the different NRP-listed risk factors, were examined. Variables that were significant (P < .05) in univariate analyses were entered into the regression model.
  
  
  RESULTS
  During the 20-year study period, 176,365 infants ≥ 35 weeks gestation were born. In presence of any of the listed risk factors, 0.3% of infants received intubation at birth compared with 0.08% in absence of any risk factor (P < .001). On logistic regression analysis, only 16 of the NRP-listed risk factors had a significant relationship with intubation at birth (P < .001). Delivery in a tertiary care center did not have an impact.
  
  
  CONCLUSIONS
  The presence of an intubation-skilled person at birth may not be indicated in all the NRP-listed ante- and intrapartum risk factors. Stratification of the relative significance of different risk factors may be of importance for the less-resourced health care units providing maternal and newborn care.
authors.affiliation: Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Almudeer
authors.affiliation: Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Canada.
authors.forename: Douglas
authors.initials: D
authors.lastname: McMillan
authors.affiliation: Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Canada; Perinatal Epidemiology Research Unit, Departments of Obstetrics and Gynecology and Pediatrics, Dalhousie University, Halifax, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: O'Connell
authors.affiliation: Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Canada. Electronic address: walid.el-naggar@iwk.nshealth.ca.
authors.forename: Walid
authors.initials: W
authors.lastname: El-Naggar
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy; D007440:Intubation / Q000379:methods*; D008423:Maternal Age; D009359:Neonatology / Q000379:methods*; D009674:Nova Scotia; D009775:Obstetrics and Gynecology Department, Hospital; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012044:Regression Analysis; D012120:Respiration Disorders / Q000628:therapy; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D000078329:Workforce