Risk factors for advanced resuscitation in term and near-term infants: a case-control study.
OBJECTIVE
(1) To determine which antepartum and/or intrapartum factors are associated with the need for advanced neonatal resuscitation (ANR) at birth in infants with gestational age (GA) ≥34 weeks. (2) To develop a risk score for the need for ANR in neonates with GA ≥34 weeks.


METHODS
Prospective multicentre, case-control study. In total, 16 centres participated in this study: 10 in Argentina, 1 in Chile, 3 in Brazil and 2 in the USA.


RESULTS
A case-control study conducted from December 2011 to April 2013. Of a total of 61 593 births, 58 429 were reported as an GA ≥34 weeks, and of these, only 219 (0.37%) received ANR. After excluding 23 cases, 196 cases and 784 consecutive birth controls were included in the analysis. The final model was generated with three antepartum and seven intrapartum factors, which correctly classified 88.9% of the observations. The area under the receiver operating characteristic (AROC) performed to evaluate discrimination was 0.88, 95% CI 0.62 to 0.91. The AROC performed for external validity testing of the model in the validation sample was 0.87 with 95% CI 0.58 to 0.92.


CONCLUSIONS
We identified 10 risk factors significantly associated with the need for ANR in newborns ≥34 weeks. We developed a validated risk score that allows the identification of newborns at higher risk of need for ANR. Using this tool, the presence of specialised personnel in the delivery room may be designated more appropriately.
Fundación para la Salud Materno Infantil, Buenos Aires, Argentina.|Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.|Hospital Universitario Austral, Pilar, Buenos Aires, Argentina.|Hospital Juan A Fernández, Buenos Aires, Argentina.
Juan Pablo
JP
Berazategui
Fundación para la Salud Materno Infantil, Buenos Aires, Argentina.
Adriana
A
Aguilar
University of Oklahoma, Oklahoma, USA.
Marilyn
M
Escobedo
University of Oklahoma, Oklahoma, USA.
Douglas
D
Dannaway
Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brasil.
Ruth
R
Guinsburg
Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brasil.
Maria Fernanda Branco
MF
de Almeida
Cleveland Clinic, Cleveland, USA.
Firas
F
Saker
Fundación para la Salud Materno Infantil, Buenos Aires, Argentina.|Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.
Ariel
A
Fernández
Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina.
Guadalupe
G
Albornoz
Hospital Juan A Fernández, Buenos Aires, Argentina.
Mariana
M
Valera
Maternidad N. S Merced, Tucumán, Argentina.
Daniel
D
Amado
Maternidad Martin, Rosario, Santa Fe, Argentina.
Gabriela
G
Puig
Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.
Fernando
F
Althabe
Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina.|University of Oklahoma, Oklahoma, USA.|Icahn School of Medicine at Mt. Sinai, USA.|Universidad Abierta Interamericana, Buenos Aires, Argentina.
Edgardo
E
Szyld
D000015:Abnormalities, Multiple / Q000453:epidemiology / Q000628:therapy*; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D003696:Delivery Rooms; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D047929:Term Birth; D013997:Time Factors
Neonatology; Resuscitation