title: Factors associated with the need for ventilation at birth of neonates weighing ≥2,500 g.
abstract: OBJECTIVE
  Approximately 20-40% of annual global neonatal deaths occur among infants with birthweights ≥2,500 g, and most of these deaths are associated with intrapartum asphyxia in low- and middle-income countries. This study aims to evaluate the peripartum variables associated with the need for resuscitation at birth of neonates weighing ≥2,500 g.
  
  
  METHODS
  This case-control retrospective study was performed on data from all public reference maternity units in the state of Ceará, Northeast Brazil, between March 2009 and March 2010. The subjects were singleton neonates without malformations weighing ≥2,500 g, who required positive-pressure ventilation in the delivery room. The controls had a 1-minute Apgar score of ≥8 and did not undergo resuscitation. Variables associated with positive-pressure ventilation in the delivery room were evaluated via conditional multivariate logistic regression.
  
  
  RESULTS
  Of the 2,233 live births with birth weights ≥2,500 g, 1-minute Apgar scores ≤7, and no malformations, 402 patients met the inclusion criteria, and they were paired with 402 controls. Risk variables for positive-pressure ventilation at birth were a gestational age <37 weeks (OR: 3.54; 95% CI: 1.14-10.92) and meconium-stained amniotic fluid (8.53; 4.17-17.47). Cervical examination at maternal admission (0.57; 0.38-0.84) and a written follow-up of the labor (0.68; 0.46-0.98) were identified as protective variables.
  
  
  CONCLUSIONS
  Significant flaws in obstetric care are associated with the need for positive-pressure ventilation at birth for neonates weighing ≥2,500 g.
authors.affiliation: Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza/CE, Brazil.
authors.forename: José Roberto Pereira de
authors.initials: JR
authors.lastname: Sousa
authors.affiliation: Universidade Federal do Ceará, Departamento de Saúde Maternal e Infantil, Fortaleza/CE, Brazil.
authors.forename: Álvaro Jorge Madeiro
authors.initials: ÁJ
authors.lastname: Leite
authors.affiliation: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, São Paulo/SP, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Sanudo
authors.affiliation: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Pediatria, São Paulo/SP, Brazil.
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
mesh_terms: D001034:Apgar Score; D001938:Brazil; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D036801:Parturition; D011175:Positive-Pressure Respiration / Q000706:statistics & numerical data*; D011247:Pregnancy; D012151:Resuscitation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors