Ante- and intra-partum factors that predict increased need for neonatal resuscitation

Abstract

In the absence of identified risk factors, 7% of term newly borns require PPV-ETT (positive pressure ventilation and/or endotracheal intubation). Factors increasing need for resuscitation, and therefore for individuals with advanced resuscitation skills, require further evaluation. To evaluate the predictive value of ante- and intra-partum risk factors for PPV-ETT in "at-risk" deliveries. Over a 30-month period, the neonatal resuscitation team (NRT) at the tertiary perinatal centre in St. Johns, Newfoundland and Labrador, prospectively recorded reasons for attending "at-risk" deliveries, and subsequent use of PPV-ETT, rates of low 1- and 5-min Apgar scores, and admission to neonatal intensive care or death. Of 5691 deliveries, 3796 (66.7%) were attended by the NRT. Data were available for 3564 (94%) at-risk attendances, of which 780 (22%) required PPV-ETT. Using multivariate logistic regression analysis, significant ante-partum risk factors for PPV-ETT included multiple pregnancy <35 weeks, maternal infection, hypertension, and oligohydramnios; intra-partum factors were preterm delivery at <36 weeks, breech presentation, meconium-stained amniotic fluid (MSAF), non-reassuring fetal heart rate, emergency Caesarean section (EmCS), shoulder dystocia, and opiates in normal labour. Elective Caesarean section (ElCS) was protective. Forceps, vacuum, and regional or general anaesthesia did not increase risk. EmCS and preterm birth predicted PPV-ETT, low Apgar scores, and admission to neonatal intensive care (or death), and along with MSAF, made up the majority of "at-risk" babies. Given the baseline risk (22%), factors that increase need for resuscitation in a tertiary centre may not alter the practice of the NRT attending all "at-risk" deliveries, with the exception of ElCS.