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Risk factors for advanced resuscitation in term and near-term infants: a case–control study
  1. Juan Pablo Berazategui1,2,3,4,
  2. Adriana Aguilar1,
  3. Marilyn Escobedo5,
  4. Douglas Dannaway5,
  5. Ruth Guinsburg6,
  6. Maria Fernanda Branco de Almeida6,
  7. Firas Saker7,
  8. Ariel Fernández1,2,
  9. Guadalupe Albornoz8,
  10. Mariana Valera4,
  11. Daniel Amado9,
  12. Gabriela Puig10,
  13. Fernando Althabe2,
  14. Edgardo Szyld2,5,11,12
  15. for the ANR study group
    1. 1Fundación para la Salud Materno Infantil, Buenos Aires, Argentina
    2. 2Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
    3. 3Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
    4. 4Hospital Juan A Fernández, Buenos Aires, Argentina
    5. 5University of Oklahoma, Oklahoma, USA
    6. 6Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brasil
    7. 7Cleveland Clinic, Cleveland, USA
    8. 8Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina
    9. 9Maternidad N. S Merced, Tucumán, Argentina
    10. 10Maternidad Martin, Rosario, Santa Fe, Argentina
    11. 11Icahn School of Medicine at Mt. Sinai, USA
    12. 12Universidad Abierta Interamericana, Buenos Aires, Argentina
    1. Correspondence to Dr Juan Pablo Berazategui, Professor Simon 2356, Villa Ballester, Buenos Aires, Argentina, CP:(1653), jpberaza{at}gmail.com

    Abstract

    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.

    Design 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.

    • Resuscitation
    • Neonatology

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