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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}


    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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    • Collaborators Jorge Tavosnaska, Carolina Olmo Herrera, Maria Lidia Failla, Valeria Quispe, Rocio Decena, Mariela Torres, Adriana Cazón, Lorna Andreussi, Carola Capelli, Lucrecia Rosales, Guillermo Colantonio, Ramón Pio Larcade, Héctor Sexer, Natalia Davase, Maria Lidia Failla, Liliana Roldan, Lory Lewis, Cristina Pinedo, Adriana Castro, Ana López, Guillermo Sudini, Ana Yessica López, Sandra Barón, Jorge Fabres, Paulina Toso, Miriam Faune Perez, F Martin, Ligia Maria Souza, Sippo Rugolo, Fabiana Enjamio, Macarena Paz Trigo.

    • Contributors JPB, ES, AA, ME and FA conceptualised and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. JPB, AA, AF, DD and FS carried out the initial analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted. RG and MFBdA designed the data collection instruments, and coordinated and supervised data collection at four (San Pablo ANR network) of the 16 sites, critically reviewed the manuscript and approved the final manuscript as submitted. GA, MV, DA and GP coordinated and supervised data collection in their sites, critically reviewed the manuscript and approved the final manuscript as submitted.

    • Funding This study was funded by FUNDASAMIN (Fundación para la Salud Materno Infantil) and IECS (Instituto de Efectividad Clínica y Sanitaria), Buenos Aires, Argentina.

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Ethics approval The research protocol and informed consents were approved by the IRB/EC of each participating centre.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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