Delivery room resuscitation intensity and associated neonatal outcomes of 24+0–31+6 weeks’ preterm infants in China: a retrospective cross-sectional study

Abstract

Background The aim of this study was to review current delivery room (DR) resuscitation intensity in Chinese tertiary neonatal intensive care units and to investigate the association between DR resuscitation intensity and short-term outcomes in preterm infants born at 24+0–31+6 weeks’ gestation age (GA). Methods This was a retrospective cross-sectional study. The source population was infants born at 24+0–31+6 weeks’ GA who were enrolled in the Chinese Neonatal Network 2019 cohort. Eligible infants were categorized into five groups: (1) regular care; (2) oxygen supplementation and/or continuous positive airway pressure (O2/CPAP); (3) mask ventilation; (4) endotracheal intubation; and (5) cardiopulmonary resuscitation (CPR). The association between DR resuscitation and short-term outcomes was evaluated by inverse propensity score-weighted logistic regression. Results Of 7939 infants included in this cohort, 2419 (30.5%) received regular care, 1994 (25.1%) received O2/CPAP, 1436 (18.1%) received mask ventilation, 1769 (22.3%) received endotracheal intubation, and 321 (4.0%) received CPR in the DR. Advanced maternal age and maternal hypertension correlated with a higher need for resuscitation, and antenatal steroid use tended to be associated with a lower need for resuscitation (P < 0.001). Severe brain impairment increased significantly with increasing amounts of resuscitation in DR after adjusting for perinatal factors. Resuscitation strategies vary widely between centers, with over 50% of preterm infants in eight centers requiring higher intensity resuscitation. Conclusions Increased intensity of DR interventions was associated with increased mortality and morbidities in very preterm infants in China. There is wide variation in resuscitative approaches across delivery centers, and ongoing quality improvement to standardize resuscitation practices is needed.

Neonatal Resuscitation Online Registry in Shenzhen: protocol for a prospective, multicentre, open, observational cohort study

“…Neonatal resuscitation almost always predicts an inability to establish spontaneous breathing, 11 and the correct implementation of neonatal resuscitation techniques can establish effective ventilation for the neonate and help him or her make a successful transition from the intrauterine to the extrauterine environment. Although guidelines for neonatal resuscitation have been updated, in China, resuscitation strategies vary widely between centres 20 and the practice and management of neonatal resuscitation are not standardised in each region. Moreover, there are very few follow-up studies on neonatal resuscitation, and the prognosis of resuscitated neonates remains unclear.…”

“…A retrospective study reported the short-term outcomes of delivery room resuscitation for very preterm and very low birth weight infants in 33 neonatal intensive care units (NICUs) in five provinces and cities in North China, although it did not provide information regarding post-discharge follow-up and outcomes of the infants. 18 Another retrospective study published in 2021 reported the clinical features of preterm infants with a birth weight of <1500 g who received resuscitation of different intensities in NICUs of 20 hospitals in Jiangsu province, 19 while yet another retrospective study published in 2023 reported the correlation between the intensity of delivery room resuscitation of preterm infants with a gestational age (GA) of 24 +0 –31 +6 weeks and their short-term outcomes from the Chinese Neonatal Network 20 ; however, both these studies provided incomplete information for some cases.…”