Juan Pablo Berazategui1,2,3,4, Adriana Aguilar1, Marilyn Escobedo5, Douglas Dannaway5, Ruth Guinsburg6, Maria Fernanda Branco de Almeida6, Firas Saker7, Ariel Fernández1,2, Guadalupe Albornoz8, Mariana Valera4, Daniel Amado9, Gabriela Puig10, Fernando Althabe2, Edgardo Szyld2,5,11,12. 1. Fundación para la Salud Materno Infantil, Buenos Aires, Argentina. 2. Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. 3. Hospital Universitario Austral, Pilar, Buenos Aires, Argentina. 4. Hospital Juan A Fernández, Buenos Aires, Argentina. 5. University of Oklahoma, Oklahoma, USA. 6. Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brasil. 7. Cleveland Clinic, Cleveland, USA. 8. Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina. 9. Maternidad N. S Merced, Tucumán, Argentina. 10. Maternidad Martin, Rosario, Santa Fe, Argentina. 11. Icahn School of Medicine at Mt. Sinai, USA. 12. Universidad Abierta Interamericana, Buenos Aires, Argentina.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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