Post-resuscitation care for neonates receiving positive pressure ventilation at birth

Area of Science:

• Neonatal Resuscitation
• Perinatal Medicine
• Pediatric Critical Care

Background:

• Positive pressure ventilation (PPV) is a common intervention for newborns requiring respiratory support at birth.
• The necessity and duration of postresuscitation care (PRC) for infants receiving PPV, particularly those with short PPV duration, require further investigation.

Purpose of the Study:

• To determine if postresuscitation care (PRC) is indicated for all infants born at ≥35 weeks' gestation who receive positive pressure ventilation (PPV) at birth.
• To explore the specific aspects of PRC and identify factors predicting its need.

Main Methods:

• Retrospective review of infants born between 1994 and 2013 who received PPV at birth (gestational age ≥35 weeks).
• Analysis of perinatal factors, admission course, neonatal morbidities, and care provided.
• Logistic regression to identify predictors for prolonged special neonatal care unit (SNCU) stay and need for advanced interventions.

Main Results:

• Of 3658 infants receiving PPV, 90% were admitted for PRC.
• Infants receiving short PPV (<1 minute) had a 59% chance of staying in the SNCU for ≥1 day.
• Prolonged PPV (≥1 minute) was associated with higher rates of morbidities and need for specialized care.
• Placental abruption, assisted delivery, small-for-dates, prematurity (<37 weeks), low Apgar score, and intubation were independent predictors for extended SNCU stay and interventions.

Conclusions:

• The study supports the need for postresuscitation care (PRC) for all infants receiving positive pressure ventilation (PPV) at birth, including those with short durations.
• Early identification of risk factors can guide the intensity and duration of neonatal care.