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Clinical and Nonclinical Factors and Advanced Neonatal Resuscitation Interventions
Breanna Pickett1, Bo Pan2, Susan Crawford3
1Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
JAMA Network Open
|April 30, 2026
Summary
Maternal socioeconomic status and residence remoteness did not impact advanced neonatal resuscitation interventions (ANRIs). Lower-level birth sites were linked to higher chest compression odds but lower intubation odds.
Area of Science:
- Neonatal Resuscitation
- Public Health
- Health Services Research
Background:
- Advanced neonatal resuscitation interventions (ANRIs) are critical for newborns requiring advanced care.
- Factors influencing ANRI use, including socioeconomic status (SES) and health system characteristics, are not fully understood.
- Understanding these associations is crucial for equitable and effective neonatal care.
Purpose of the Study:
- To investigate the relationship between maternal SES, residence remoteness, birth-site level of service, and the utilization of ANRIs.
- To identify key clinical factors associated with ANRI use.
- To inform strategies for improving neonatal resuscitation outcomes.
Main Methods:
- Cross-sectional study of 966,475 live births (≥34 weeks gestation) in Alberta, Canada (2000-2020).
- Utilized administrative data, classifying maternal SES by deprivation index and residence by remoteness index.
- Multivariable logistic regression analyzed associations between exposures and ANRI, including endotracheal intubation, chest compressions, and epinephrine administration.
Main Results:
- No association found between maternal SES or residence remoteness and ANRI odds.
- Lower-level birth sites (e.g., Level 1A) showed higher odds of ANRI and chest compressions compared to Level 2 sites.
- Home births and lower-level birth sites were associated with lower odds of endotracheal intubation.
- Maternal general anesthesia, lower gestational age, cesarean delivery, meconium-stained fluid, and macrosomia were significantly associated with increased ANRI likelihood.
Conclusions:
- Maternal SES and residence remoteness do not appear to be direct predictors of ANRI use in this universal healthcare setting.
- Birth site level of service influences specific resuscitation techniques, with lower-level sites associated with more chest compressions but fewer intubations.
- Clinical factors, particularly maternal general anesthesia, are strongly linked to ANRI necessity, highlighting the need for preparedness.
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