563 - Risk Factors and Clinical Outcomes of Delivery-Room Resuscitation Strategy in Preterm, Very-Low-Birth-Weight Infants: A Cohort Study in Taiwan

Publication Number: 3544.563

Ye Syuan Lin, E-da hospital, KaoHsiung, Kaohsiung, Taiwan (Republic of China); Pei Ling Wu, Eda hospital, Kaohsiung, Kaohsiung, Taiwan (Republic of China); Chyi-Her Lin, E-Da Hospital, Kaohsiung, Kaohsiung, Taiwan (Republic of China)

Background: According to current Neonatal Resuscitation Program guidelines, nasal continuous positive airway pressure is recommended as the initial respiratory support in the delivery room for very preterm (gestational age < 32 weeks) or very-low-birth-weight (birth weight < 1500 grams) infants. Nevertheless, a subset of infants initially stabilized on delivery room nCPAP subsequently requires advanced resuscitation in the delivery room. The risk factors for such delivery room escalation remain incompletely defined.

Objective: Using data from the Taiwan Neonatal Network, this study examined infants with gestational age (GA) ≤ 30 weeks and birth weight (BW) ≤ 1500 g who were initially managed with preliminary delivery room (DR) resuscitation to identify risk factors of advanced resuscitation and to quantify associated clinical outcomes.

Design/Methods: We retrieved cohort data from the Taiwan Neonatal Network. Eligible infants were GA≤ 30 weeks and BW ≤ 1500 g born between Jan 2016-Aug 2024 and received resuscitation in the DR. Infants were categorized by DR resuscitation strategy: Preliminary resuscitation group-managed exclusively with nCPAP or positive-pressure ventilation; and advanced resuscitation group-required escalation in the DR, including endotracheal intubation, chest compressions, or epinephrine after initial DR support.
We compared maternal characteristics, prenatal factors, and neonatal outcomes between groups. Factors associated with DR escalation were examined using multivariable logistic regression with advanced DR resuscitation (=1) as the dependent variable. Clinical outcomes were summarized as group rates and P values.

Results: Among 5,681 infants, 3,164 (55.7%) remained on preliminary DR resuscitation and 2,517 (44.3%) required escalation. In multivariable models, higher BW, greater GA, better 1- and 5-min Apgar scores, and antenatal steroids independently reduced the odds of DR escalation (aOR < 1). Multiple birth and maternal pregnancy-induced hypertension were also linked to lower escalation risk. Adverse clinical outcomes were generally more frequent in the advanced group, except necrotizing enterocolitis, which did not differ.

Conclusion(s): Among preterm infants who initially received preliminary resuscitation in the DR, BW, GA, 1- and 5-minute Apgar scores, and antenatal steroids were significantly associated with successful stabilization. As expected, infants who required escalation in the DR experienced significantly worse clinical outcomes. Further prospective studies are warranted to validate these findings and to explore additional determinants of resuscitation success in the DR.

Figure 1. Patient inclusion flowchart
Infants with GA <30 weeks and BW <1500 g were screened (N=7,378). Exclusions: outborn (n=578), incomplete records (n=184), and no DR resuscitation (n=935), yielding the analytic cohort (n=5,681) who received DR resuscitation. Cohort was classified as preliminary DR resuscitation (n=3,164: nCPAP n=1,135; PPV n=2,029) or advanced DR resuscitation (n=2,517: ETT n=2,039; chest compressions n=138; epinephrine(Bosmin) n=340).

Table 1. Baseline Characteristics of the Study Population and multivariable logistic regression for advanced delivery-room (DR) resuscitation (=1)
(A)
† Plus-minus values are means ± SD; categorical data are n/N (%).
*Indicates statistical significance (p < 0.05).
Abbreviations: DR, delivery room; PPV, positive-pressure ventilation; ETT, endotracheal intubation; PIH, pregnancy-induced hypertension; IUGR, intrauterine growth restriction.
(B)
Adjusted odds ratios (OR) with 95% confidence intervals for advanced DR resuscitation versus preliminary DR resuscitation. Covariates: birth weight (per 100 g), gestational age (per week), Apgar at 1 and 5 min, female sex, multiple birth, antenatal steroids, chorioamnionitis, pregnancy-induced hypertension (PIH), and intrauterine growth restriction (IUGR). OR < 1 indicates lower odds of escalation (protective). Statistically significant results are marked with * (p < 0.05).

Table 2. Clinical outcomes by delivery-room strategy
Event rates are shown as n (%) for the preliminary DR group (n=3,164) and the advanced DR group (n=2,517).
*Indicates statistical significance (p < 0.05).
Abbreviations: DR, delivery room; RDS, respiratory distress syndrome; CLD, chronic lung disease; NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; hsPDA, hemodynamically significant patent ductus arteriosus; iNO, inhaled nitric oxide; ROP, retinopathy of prematurity.