Postresuscitation care may be needed regardless of PPV duration

1. Among infants born at > 35 weeks, the majority of neonates studied required postresuscitation care (PRC) including ventilator support, parenteral nutrition, or prolonged intensive care stay regardless of short (< 1 min) or prolonged (≥ 1 min) positive pressure ventilation (PPV) at birth.

2. Placental abruption, preterm and small for gestation age (SGA) infants, low 5-minute APGAR scores, longer PPV duration, and need for intubation were associated with PRC requirements.

Evidence Rating Level: 2 (Good)           

Study Rundown: While the Neonatal Resuscitation Program (NRP) educational curriculum teaches appropriate newborn resuscitation methods, NRP guidelines do not differentiate between neonates requiring short periods of positive pressure ventilation (PPV) at birth and those requiring more extensive PPV in directing PRC. PRC includes assisted ventilation, central venous line placement for medication administration, parenteral nutrition, and intensive care stays. This study retrospectively examined the potential association between PPV duration and requirement for PRC. Regardless of length of PPV, neonates had similar needs for ≥ 1 day of intensive care. Neonates requiring short (< 1 min) PPV were significantly more likely to need ≥ 1 day of intensive care, assisted ventilation, or parenteral nutrition when compared to those requiring no PPV. Furthermore, neonates needing longer PPV (≥ 1 min) required similar PRC interventions when compared to neonates requiring short PPV. The authors were able to identify multiple patient and delivery-specific risk factors for PRC need. It is unclear how generalizable these results are, as this was a single-center study in a tertiary care facility that could not control for variability among provider preference for intensive care admission and intervention. However, the large cohort and strong study design add strength to the conclusion that neonates requiring any PPV should be considered for PRC.

Click to read the study, published today in Pediatrics

Relevant Reading: Post-resuscitation complications in term neonates (Nature)

In-Depth [retrospective cohort study]: This study examined a cohort of 87 464 neonates born between 1994 and 2013 at a gestational age ≥ 35 weeks in a major tertiary referral center in Nova Scotia. A neonate was considered to have received “short” positive pressure ventilation (PPV) if it was < 1 minute in duration (N = 1429) and “prolonged” if it was administered for ≥1 minute in duration (N = 1876). When compared to infants requiring no PPV (N = 83 806), those receiving short PPV were more likely to need NICU stays ≥ 1 day (OR 18.7, CI: 16.8-20.7), assisted ventilation (OR 13, CI: 10.1-16.6) and parenteral nutrition (OR 6.1, CI: 4-9.3). Those receiving prolonged PPV were more likely than those receiving short PPV to require assisted ventilation (OR 3.3, CI: 2.5-4.2) and parenteral nutrition (OR 2.9, CI: 1.9-4.4). NICU stay was significantly longer in the prolonged PPV group when compared to the short PPV group (4.9 days and 3.4 days, respectively, P < 0.0001). To address the influence of changing clinical care, the authors examined 2 time periods (1993-2003 and 2004-2013), both of which were following the introduction of NRP. There were no significant differences in outcomes between these time periods. In addition, multiple regression analysis indicated that placental abruption, assisted vaginal/cesarean delivery, SGA infants, preterm birth, longer PPV duration, intubation at birth and low 5-minute APGARS (< 3) were independent predictors of the need for PRC. Specific statistics related to the regression analysis were not included in the published study content.

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