[8315.7] Ventilation of Late Preterm Neonates at Birth: A Brazilian Prospective Multicenter Study
Ruth Guinsburg, M. Fernanda B. de Almeida, Jose O. da Costa, Leni M. Anchieta, Lincoln M.S. Freire, Dioclecio Campos, Jr, Brazilian NRP Investigators. Brazilian Pediatric Society, So Paulo, SP, Brazil.
BACKGROUND: In 2003, there were 3,038,251 live births in Brazil. Around 140,000 of these occurred between 34 and 36 weeks of gestation. There are no national data about the need of resuscitation procedures in late preterm neonates.
OBJECTIVE: Evaluate the need of bag and mask ventilation (BM) at birth in late preterm infants and the perinatal risk factors associated to this need in the main public maternity hospitals across Brazil.
DESIGN/METHODS: Multicenter prospective cohort study of all born alive infants during Sep/2003 at 35 public hospitals in 20 Brazilian state capitals with 340/7 and 366/7 wk of gestation without malformations. The 35 hospitals had appropriate equipment and human resources for neonatal resuscitation, according to AAP guidelines. Maternal and neonatal characteristics and delivery room assistance were analyzed by SPSS 12.0. Risk factors for BM were determined by stepwise logistic regression. Missing information for all studied variables was 1% or less.
RESULTS: In Sep/2003, there were 11,922 born alive infants, of which 1,054 (9%) were late preterm infants without malformations. Maternal characteristics: 25 7 years (23% teenagers); 2.5 1.9 gestations (40% in the 1st gestation); 5 3 prenatal visits (25% with <4 visits); hypertension in 20%; diabetes in 3%; ROM >18h in 12%; meconium stained amniotic fluid in 5%; non-cephalic presentation in 8%; and C-section in 45%. Neonatal characteristics: BW 2539 560g (15% <2000g); 28% SGA; 53% male. Out of the 1,054 patients, 97% were assisted by at least 1 pediatrician in the DR. Resuscitation procedures: 143 (14%) were B M ventilated (117 improved); 27 (3%) were intubated, and 10 (1%) received chest compressions, and/or drugs. Risk factors associated to B M in DR were: twin gestation (OR 2.21; 95%CI 1.28-3.85); maternal hypertension (OR 1.63; 1.03-2.56); non-cephalic presentation (OR 2.51; 1.43-4.40); C-section (OR 1.53; 1.01-2.32); and lower GA (340/7-356/7 vs 360/7-366/7: OR 1.70; 1.15-2.51).
CONCLUSIONS: One out of 7 late preterm infants need B M at birth. In order to improve neonatal vitality it is important to improve perinatal care, especially in twin gestations and in pregnancies complicated by hypertension. Increasing the length of gestation by 1-2 weeks significantly decreases the need of ventilation at delivery room.