Assessment of Delivery Room Resuscitation with Different Levels and Its Related Factors in Preterm Neonates

Document Type: Original Article


1 Shahid Beheshti University of Medical Sciences, Imam Hossein Hospital, Tehran, Iran

2 Neonatal Health Research Center, Research Institute for children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: There are many known risk factors related to maternal or neonatal problems which can predict the need for resuscitation. In this study, we evaluated the resuscitation process of preterm neonates and analyzed the impact of different risk factors on the level of resuscitation required in the patients.
Methods: This cross-sectional descriptive study was conducted on inborn preterm infants with a birth weight of < 1500 g during one year. Moreover, the present study evaluated the resuscitation process of the delivery room and analyzed the association of maternal-neonatal risk factors and requirement for different levels of resuscitation.
Results: In the present study, 193 preterm neonates were evaluated. In addition, 82 (42.5%) and 110 (57%) patients were female and male, respectively. The mean values of gestational age and birth weight of the patients were 29.9±2.4 weeks and 1191.6±265.2 g, respectively. The mode of delivery in 159 (82.4%) patients was cesarean section.
In the assessment of different levels of resuscitation, 84 (43.5%), 35 (18.1%), 54 (28%), 10 (5.2%), 10 (5.2%), and 9 (4.7%) neonates needed initial steps, free flow of oxygen, positive pressure ventilation, endotracheal intubation, chest compression, and drug administration, respectively. The rate of neonatal mortality was 23.8% (n=46), and hypoxic-ischemic encephalopathy was recorded in 10 (21.7%) subjects. In the evaluation of mothers, 117 (60.6%) subjects had medical problems during pregnancy. The most common problem was preeclampsia in 44 (22.8%) mothers. The lower birth weight (P<0.001), gestational age (P<0.001), Apgar score (P<0.001), and longer duration of resuscitation had a significant effect on the needed level of resuscitation in neonates.
Conclusion: According to the obtained results, it was shown that premature neonates needed more advanced resuscitation. Therefore, improving the quality of care for mothers and neonates is necessary to obtain better outcomes. Regarding the need for noninvasive positive pressure ventilation was the second most frequent intervention, the proper use of equipment is necessary for the prevention of advanced resuscitation.


1. Müller EB, Zampieri MD. Divergences regarding the care of newborns in the obstetric center. Escola Anna Nery. 2014; 18(2):247-56.

2. Ogunlesi T. Mortality within the first 24 hours of admission among neonates aged less than 24 hours in a special care baby unit (SCBU) in Nigeria: the role of significant hypothermia and hypoglycemia. Iran J Neonatol. 2015; 6(1):1-7.

3. Glass HC, Costarino AT, Stayer SA, Brett C, Cladis F, Davis PJ. Outcomes for extremely premature infants. Anesth Analg. 2015; 120(6):1337.

4. Tehranian N, Ranjbar M, Shobeiri F. The prevalence and risk factors for preterm delivery in Tehran, Iran. J Midwifery Reprod Health. 2016; 4(2):600-4.

5. Patel A, Khatib MN, Kurhe K, Bhargava S, Bang A. Impact of neonatal resuscitation trainings on neonatal and perinatal mortality: a systematic review and meta-analysis. BMJ Paediatr Open. 2017; 1(1):e000183.

6. Delgado CA, Gómez Pomar EM, Velásquez P, Sánchez V, Shimabuku R, Huicho L, et al. Continuous training and certification in neonatal resuscitation in remote areas using a multi-platform information and communication technology intervention, compared to standard training: a randomized cluster trial study protocol. F1000 Res. 2017; 6:1599.

7. Maya-Enero S, Botet-Mussons F, Figueras-Aloy J, Izquierdo-Renau M, Thió M, Iriondo-Sanz M. Adherence to the neonatal resuscitation algorithm for preterm infants in a tertiary hospital in Spain. BMC Pediatr. 2018; 18(1):319.

8. -Wang MJ, Kuper SG, Steele R, Sievert RA, Tita AT, Harper LM. Outcomes of medically indicated preterm births differ by indication. Am J Perinatol. 2018; 35(8):758-63.
9. Sawyer T, Umoren RA, Gray MM. Neonatal resuscitation: advances in training and practice. Adv 

Med Educ Pract. 2016; 8:11-9.

10. Raghuveer TS, Cox AJ. Neonatal resuscitation: an update. Am Fam Physician. 2011; 83(8):911-8.

11. Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132(18 Suppl 2):S543-60.

12. Rezaeizadeh G, Nayeri F, Shariat M. A history of neonatal medicine in Iran. Arch Iran Med. 2014; 17(12):855-61.

13. Perlman J. Delivery room resuscitation of extremely preterm infants. JAMA. 2019; 321(12):1161-2. 14. Afjeh SA, Sabzehei MK, Esmaili F. Neonatal resuscitation in the delivery room from a tertiary level hospital: risk factors and outcome. Iran J Pediatr. 2013; 23(6):675-80.

15. Abdel Razeq NM, Khader YS, Batieha AM. The incidence, risk factors, and mortality of preterm neonates: A prospective study from Jordan (2012-2013). Turk J Obstet Gynecol. 2017; 14(1):28-36.

16. Handley SC, Sun Y, Wyckoff MH, Lee HC. Outcomes of extremely preterm infants after delivery room cardiopulmonary resuscitation in a population-based cohort. J Perinatol. 2015; 35(5):379-83.

17. O'Driscoll DN, McGovern M, Greene CM, Molloy EJ. Gender disparities in preterm neonatal outcomes. Acta Paediatr. 2018; 107(9):1494-9.

18. Holzer I, Lehner R, Ristl R, Husslein PW, Berger A, Farr A. Effect of delivery mode on neonatal outcome among preterm infants: an observational study. Wien Klin Wochenschr. 2017; 129(17-18):612-7.

19. Blue NR, Van Winden KR, Pathak B, Barton L, Opper N, Lane CJ, et al. Neonatal outcomes by mode of delivery in preterm birth. Am J Perinatol. 2015; 32(14):1292-7.

20. Bajaj M, Natarajan G, Shankaran S, Wyckoff M, Laptook AR, Bell EF, et al. Delivery room resuscitation and short-term outcomes in moderately preterm infants. J Pediatr. 2018; 195:33-8.

21. Risso SD, Nascimento LF. Risk factors for neonatal death in neonatal intensive care unit according to survival analysis. Rev Bras Ter Intensiva. 2010; 22(1):19-26.
22. Ferreira CH, Carmona F, Martinez FE. Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns. J Pediatr. 2014; 90(2):316-22.