Abstract Objective To explore the risk factors for endotracheal intubation during resuscitation in the delivery room among very preterm infants. Methods A retrospective analysis was performed for 455 very preterm infants who were admitted to the neonatal intensive care unit from January 2017 to December 2019. They were divided into an intubation group (n=79) and a non-intubation group (n=376) according to whether endotracheal intubation was performed during resuscitation. The risk factors for endotracheal intubation during resuscitation were evaluated by multivariate logistic regression analysis. Results The intubation rate was 17.4% (79/455). Compared with the intubation group, the non-intubation group had significantly higher gestational age, birth weight, and rates of caesarean birth, delayed cord clamping (DCC), resuscitation quality improvement, regular use of antenatal glucocorticoids in mothers and premature rupture of membranes > 18 hours (P < 0.05), but significantly lower rates of maternal gestational diabetes mellitus, placental abruption, placenta previa or placenta previa status, and maternal thyroid dysfunction (P < 0.05). Regular use of antenatal glucocorticoids in mothers (OR=0.368, P < 0.05) and DCC (OR=0.222, P < 0.05) were protective factors against intubation during resuscitation, while younger gestational age, birth weight < 750 g, maternal gestational diabetes mellitus, and placenta previa or placenta previa status were risk factors for intubation during resuscitation (P < 0.05). Conclusions Very preterm infants with younger gestational age, birth weight < 750 g, maternal diabetes mellitus, placenta previa or placenta previa status may have a higher risk for endotracheal intubation after birth. The regular use of antenatal glucocorticoids and DCC can reduce the risk of intubation during resuscitation in very preterm infants.
OU Jiang-Feng,WU Yan,ZHONG Xiao-Yun et al. Risk factors for endotracheal intubation during resuscitation in the delivery room among very preterm infants[J]. CJCP, 2021, 23(4): 369-374.
OU Jiang-Feng,WU Yan,ZHONG Xiao-Yun et al. Risk factors for endotracheal intubation during resuscitation in the delivery room among very preterm infants[J]. CJCP, 2021, 23(4): 369-374.
Jiravisitkul P, Rattanasiri S, Nuntnarumit P. Randomised controlled trial of sustained lung inflation for resuscitation of preterm infants in the delivery room[J]. Resuscitation, 2017, 111:68-73.
[2]
Kakkilaya V, Jubran I, Mashruwala V, et al. Quality improvement project to decrease delivery room intubations in preterm infants[J]. Pediatrics, 2019, 143(2):e20180201.
[3]
Subramaniam P, Ho JJ, Davis PG. Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants[J]. Cochrane Database Syst Rev, 2016, 14(6):CD001243.
[4]
Perlman JM, Wyllie J, Kattwinkel J, et al. Part 7:neonatal resuscitation:2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J]. Circulation, 2015, 132(16 Suppl 1):S204-S241.
American Heart Association, American Academy of Pediatrics. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients:neonatal resuscitation guidelines[J]. Pediatrics, 2006, 117(5):e1029-e1038.
Fogarty M, Osborn DA, Askie L, et al. Delayed vs early umbilical cord clamping for preterm infants:a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2018, 218(1):1-18.
[12]
Ghirardello S, Di Tommaso M, Fiocchi S, et al. Italian recommendations for placental transfusion strategies[J]. Front Pediatr, 2018, 6:372.
[13]
Vesoulis ZA, Liao SM, Mathur AM. Delayed cord clamping is associated with improved dynamic cerebral autoregulation and decreased incidence of intraventricular hemorrhage in preterm infants[J]. J Appl Physiol (1985), 2019, 127(1):103-110.
[14]
Ruangkit C, Moroney V, Viswanathan S, et al. Safety and efficacy of delayed umbilical cord clamping in multiple and singleton premature infants-a quality improvement study[J]. J Neonatal Perinatal Med, 2015, 8(4):393-402.
[15]
Jobe AH, Goldenberg RL. Antenatal corticosteroids:an assessment of anticipated benefits and potential risks[J]. Am J Obstet Gynecol, 2018, 219(1):62-74.
[16]
McGoldrick E, Stewart F, Parker R, et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth[J]. Cochrane Database Syst Rev, 2020, 12:CD004454.
[17]
Chawla S, Natarajan G, Shankaran S, et al. Association of neurodevelopmental outcomes and neonatal morbidities of extremely premature infants with differential exposure to antenatal steroids[J]. JAMA Pediatr, 2016, 170(12):1164-1172.
[18]
Inoue H, Ochiai M, Yasuoka K, et al. Early mortality and morbidity in infants with birth weight of 500 grams or less in Japan[J]. J Pediatr, 2017, 190:112-117.e3.
[19]
Bergenhenegouwen LA, Meertens LJ, Schaaf J, et al. Vaginal delivery versus caesarean section in preterm breech delivery:a systematic review[J]. Eur J Obstet Gynecol Reprod Biol, 2014, 172:1-6.
[20]
McIntire DD, Bloom SL, Casey BM, et al. Birth weight in relation to morbidity and mortality among newborn infants[J]. N Engl J Med, 1999, 340(16):1234-1238.
[21]
Vahanian SA, Lavery JA, Ananth CV, et al. Placental implantation abnormalities and risk of preterm delivery:a systematic review and meta analysis[J]. Am J Obstet Gynecol, 2015, 213(4 Suppl):S78-S90.
[22]
Soliman A, Salama H, Al Rifai H, et al. The effect of different forms of dysglycemia during pregnancy on maternal and fetal outcomes in treated women and comparison with large cohort studies[J]. Acta Biomed, 2018, 89(S5):11-21.
LI Lei, ZHANG Zhi-Quan, ZHENG Cheng-Zhong, SHI Yuan, Pediatric Disaster Branch of Chinese Pediatric Society of Chinese Medical Association, Pediatric Branch of Chinese People's Liberation Army. Expert consensus on the prevention and treatment of drowning in children[J]. CJCP, 2021, 23(1): 12-17.