Immediate outcome of delivery room resuscitation in mild lydepressed neonates in a tertiary care center

Abstract

Background: Perinatal asphyxia remains a significant contributor to neonatal morbidity and mortality. Understanding the benefits of delivery room resuscitation in mildly depressed neonates is crucial for optimizing care protocols in tertiary settings. Objectives: To evaluate the immediate outcomes of delivery room resuscitation in mildly depressed neonates and identify factors associated with Neonatal Intensive Care Unit (NICU) admission in a tertiary care center. Methods: This prospective observational study conducted from March 2024 to August 2024 included 400 neonates with initial Apgar scores of 4-6. All resuscitations were performed following standardized Neonatal Resuscitation Program (NRP) guidelines. Primary outcomes included improvement in Apgar scores, time to sustained spontaneous breathing, and need for NICU admission. Secondary outcomes included duration of NICU stay and early neonatal complications Results: Among the 400 neonates (54% male, mean gestational age 37.8 ± 2.3 weeks), the median time to initiate positive pressure ventilation was 42 seconds (IQR: 35-52). Apgar scores improved from a mean of 5.1 ± 0.8 at 1 minute to 7.8 ± 1.1 at 5 minutes and 8.9 ± 0.7 at 10 minutes. NICU admission was required for 92 neonates (23%), primarily for respiratory distress (52.2%). Factors significantly associated with NICU admission included initial Apgar score _4 (OR 2.8, 95% CI 1.6-4.9), delayed Positive Pressure Ventilation (PPV) initiation >60 seconds (OR 2.1, 95% CI 1.3-3.4), and late preterm gestation (OR 2.4, 95% CI 1.4-4.1). The majority (64%) required minimal oxygen supplementation (FiO2 0.21-0.3). Overall, 396 neonates (99%) were discharged home in stable condition, with no mortality reported. Conclusion: Prompt and standardized delivery room resuscitation resulted in favorable outcomes for mildly depressed neonates. Early recognition of risk factors and timely intervention were associated with reduced NICU admission rates. These findings support the effectiveness of current resuscitation protocols in tertiary care settings.

DS (Child) H J 2024; 40(2): 20-24