A clinical scoring system to predict the need for extensive resuscitation at birth in very low birth weight infants

BACKGROUND: To analyze the risk factors for extensive cardiopulmonary resuscitation in the delivery room and develop a prediction model for outcomes in very low birth weight (VLBW) infants. METHODS: The sample was 5298 VLBW infants registered in the Korean neonatal network database from 2013 to 2015. Univariate and multivariate analyses were used to analyze the risk factors for extensive resuscitation. In addition, a multivariable model predicting extensive resuscitation in VLBW infants was developed. RESULTS: Univariate regression analysis of antenatal factors showed that lower gestational age, lower birth weight, birth weight less than third percentile, male sex, maternal hypertension, abnormal amniotic fluid volume, no antenatal steroid use, outborn, and chorioamnionitis were associated with extensive resuscitation at birth. Lower gestational age (25 to 27 gestational weeks, odds ratio [OR] and 95% confidence interval [CI]: 3.003 [1.977–4.562]; less than 25 gestational weeks, OR and 95% CI: 4.921 [2.926–8.276]), birth weight less than 1000 g (OR and 95% CI: 1.509 [1.013–2.246]), male sex (OR and 95% CI: 1.329 [1.002–1.761]), oligohydramnios (OR and 95% CI: 1.820 [1.286–2.575]), polyhydramnios (OR and 95% CI: 6.203 [3.185–12.081]), and no antenatal steroid use (OR and 95% CI: 2.164 [1.549–3.023]) were associated on multivariate regression analysis. The final prediction model for extensive resuscitation included gestational age, amniotic fluid, and antenatal steroid use. It presented a sensitivity of 0.795 and specificity of 0.575 in predicting extensive resuscitation at birth, corresponding to a score cut-off of 2. The area under the receiver operating characteristic curve was 0.738. CONCLUSIONS: Lower gestational age, abnormal amniotic fluid volume, and no use of antenatal steroid in VLBW infants are important predictors of extensive resuscitation in the delivery room.