Original Article | Published:

Intensity of delivery room resuscitation and neonatal outcomes in infants born at 33 to 36 weeks’ gestation

Journal of Perinatology volume 36, pages 100105 (2016) | Download Citation



Examine the relationship between delivery room resuscitation intensity and mortality, morbidities and resource use in late preterm infants.

Study Design:

Retrospective cohort study of inborn infants born at 33 to 36 weeks’ gestation and admitted to Canadian neonatal intensive care units during 2010 to 2013. The 13 619 infants were grouped according to delivery room resuscitation intensity: no or minimal resuscitation (64.5%); continuous positive airway pressure (10.2%); bag-mask ventilation (21.7%); endotracheal intubation (3.1%); and cardiopulmonary resuscitation (CPR) (0.6%).


Overall mortality, early mortality, respiratory distress, pneumothorax, late-onset sepsis and resource use increased with higher intensity resuscitation. Compared with no or minimal resuscitation, intubation and CPR were associated with increased odds of mortality (adjusted odds ratio (95% confidence interval): 50 (20 to 125) and 180 (63 to 518), respectively).


Intubation or higher intensity delivery room resuscitation is associated with increased mortality, morbidities and resource use in late preterm infants. Extra intensive care is required for such infants, especially during the first week of life.

  • Subscribe to Journal of Perinatology for full access:



Additional access options:

Already a subscriber?  Log in  now or  Register  for online access.


  1. 1.

    , , , , . Statistics DoV. Birth: final data for 2012. Natl Vital Stat Rep 2013; 62(9): 1–87.

  2. 2.

    Statistics Canada. Table 102-4512 - Live births, by weeks of gestation and sex, Canada, provinces and territories, annual, CANSIM (database), 2013. Available from (accessed on 1 April 2015).

  3. 3.

    , , , , , et al. Respiratory morbidity in late preterm births. JAMA 2010; 304(4): 419–425.

  4. 4.

    , , , , , et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 2005; 90(2): 125–131.

  5. 5.

    The Canadian Neonatal Network Annual Report 2013, 2014. Available from (accessed on 1 April 2015).

  6. 6.

    , , , , , et al. Impact of late preterm and early term infants on canadian neonatal intensive care units. Am J Perinatol 2014; 31(4): 269–277.

  7. 7.

    , , , , , . Late preterm infants: birth outcomes and health care utilization in the first year. Pediatrics 2010; 126(2): E311–E319.

  8. 8.

    , , , . Clinical outcomes of near-term infants. Pediatrics 2004; 114(2): 372–376.

  9. 9.

    , , , , , et al. The contribution of mild and moderate preterm birth to infant mortality. JAMA 2000; 284(7): 843–849.

  10. 10.

    , , , . Perinatal outcomes associated with preterm birth at 33 to 36 weeks' gestation: a population-based cohort study. Pediatrics 2009; 123(1): 109–113.

  11. 11.

    , . Late preterm infants: near term but still in a critical developmental time period. Pediatrics 2013; 132(4): 741–751.

  12. 12.

    , , , , , . Resuscitative procedures at birth in late preterm infants. J Perinatol 2007; 27(12): 761–765.

  13. 13.

    , , , , , et al. Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics 2008; 121(2): E223–E232.

  14. 14.

    , , , , , et al. Determinants of morbidity in late preterm infants. Early Hum Dev 2010; 86(9): 587–591.

  15. 15.

    , , , , . Weight for gestational age affects the mortality of late preterm infants. Pediatrics 2009; 123(6): E1072–E1077.

  16. 16.

    , , , , , et al. Variations in practice and outcomes in the Canadian NICU network: 1996-1997. Pediatrics 2000; 106(5): 1070–1079.

  17. 17.

    The Canadian Neonatal Network Abstractor's Manual CNN v.2.1.3, 2014. Available from (accessed on 1 April 2015).

  18. 18.

    World Health Organization MaNHSM. Thermal protection of the newborn: a practical guide, 1997. Available from (accessed on 20 January 2015).

  19. 19.

    , , , , , et al. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108(2): 7.

  20. 20.

    , , , . Post-resuscitation care for neonates receiving positive pressure ventilation at birth. Pediatrics 2014; 134(4): E1057–E1062.

  21. 21.

    , , , . Neonatal problems of late and moderate preterm infants. Semin Fetal Neonatal Med 2012; 17(3): 146–152.

Download references


We like to thank the staff of the Canadian Neonatal Network (CNN) Coordinating Centre for their hard work and Dr Ruth Warre for providing editorial support during preparation of the manuscript. Although no funding was received specifically for this study, the CNN received organizational support from the CNN Coordinating Centre, which is based at the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital, Toronto, Ontario, Canada. MiCare is supported by funding from the Canadian Institutes of Health Research and Mount Sinai Hospital, Toronto. Prakesh Shah is supported by an Applied Research Chair in Maternal Reproductive and Health Services Research from Canadian Institutes of Health Research and Yanyu Lyu is supported by a Beijing Outstanding Talents Overseas Training Project grant (2012A003034000017).

Site Investigators for the Canadian Neonatal Network

Prakesh S Shah (Director, Canadian Neonatal Network; Mount Sinai Hospital, Toronto, ON); Shoo K Lee (Chair, Canadian Neonatal Network; Mount Sinai Hospital, Toronto, ON); Carlos Fajardo (Alberta Children’s Hospital, Calgary, AB); Andrzej Kajetanowicz (Cape Breton Regional Hospital, Sydney, NS); Anne Synnes and Joseph Ting (Children’s and Women’s Health Centre of British Columbia, Vancouver, BC); Brigitte Lemyre (Children’s Hospital of Eastern Ontario, Ottawa, ON); Bruno Piedboeuf and Christine Drolet (Centre Hospitalier Universitaire de Quebec, Sainte Foy, QC); Valerie Bertelle and Edith Masse (Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, QC); Hala Makary (Dr. Everett Chalmers Regional Hospital, Fredericton, NB); Wendy Yee (Foothills Medical Centre, Calgary, AB); Sandesh Shivananda (Hamilton Health Sciences Centre, Hamilton, ON); Kyong-Soon Lee (Hospital for Sick Children, Toronto, ON); Molly Seshia (Health Sciences Centre, Winnipeg, MB); Keith Barrington (Hospital Sainte-Justine, Montreal, QC); Jehier Afifi (IWK Health Centre, Halifax, NS); Akhil Deshpandey (Janeway Children’s Health and Rehabilitation Centre, St Johns, NL); Ermelinda Pelausa (Jewish General Hospital, Montreal, QC); Kimberly Dow (Kingston General Hospital, Kingston, ON); Orlando da Silva (London Health Sciences Centre; London, ON); Martine Claveau and Daniel Faucher (McGill University Health Centre); Prakesh S Shah (Mount Sinai Hospital, Toronto, ON); Zarin Kalapesi (Regina General Hospital, Regina, SK); Khalid Aziz (Royal Alexandra Hospital/Stollery Children’s Hospital, Edmonton, AB); Zenon Cieslak (Royal Columbian Hospital, New Westminster, BC); Koravangattu Sankaran and Sibasis Daspal (Royal University Hospital, Saskatoon, SK); Ruben Alvaro (St Boniface General Hospital, Winnipeg, MB); Cecil Ojah and Luis Monterrosa (Saint John Regional Hospital, Saint John, NB); Michael Dunn (Sunnybrook Health Sciences Centre, Toronto, ON); Todd Sorokan (Surrey Memorial Hospital, Surrey, BC); Roderick Canning (The Moncton Hospital, Moncton, NB); Adele Harrison (Victoria General Hospital, Victoria, BC); and Chuks Nwaesei /Mohammed Adie (Windsor Regional Hospital, Windsor, ON).

Author information


  1. Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada

    • S Jiang
    • , Y Lyu
    • , X Y Ye
    • , P S Shah
    •  & S K Lee
  2. Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China

    • S Jiang
  3. Department of Child Health Development, Capital Institute of Pediatrics, Beijing, China

    • Y Lyu
  4. Department of Paediatrics, Saint John Regional Hospital, Saint John, New Brunswick, Canada

    • L Monterrosa
  5. Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada

    • P S Shah
    •  & S K Lee


  1. Search for S Jiang in:

  2. Search for Y Lyu in:

  3. Search for X Y Ye in:

  4. Search for L Monterrosa in:

  5. Search for P S Shah in:

  6. Search for S K Lee in:

Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to S K Lee.

About this article

Publication history







Rights and permissions

To obtain permission to re-use content from this article visit RightsLink.