Investigating the Outcomes of Advanced Neonatal Resuscitation in Preterm Neonates: A Retrospective Cohort Study in Iran

Background and Aims Given the higher need for advanced resuscitation methods at birth in premature neonates, it is crucial to identify the associated consequences. Due to a lack of data in this area, we aimed to investigate the association of advanced neonatal resuscitation at birth with the short‐term prognosis of preterm neonates. Methods This retrospective cohort study examined premature neonates with gestational age < 33 weeks born at Vali‐e‐Asr Hospital, Tehran, Iran, during the years 2020–2021. Advanced resuscitation included endotracheal intubation, chest compression, or epinephrine injection. The primary outcome was neonatal death within 28 days, with secondary outcomes including other adverse events. Statistical analyses included Chi‐square, Fisher's exact, and independent t ‐tests, along with multivariate logistic regression. The study methodology and reporting adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results Of the 444 neonates studied, 224 received advanced resuscitation (intervention group), and 220 did not (control group). Neonatal death was significantly higher in the intervention group (26.8% vs. 7.7%; p < 0.001). The intervention group also had higher incidences of respiratory distress syndrome, pneumothorax, patent ductus arteriosus, and intraventricular hemorrhage ( p < 0.001). Multivariate logistic regression showed advanced resuscitation was independently associated with respiratory distress syndrome (odds ratio = 3.179 [95% confidence interval (CI): 1.518–6.657]), pneumothorax (odds ratio = 3.805 [95% CI: 1.007–14.382]), and patent ductus arteriosus (odds ratio = 2.804 [95% CI: 1.594–4.930]), but not other adverse outcomes. Conclusion While a higher incidence of adverse outcomes was observed in premature neonates who received advanced resuscitation, this finding should be interpreted with caution. It suggests that careful attention to the indications for advanced resuscitation, along with structured follow‐up of survivors, may be appropriate given their potentially elevated risk of complications.