Background: Very preterm infants (<32 weeks’ gestation) are at high risk of requiring
advanced neonatal resuscitation at birth. However, comprehensive national-level data
describing delivery room management and outcomes in this vulnerable group remain limited
in Thailand.
Objective: To (1) describe the characteristics of neonatal resuscitation at birth among very
preterm infants in Thailand, (2) identify maternal and perinatal factors associated with the
need for advanced resuscitation, and (3) compare short-term in-hospital outcomes between
infants who required advanced resuscitation and those who did not.
Methods: We conducted a retrospective cohort study using data from the Thai National
Newborn Network registry (ThaiNy). All Thai preterm neonates born at gestational age <32
weeks in ThaiNy member hospitals were eligible. Exclusion criteria included birth before
arrival, outborn delivery, death in the delivery room, palliative care at birth, major congenital
anomalies or genetic disorders, and incomplete records. Neonatal, maternal, and obstetric
characteristics were extracted. Resuscitation practices were categorized as brief
resuscitation (positive pressure ventilation and/or CPAP) or advanced resuscitation
(intubation, chest compressions, epinephrine, or fluid bolus). Maternal and obstetric factors
associated with advanced resuscitation will be analysed. In-hospital outcomes—including
overall mortality, severe respiratory morbidities, and composite severe neonatal adverse
outcomes—will be compared between groups.
Expected Results: The study will provide national data on delivery room resuscitation
practices among very preterm infants in Thailand, highlight factors associated with advanced
resuscitation, and quantify associations with morbidity and severe adverse outcome.
Conclusion: Findings from this multi-centred, registry-based study will inform strategies to
optimize perinatal management and neonatal resuscitation training across ThaiNy member
hospitals, with the goal of improving survival and outcomes for very preterm infants in
Thailand.