Hospital level of service, rural-urban location, and neonatal resuscitation interventions: A population study in Alberta Canada from 2000 to 2020.

Background and objectives: Advanced neonatal resuscitation interventions (ANRIs) are rarely performed for late preterm and term infants. However, healthcare providers in community hospitals may need to perform ANRIs, while having limited experience and resources. Understanding practice differences between hospitals of different levels of service (LoS) and rural/urban location may inform quality improvement. Our objective are to a) examine how hospital LoS and rural/urban location relate to ANRI rates in Alberta, Canada, a public health system with standardized Neonatal Resuscitation Program® training and b) describe trends in neonatal resuscitation interventions and outcomes.

Methods/design: All live births ≥ 34 weeks in Alberta from 2000 to 2020 were examined using retrospective, administrative data. Hospitals (n = 97) were categorized based on availability of delivery support, cesarian sections, pediatricians/obstetricians, and NICUs, then subcategorized by population and proximity to metropolitan centres. Rates of individual interventions or any ANRI were compared.

Results: 966,475 births were included. ANRI rates were: intubation for ventilation (0.8%), chest compression (0.2%), epinephrine (0.02%), any ANRI (0.95%). While ANRIs were lower in community hospitals and home births, with lower hospital level of service, intubation rates decreased and chest compressions rates increased. Level 1A (OR:4.52, 95% CI 3.59-5.62) and home births (OR:3.09, 95% CI 2.52-3.76) had much higher odds of chest compressions. No pattern was observed between rural/remote sites of similar LoS.

Conclusions: In this population study, there were higher chest compressions rates and lower intubation rates at hospitals without NICUs, despite standardized training. Reasons for this difference require further investigation.