Hospital Birth Volume and Neonatal Resuscitation Prior to Therapeutic Hypothermia

BACKGROUND AND OBJECTIVE: Clinicians working in hospitals with low birth volumes lack regular opportunities to maintain neonatal resuscitation skills, which may impact resuscitation practices in these settings. We assessed the impact of birth volume on resuscitation practices using data from an existing database of neonates treated with therapeutic hypothermia. METHODS: We conducted a retrospective, multicenter review of neonates treated with therapeutic hypothermia at 4 Northern New England hospitals from 2009 to 2024. Overall, 561 neonates were identified; neonates younger than 35 weeks' gestational age and neonates intubated more than 1 hour after birth due to clinical deterioration were excluded. Study variables were stratified by annual hospital birth volume. Group differences were assessed by Fisher exact tests, χ2 tests, Wilcoxon rank-sum tests, and Cochran-Armitage trend tests. The primary outcome was resuscitation practices including time to advanced airway and rate of chest compressions. Our secondary outcome was mortality rate. RESULTS: Small- and medium-birth-volume hospitals had a higher rate of chest compression utilization than large-birth-volume hospitals (35% vs 20% vs 10%, P < .001). Placing an advanced airway took more than twice as long in small- and medium-birth-volume hospitals compared with large-volume hospitals (6 vs 6 vs 3 minutes, P < .001). Neonates born in high-birth-volume hospitals had decreased mortality compared with low-volume hospitals (5.7% vs 14%, P < .001). CONCLUSIONS: Newborns transported to receive therapeutic hypothermia that were born at low-birth-volume hospitals were more likely to receive chest compressions, have delayed airway placement, and have an increased risk of mortality. These results support the need for increased education for clinicians in lower-birth-volume hospitals to maintain adequate resuscitation practices.