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Background: Approximately 5-10 % of newborns require some form of resuscitationupon delivery; several factors, such as maternal abnormal conditions, gestational age and type of delivery could be responsible for this trend. This study aimed to describe the factors associated with the need for positive pressure ventilation (PPV) via a mask or endotracheal tube and the use of supplemental O2 in newborns with a gestational age greater than 34 weeks in Brazil., Methods: We performed a cross-sectional study and obtained data from the Birth in Brazil Survey. The inclusion criterion was a gestational age ≥34 weeks. Exclusion criteria were newborns with congenital malformations, and cases with undetermined gestational age or type of delivery (vaginal, pre labor cesarean section and cesarean section during labor). The primary outcomes were need of PPV via a mask or endotracheal tube and the use of supplemental oxygen without PPV. Confounding variables, including maternal age, source of birth payment, years of maternal schooling, previous birth, newborn presentation, multiple pregnancy, and maternal obstetric risk, were analyzed., Results: We included 22,720 newborns. Of these, 2974 (13.1 %) required supplementary oxygen. PPV with a bag and mask was used for 727 (3.2 %) newborns and tracheal intubation for 192 (0.8 %) newborns. Chest compression was necessary for 136 (0.6 %) newborns and drugs administered in 114 (0.5 %). 51.3 % of newborns were delivered by cesarean section, with the majority of cesarean sections (88.7 %) being performed prior to labor. Gestational age (late preterm infants: (Relative Risk-(RR) 2.46; 95 % (Confidence interval-CI 1.79-3.39), maternal obstetric risk (RR 1.59; 95 % CI1.30-1.94), and maternal age of 12-19 years old (RR 1.36; 95 % CI1.06-1.74) contributed to rates of PPV in the logistic regression analysis. Newborns aged between 37-38 weeks of gestaional age weren´t less likely to require PPV compared with those aged 39-41 weeks of gestational age., Conclusions: Late preterm infants, previous maternal obstetric risks and maternal age contributed to the higher needs of PPV and use of O2 in the delivery room. These variables need to be considered in planning care in the delivery room.

Background: A valid, accurate method for determining gestational age (GA) is crucial in classifying early and late prematurity, and it is a relevant issue in perinatology. This study aimed at assessing the validity of different measures for approximating GA, and it provides an insight into the development of algorithms that can be adopted in places with similar characteristics to Brazil. A follow-up study was carried out in two cities in southeast Brazil. Participants were interviewed in the first trimester of pregnancy and in the postpartum period, with a final sample of 1483 participants after exclusions. The distribution of GA estimates at birth using ultrasound (US) at 21-28 weeks, US at 29+ weeks, last menstrual period (LMP), and the Capurro method were compared with GA estimates at birth using the reference US (at 7-20 weeks of gestation). Kappa, sensitivity, and specificity tests were calculated for preterm (<37 weeks of gestation) and post-term (>=42 weeks) birth rates. The difference in days in the GA estimates between the reference US and the LMP and between the reference US and the Capurro method were evaluated in terms of maternal and infant characteristics, respectively., Results: For prematurity, US at 21-28 weeks had the highest sensitivity (0.84) and the Capurro method the highest specificity (0.97). For postmaturity, US at 21-28 weeks and the Capurro method had a very high sensitivity (0.98). All methods of GA estimation had a very low specificity (≤0.50) for postmaturity. GA estimates at birth with the algorithm and the reference US produced very similar results, with a preterm birth rate of 12.5%., Conclusions: In countries such as Brazil, where there is less accurate information about the LMP and lower coverage of early obstetric US examinations, we recommend the development of algorithms that enable the use of available information using methodological strategies to reduce the chance of errors with GA. Thus, this study calls into attention the care needed when comparing preterm birth rates of different localities if they are calculated using different methods.

Background: Caesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction., Methods: Nationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients' medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson's groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design., Discussion: This study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it's consequences on postnatal health.