This prospective observational study from Haydom included newborns ≥28 weeks gestation. Trained research assistants observed and recorded all deliveries and resuscitations 24 h a day, 7 days a week, logging interventions in real time using the Liveborn Observation app.
Among 2431 enrolled newborns, 1755 (72.2%) started spontaneous breathing before 30 s from birth and 438 (18.0%) started breathing beyond 30 s. Almost 10% (n=238) received bag mask ventilation (BMV) at 82 (54,120) s after birth, 1/3 within the first min. 159/238 (66.8%) were suctioned for 26 (17,40) s. The first suction sequence was initiated at 44 (24,78) s after birth. In 24/238 (10.1%) newborns, BMV continued for more than 10 min, with an increased risk of dying within 24 h (RR=4.26, 95% CI; 1.3–10.0, p=0.016) and seven days (RR=8.14, 95% CI; 3.5–17.6, p<0.001) compared to those ventilated for less than 10 min. Excessive use of suctioning likely delayed the start of BMV, and prolonged ventilation beyond 10 min was associated with higher mortality.