Am J Perinatol 2024; 41(06): 747-755
DOI: 10.1055/a-1772-4637
Original Article

Association of 24-Hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

Anthony Debay
1   Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
Prakesh Shah
2   Departement of Pediatrics, Toronto University, Toronto, Ontario, Canada
Abhay Lodha
3   Departement of Pediatrics, University of Calgary, Calgary, Alberta, Canada
Sandesh Shivananda
4   Departement of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Stephanie Redpath
5   Departement of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
Mary Seshia
6   Departement of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
Jon Dorling
7   Departement of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
Anie Lapointe
8   Departement of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
Rody Canning
9   Departement of Pediatrics, Moncton Hospital, Moncton, Alberta, Canada
Lannae Strueby
10   Departement of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Marc Beltempo
1   Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
on behalf of the Canadian Neonatal Network Investigators › Author Affiliations
Funding M.B. holds an Early Career Investigator Grant from the CIHR Institute of Human Development, Child and Youth Health (IHDCYH), a Research Grant Funding from the FRSQ Clinical Research Scholar Career Award Junior 1, and an Early Career Investigator Grant from the Montreal Children's Hospital Foundation. J.D. holds grants from the Canadian Institutes of Health Research (CIHR), Research Nova Scotia, the National Institutes of Health Research, and the IWK Health Centre. This study was supported by a grant from the CIHR funding the Canadian Preterm Birth Network, Government of Canada (grant no.: PBN 150642).


Objective This study aimed to assess if 24-hour in-house neonatologist (NN) coverage is associated with delivery room (DR) resuscitation/stabilization and outcomes among inborn infants <29 weeks' gestational age (GA).

Study design Survey-linked cohort study of 2,476 inborn infants of 23 to 28 weeks' gestation, admitted between 2014 and 2015 to Canadian Neonatal Network Level-3 neonatal intensive care units (NICUs) with a maternity unit. Exposures were classified using survey responses based on the most senior provider offering 24-hour in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, and retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders.

Results Among the 28 participating NICUs, most senior providers ensuring 24-hour in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). No NN/fellow coverage and 24-hour fellow coverage were associated with higher odds of infants receiving DR chest compressions/epinephrine compared with 24-hour NN coverage (adjusted odds ratio [aOR] = 4.72, 95% confidence interval [CI]: 2.12–10.6 and aOR = 3.33, 95% CI: 1.44–7.70, respectively). Rates of mortality/major morbidity did not differ significantly among the three groups: NN, 63% (249/395 infants); fellow, 64% (1092/1700 infants); no NN/fellow, 70% (266/381 infants).

Conclusion 24-hour in-house NN coverage was associated with lower rates of DR chest compressions/epinephrine. There was no difference in neonatal outcomes based on type of coverage; however, further studies are needed as ecological fallacy cannot be ruled out.

Key Points

  • Lower rates of DR cardiopulmonary resuscitation with 24h in-house NN coverage

  • The type of 24h in-house coverage was not associated with mortality and/or major morbidity.

  • High-volume centers more often have 24h in-house neonatal fellow coverage


This study was partly presented at the Canadian Pediatric Socciteoes – June 11th 2021 Annual Conference (Oral Presentation) and Pediatric Academic Societies – May 2nd 2021 (Poster Presentation).

Supplementary Material

Publication History

Received: 11 January 2022

Accepted: 14 February 2022

Accepted Manuscript online:
15 February 2022

Article published online:
18 April 2022

© 2022. Thieme. All rights reserved.

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