Rinawati Rohsiswatmo ^1* Rizalya Dewi ² Jennie Sutantio ¹ ZUBAIR AMIN ³ YoungAh Youn ⁴ Sae Yun Kim ⁴ Su Jin Cho ⁵ Yun Sil Chang ⁶ Satoshi Kusuda ⁷ Fuyu Miyake ⁸ Tetsuya Isayama ⁸

• ¹ RSUPN Dr. Cipto Mangunkusumo, Jakarta, Indonesia
• ² Budhi Mulia Hospital, Pekanbaru, Indonesia
• ³ National University of Singapore, Singapore, Singapore
• ⁴ Catholic University of Korea, Seoul, Seoul, Republic of Korea
• ⁵ Ewha Womans University, Seoul, Seoul, Republic of Korea
• ⁶ Sungkyunkwan University, Jongno-gu, Seoul, Republic of Korea
• ⁷ Kyorin University, Mitaka, Tōkyō, Japan
• ⁸ National Center for Child Health and Development (NCCHD), Tokyo, Japan

Background: Optimum neonatal resuscitation practices are vital for improving neonatal survival and neurodevelopment outcomes, particularly in extremely preterm infants. However, such practices may vary between high-income countries (HICs) and low-middle-income countries (LMICs). This study aimed to evaluate the resuscitation practices of high-risk infants in a large multi-country sample of healthcare facilities among HICs and LMICs in Asia under the AsianNeo Network. Methods: In 2021, a customized 6-item online survey on resuscitation practices of infants born at < 29 weeks gestation (or birth weight < 1200 g) was sent by the representative of each country’s neonatal network to all the Neonatal Intensive Care Units (NICUs) participating in AsianNeo network. At the time of the survey, there were 428 participating hospitals in eight countries: four high-income countries (Japan, Singapore, South Korea, and Taiwan) and four low-middle-income countries (Malaysia, Indonesia, Philippines, and Thailand). Results: The study included 446 hospitals, with a response rate of 72.6% (ranging from 62.7% to 100%), with 179 (55.2%) in HICs and 145 (44.7%) in LMICs. Routine attendance of experienced NICU physicians during resuscitations is reported to be higher in HICs than LMICs, both during daytime (79.7% vs 40%) and nighttime (62.1% vs. 22.2%). The NRP guidelines in each country were varied, with 4 out of 8 countries using indigenously developed guidelines. Equipment availability during resuscitation was also variable; saturation monitors, radiant warmers, and plastic wraps were available in almost all hospitals, whereas oxygen and air blenders, heated humidified gas, and end-tidal CO2 detectors were more available in HICs. The most common device for Positive Pressure Ventilation (PPV) was the T-piece resuscitator (52.3%). Conclusion: The neonatal resuscitation practices for extremely preterm infants, encompassing staff, equipment, and guidelines, exhibited variance between HICs and LMICs in the AsianNeo region. Further enhancements are imperative to narrow this gap and optimize neonatal outcomes.