Outcome of Extremely Low Birth Weight Infants Who Received Delivery Room Cardiopulmonary Resuscitation

• Type of Material: Article
• Authors: Myra H. Wyckoff, University of Texas Southwestern Medical Center Dallas; Walid A. Salhab, University of Texas Southwestern Medical Center Dallas; Roy J. Heyne, University of Texas Southwestern Medical Center Dallas; Douglas E. Kendrick, RTI International; Abbot R. Laptook, Women & Infants Hospital Rhode Island; Barbara Stoll, Emory University
• Language: English
• Date: 2012-02-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2012 Mosby Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpeds.2011.07.041
• Title of Journal or Parent Work: Journal of Pediatrics
• ISSN: 0022-3476
• Volume: 160
• Issue: 2
• Start Page: 239
• End Page: U283
• Grant/Funding Information: Supported by the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which provided grants for the Neonatal Research Network’s Generic Database Study and Follow-up Study.
• Keywords: Science & Technology; QUALITY; TERM; Pediatrics; LESS; NETWORK; PRETERM INFANT; GESTATIONAL-AGE; NEONATAL RESUSCITATION; Life Sciences & Biomedicine; CARE; SURVIVAL; ADRENALINE
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Objective: To determine whether delivery room cardiopulmonary resuscitation (DR-CPR) independently predicts morbidities and neurodevelopmental impairment (NDI) in extremely low birth weight infants. Study design: We conducted a cohort study of infants born with birth weight of 401 to 1000 g and gestational age of 23 to 30 weeks. DR-CPR was defined as chest compressions, medications, or both. Logistic regression was used to determine associations among DR-CPR and morbidities, mortality, and NDI at 18 to 24 months of age (Bayley II mental or psychomotor index <70, cerebral palsy, blindness, or deafness). Data are adjusted ORs with 95% CIs. Results: Of 8685 infants, 1333 (15%) received DR-CPR. Infants who received DR-CPR had lower birth weight (708 ± 141 g versus 764 ± 146g, P <.0001) and gestational age (25 ± 2 weeks versus 26 ± 2 weeks, P <.0001). Infants who received DR-CPR had more pneumothoraces (OR, 1.28; 95% CI, 1.48-2.99), grade 3 to 4 intraventricular hemorrhage (OR, 1.47; 95% CI, 1.23-1.74), bronchopulmonary dysplasia (OR, 1.34; 95% CI, 1.13-1.59), death by 12 hours (OR, 3.69; 95% CI, 2.98-4.57), and death by 120 days after birth (OR, 2.22; 95% CI, 1.93-2.57). Rates of NDI in survivors (OR, 1.23; 95% CI, 1.02-1.49) and death or NDI (OR, 1.70; 95% CI, 1.46-1.99) were higher for DR-CPR infants. Only 14% of DR-CPR recipients with 5-minute Apgar score <2 survived without NDI. Conclusions: DR-CPR is a prognostic marker for higher rates of mortality and NDI for extremely low birth weight infants. New DR-CPR strategies are needed for this population.