Effective ventilation and temperature control are vital to outborn resuscitation

Abstract

Objective: To determine perinatal clinical characteristics of outborn infants and to examine the early postdelivery management and subsequent clinical outcome of outborns compared with inborns.

Methods: The authors conducted a retrospective chart review of outborns admitted to the neonatal intensive care unit from January 1994 to December 2000. Inborns were matched for birth weight (BW)+/-50 g, gestational age (GA), and vaginal delivery+/-2 weeks of index cases.

Results: Sixty-five outborns of BW 1,991+/-824 g and GA 34+/-5 weeks were admitted. Fifty were of BW <2,500 g, 20 <1,500 g, and six <1,000 g. Forty-seven were <37 weeks, 17 <32 weeks, and nine <29 weeks GA. Prehospital interventions included oxygen (O(2)) (n=7), bag/mask ventilation (BMV) (n=2), and failed intubation (n=1). On hospital arrival, 13 (20%) required additional BMV (n=3), intubation (n=7), or cardiopulmonary resuscitation (n=3). Thirty-eight percent of inborns required delivery room resuscitation, i.e., BMV (n=12) and intubation (n=13); none required cardiopulmonary resuscitation. Initial temperatures for outborns versus inborns were 35+/-1.8 versus 36.3+/-0.8 degrees C (p=0.0005); 23 (35%) outborns versus 3 (5%) inborns (p=0.008) were <35 degrees C and 10 (15%) versus 1 (2%) were <34 degrees C (p=0.008). Outborns who died versus survivors had lower BW 1,022 versus 2,119 g (p=0.0002), lower GA 28 versus 34 weeks (p=0.0008), lower temperature, i.e., 33.2+/-2.4 versus 35.2+/-1.5 degrees C (p=0.002), higher blood glucose 113+/-93 versus 48+/-33 mg/dL (p=0.007), and lower hematocrit, i.e., 44%+/-5% versus 56%+/-8% (p=0.0004).

Conclusions: Most outborns were premature, of low BW, and more likely to have hypoglycemia and hypothermia. For the majority of outborn infants who required BMV for effective resuscitation, this was only initiated on arrival to the hospital; this delay could have contributed to the subsequent need for cardiopulmonary resuscitation. Training prehospital providers to effectively bag mask ventilate preterm infants and prevent hypothermia must be a priority.