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. 2012 Feb;160(2):239-244.e2.
doi: 10.1016/j.jpeds.2011.07.041. Epub 2011 Sep 17.

Outcome of extremely low birth weight infants who received delivery room cardiopulmonary resuscitation

Myra H Wyckoff  1 , Walid A Salhab, Roy J Heyne, Douglas E Kendrick, Barbara J Stoll, Abbot R Laptook; National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations

Outcome of extremely low birth weight infants who received delivery room cardiopulmonary resuscitation

Myra H Wyckoff et al. J Pediatr. 2012 Feb.

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.

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Figures

Figure 1
Figure 1
Flow diagram of patient selection
Figure 2
Figure 2
Proportion of ELBW infants receiving DR-CPR by A, center and B, gestational age. Note: There were center differences (p<0.0001) and gestational age differences (p<0.0001) in the proportion of infants who needed DR-CPR.
See this image and copyright information in PMC

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