Impact of Delivery Room Resuscitation on Outcomes up to 18 Months in Very Low Birth Weight Infants (original) (raw)
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Delivery Room Resuscitation and Short-Term Outcomes in Moderately Preterm Infants
The Journal of pediatrics, 2018
To describe the frequency and extent of delivery room resuscitation and evaluate the association of delivery room resuscitation with neonatal outcomes in moderately preterm (MPT) infants. This was an observational cohort study of MPT infants delivered at 290/7 to 336/7 weeks' gestational age (GA) enrolled in the Neonatal Research Network MPT registry. Infants were categorized into 5 groups based on the highest level of delivery room intervention: routine care, oxygen and/or continuous positive airway pressure, bag and mask ventilation, endotracheal intubation, and cardiopulmonary resuscitation including chest compressions and/or epinephrine use. The association of antepartum and intrapartum risk factors and discharge outcomes with the intensity of resuscitation was evaluated. Of 7014 included infants, 1684 (24.0%) received routine care and no additional resuscitation, 2279 (32.5%) received oxygen or continuous positive airway pressure, 1831 (26.1%) received bag and mask ventilat...
Delivery room resuscitation and adverse outcomes among very low birth weight preterm infants
Journal of Perinatology, 2017
in collaboration with the Israel Neonatal Network 3 OBJECTIVE: To evaluate risk factors and impact of delivery room cardiopulmonary resuscitation (DR-CPR) on very low birth weight (VLBW) preterm infants. STUDY DESIGN: A national, population-based, observational study evaluating risk factors and short-term neonatal outcomes associated with DR-CPR among VLBW, extremely preterm infants (EPIs, 24 to 27 weeks' gestation) and very preterm infants (VPI, 28 to 31 weeks' gestation) born in 1995 to 2010. RESULTS: Among 17 564 VLBW infants, 636 (3.6%) required DR-CPR. In the group of 6478 EPI, 412 (6.4%) received DR-CPR compared with 224 of 11 086 infants (2.0%) in the VPI group. EPI who underwent DR-CPR had higher odds ratios (ORs (95% confidence interval)) for mortality compared to EPI not requiring DR-CPR (OR 3.32 (2.58, 4.29)), grades 3 to 4 intraventricular hemorrhage (IVH) (OR 1.59 (1.20, 2.10)) and periventricular leukomalacia (OR 1.81 (1.17, 2.82)). DR-CPR among VPI was associated with higher ORs for mortality (OR 4.99 (3.59, 6.94)), early sepsis (OR 2.07 (1.05, 4.09)), grades 3 to 4 IVH (OR 3.74 (2.55, 5.50)) and grades 3 to 4 retinopathy of prematurity (ROP) (OR 2.53 (1.18, 5.41)) compared to VPI not requiring DR-CPR. Only 11% of infants in the EPI DR-CPR group had favorable outcomes compared with 44% in the VPI DR-CPR group. Significantly higher ORs for mortality, IVH and ROP were found in the VPI compared to the EPI group. CONCLUSION: Preterm VLBW infants requiring DR-CPR were at increased risk of adverse outcomes compared to those not requiring CPR. This effect was more pronounced in the VPI group.
Outcomes of preterm infants following the introduction of room air resuscitation
Resuscitation, 2015
Background: After 2006 most neonatal intensive care units (NICUs) in Canada stopped initiating newborn resuscitation with 100% oxygen. Methods: In this retrospective cohort study, we compared neonatal outcomes in infants born at ≤27 weeks gestation that received <100% oxygen (OX titrate group, typically 21-40% oxygen) during delivery room resuscitation to infants that received 100% oxygen (OX 100 group). Results: Data from 17 NICUs included 2326 infants, 1244 in the OX titrate group and 1082 in the OX 100 group. The adjusted odds ratio (AOR) for the primary outcome of severe neurologic injury or death was higher in the OX titrate group compared with the OX 100 group (AOR 1.36; 95% CI 1.11, 1.66). A similar increase was also noted when comparing infants initially resuscitated with room air to the OX 100 group (AOR 1.33; 95% CI 1.04, 1.69). Infants in the OX titrate group were less likely to have received either medical or surgical treatment for a patent ductus arteriosus (AOR 0.53; 95% CI 0.37, 0.74). Conclusions: In Canadian NICUs, we observed a higher risk of severe neurologic injury or death among preterm infants of ≤27 weeks gestation following a change in practice to initiating resuscitation with either room air or an intermediate oxygen concentration.
PEDIATRICS, 2015
In babies requiring resuscitation (P), does electrocardiography (ECG/EKG) (I), compared with oximetry or auscultation (C), measure heart rate faster and more accurately (O)? In preterm infants, including those who received resuscitation (P), does delayed cord clamping (greater than 30 seconds) (I), compared with immediate cord clamping (C), improve survival, long-term developmental outcome, cardiovascular stability, occurrence of intraventricular hemorrhage (IVH), necrotizing enterocolitis, temperature on admission to a newborn area, and hyperbilirubinemia (O)? hematologic indices, (initial hemoglobin, need for transfusion), hyperbilirubinemia, need for phototherapy, or need for exchange transfusion (O)? Among preterm neonates who are under radiant warmers in the hospital delivery room (P), does increased room temperature, thermal mattress, or another intervention (I), compared with plastic wraps alone (C), reduce hypothermia (less than 36°C) on admission to neonatal intensive care unit (NICU) (O)? In newborns who are hypothermic (temperature less than 36.0°C) on admission (P), does rapid rewarming (I), compared with slow rewarming (C), change mortality rate, short and long-term neurologic outcome, hemorrhage, episodes of apnea and hypoglycemia, or need for respiratory support (O)? Babies Born to Mothers Who Are Hypothermic or Hyperthermic in Labor-Prognosis (NRP 804) In newborn babies (P), does maternal hypothermia or hyperthermia in labor (I), versus normal maternal temperature (C), result in adverse neonatal effects (O)? Outcomes include mortality, neonatal seizures, and adverse neurologic states. In spontaneously breathing preterm infants with respiratory distress requiring respiratory support in the delivery room (P), does the use of CPAP (I), compared with intubation and IPPV (C), improve outcome (O)? with using a self-inflating bag without PEEP (C), achieve spontaneous breathing sooner and/or reduce the incidence of pneumothorax, bronchopulmonary dysplasia, and mortality (O)? In extremely preterm infants (less than 25 weeks) (P), does delivery room assessment with a prognostic score (I), compared with gestational age assessment alone (C), change survival to 18 to 22 months (O)? Apgar Score of 0 for 10 Minutes or Longer-Prognosis (NRP 896) In infants with a gestational age of 36 weeks or greater and an Apgar score of 0 for 10 minutes or longer, despite ongoing resuscitation (P), whatis therate of survival to NICU admission and death or neurocognitive impairment at 18 to 22 months (O)?
Neonatal outcomes based on mode and intensity of delivery room resuscitation
Journal of Perinatology, 2017
OBJECTIVE: To examine outcomes of neonates based on the mode and intensity of resuscitation received in the delivery room (DR). STUDY DESIGN: A retrospective study of 439 infants with birth weight ⩽ 1500 g receiving DR resuscitation at two hospital centers in Philadelphia, Pennsylvania. RESULTS: Of 439 infants, 22 (5%) received routine care, 188 (43%) received noninvasive positive pressure ventilation (PPV) and 229 (52%) received endotracheal tube (ETT) intubation in the DR. Adjusted odds for respiratory distress syndrome was associated with lower rates in infants requiring lower intensity of DR resuscitation (Po 0.001). Noninvasive PPV vs ETT was associated with decreased odds of developing intraventricular hemorrhage and retinopathy of prematurity (P o0.05). Routine vs noninvasive PPV or ETT had decreased odds of developing bronchopulmonary dysplasia (Po 0.05). CONCLUSION: Decreased intensity of DR resuscitation was associated with a decreased risk of specific morbidities.
Anales de pediatría (Barcelona, Spain : 2003), 2007
To assess the short- and long-term outcome of infants<or=1250 grams who have received delivery room cardiopulmonary resuscitation (DR-CPR). In a cohort of infants<or=1250 grams born between 01/2000 and 12/2003, we compared the rates of death, severe intraventricular hemorrhage (S-IVH), periventricular leukomalacia and combined poor short-term outcome (CO). At 18 months post- conception age (PCA) we compared DR-CPR and non-DR-CPR groups on the Bayley II Mental and Psychomotor Developmental Indices (MDI and PDI). Of 397 infants who met enrollment criteria, the 53 (13%) who received DR-CPR had a higher risk for mortality, S-IVH, PVL and CO. At 18 months PCA, MDI and PDI scores were lower in the DR-CPR group (67.7+/-18.3 vs. 81.3+/-17.7; p=0.006) and (74.4+/-19.9 vs. 85.1+/-17.2; p=0.027), respectively. DR-CPR in infants<1250 grams is associated with higher mortality and greater short- and long-term morbidity.
Pediatrics, 2010
In babies requiring resuscitation (P), does electrocardiography (ECG/EKG) (I), compared with oximetry or auscultation (C), measure heart rate faster and more accurately (O)? In preterm infants, including those who received resuscitation (P), does delayed cord clamping (greater than 30 seconds) (I), compared with immediate cord clamping (C), improve survival, long-term developmental outcome, cardiovascular stability, occurrence of intraventricular hemorrhage (IVH), necrotizing enterocolitis, temperature on admission to a newborn area, and hyperbilirubinemia (O)? hematologic indices, (initial hemoglobin, need for transfusion), hyperbilirubinemia, need for phototherapy, or need for exchange transfusion (O)? Among preterm neonates who are under radiant warmers in the hospital delivery room (P), does increased room temperature, thermal mattress, or another intervention (I), compared with plastic wraps alone (C), reduce hypothermia (less than 36°C) on admission to neonatal intensive care unit (NICU) (O)? In newborns who are hypothermic (temperature less than 36.0°C) on admission (P), does rapid rewarming (I), compared with slow rewarming (C), change mortality rate, short and long-term neurologic outcome, hemorrhage, episodes of apnea and hypoglycemia, or need for respiratory support (O)? Babies Born to Mothers Who Are Hypothermic or Hyperthermic in Labor-Prognosis (NRP 804) In newborn babies (P), does maternal hypothermia or hyperthermia in labor (I), versus normal maternal temperature (C), result in adverse neonatal effects (O)? Outcomes include mortality, neonatal seizures, and adverse neurologic states. In spontaneously breathing preterm infants with respiratory distress requiring respiratory support in the delivery room (P), does the use of CPAP (I), compared with intubation and IPPV (C), improve outcome (O)? with using a self-inflating bag without PEEP (C), achieve spontaneous breathing sooner and/or reduce the incidence of pneumothorax, bronchopulmonary dysplasia, and mortality (O)? In extremely preterm infants (less than 25 weeks) (P), does delivery room assessment with a prognostic score (I), compared with gestational age assessment alone (C), change survival to 18 to 22 months (O)? Apgar Score of 0 for 10 Minutes or Longer-Prognosis (NRP 896) In infants with a gestational age of 36 weeks or greater and an Apgar score of 0 for 10 minutes or longer, despite ongoing resuscitation (P), whatis therate of survival to NICU admission and death or neurocognitive impairment at 18 to 22 months (O)?
Resuscitation of extremely preterm infants - controversies and current evidence
World journal of clinical pediatrics, 2016
Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable (gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenat...