Chest compression and/or epinephrine at birth for preterm infants &lt;32 weeks gestational age: matched cohort study of neonatal outcomes

Shah, Prakeshkumar S; Tai, Kin Fan Young

doi:10.1038/jp.2009.70

Cited by 37 publications

(20 citation statements)

References 19 publications

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“…In preterm infants due to lack of good evidence for use of epinephrine and its adverse effects of epinephrine especially postresuscitation hypertension, outcome data become even more important. Multiple retrospective observational studies have noted that preterm neonates requiring CPR and epinephrine have significantly lower survival, higher incidence of early onset sepsis, NEC, grade 3–4 intraventricular hemorrhage, cystic periventricular leukomalacia, bronchopulmonary dysplasia, and neurodevelopmental impairment (7, 74–76). These studies frequently suffer from small numbers and selection bias as the most compromised and sicker preterm neonates may require CPR but all studies point toward worse outcomes associated with extensive delivery room CPR.…”

Section: Outcomes In Newborns Who Require Epinephrine In the Deliverymentioning

confidence: 99%

Epinephrine Use during Newborn Resuscitation

Kapadia

Wyckoff

2017

Front. Pediatr.

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Epinephrine use in the delivery room for resuscitation of the newborn is associated with significant morbidity and mortality. Evidence for optimal dose, timing, and route of administration of epinephrine during neonatal resuscitation comes largely from extrapolated adult or animal literature. In this review, we provide the current recommendations for use of epinephrine during neonatal resuscitation and also the evidence behind these recommendations. In addition, we review the current proposed mechanism of action of epinephrine during neonatal resuscitation, review its adverse effects, and identify gaps in knowledge requiring urgent research.

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Section: Outcomes In Newborns Who Require Epinephrine In the Deliverymentioning

confidence: 99%

Epinephrine Use during Newborn Resuscitation

Kapadia

Wyckoff

2017

Front. Pediatr.

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“…No information was available regarding whether DR-CPR was administered according to guidelines and no long-term outcomes were available. Subsequent reports of DR-CPR for preterm infants suffer from similar shortcomings 9,22-24 with limited insight into the need for DR-CPR, low rates of follow-up for long-term outcomes and small numbers of reported babies, making the data difficult to interpret. In addition, the length of follow-up is not consistent among all reports.…”

Section: Discussionmentioning

confidence: 99%

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

Wyckoff

Salhab

Heyne

et al. 2012

The Journal of Pediatrics

118

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Objective To determine whether delivery room cardiopulmonary resuscitation (DR-CPR) independently predicts morbidities and neurodevelopmental impairment (NI) in extremely low birth weight (ELBW) infants. Study design Cohort study of infants born with birth weight (BW) 401-1000g and gestational age (GA) 23-30wks. DR-CPR was defined as chest compressions and/or drugs. Logistic regression was used to determine associations between DR-CPR and morbidities, mortality and NI at 18-24 months (Bayley II mental or psychomotor index < 70, cerebral palsy, blindness or deafness). Data are adjusted Odds Ratio (OR) with 95% confidence interval. Results Of 8685 infants, 1333(15%) received DR-CPR. DR-CPR infants had lower BW (708±141vs 764±146g, p<0.0001) and GA (25±2 vs 26±2 wks, p<0.0001). DR-CPR infants had more pneumothoraces (OR 1.28, 1.48-2.99), Grade 3-4 intraventricular hemorrhage (OR 1.47, 1.23-1.74), bronchopulmonary dysplasia (OR 1.34, 1.13-1.59), death by 12 hours (OR 3.69, 2.98-4.57) and by 120 days after birth (OR 2.22, 1.93-2.57). NI among survivors (OR 1.23, 1.02-1.49), and death or NI (OR 1.70, 1.46-1.99) were higher for DR-CPR infants. Only 14% of DR-CPR recipients with 5-minute Apgar score<2 survived without NI. Conclusions DR-CPR is a prognostic marker for higher mortality and NI for ELBW survivors. New DR-CPR strategies are needed for this population.

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“…An estimated 10% of newborns need assistance to establish effective ventilation at birth, which remains the most critical step of neonatal resuscitation [1]. The need for chest compressions (CC) in the delivery room is rare (approximately 0.1% of term infants and up to 15% of preterm infants) [2][3][4][5][6][7][8]. A recent review of newborns who received prolonged CC without signs of life at 10 minutes following birth noted 83% mortality, with 93% of survivors suffering moderate-to-severe disability [9].…”

Section: Introductionmentioning

confidence: 99%

Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

Shim

Kim

Cheung

et al. 2020

Preprint

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ObjectiveSustained inflation (SI) during chest compression (CC = CC+SI) significantly reduces time to return of spontaneous circulation (ROSC) compared to 3:1 compression-to-ventilation ratio during neonatal resuscitation. However, the optimal peak inflation pressure (PIP) of SI during CC+SI to improve ROSC and hemodynamic recovery in severely asphyxiated piglets is unknown.AimTo examine if different PIPs of SI during CC+SI will improve ROSC and hemodynamic recovery in severely asphyxiated piglets.Intervention and measurementsTwenty-nine newborn piglets (1-3 days old) were anesthetized, intubated, instrumented and exposed to 30-min normocapnic hypoxia followed by asphyxia. Piglets were randomized into four groups: CC+SI with a PIP of 10 cmH2O (CC+SI_PIP_10, n=8), a PIP of 20 cmH2O (CC+SI_PIP_20, n=8), a PIP of 30 cmH2O (CC+SI_PIP_30, n=8), and a sham-operated control group (n=5). Heart rate, arterial blood pressure, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment.Main resultsBaseline parameters were similar between all groups. There was no difference in asphyxiation (duration and degree) between intervention groups. PIP correlated positively with tidal volume and inversely with exhaled CO2 during cardiopulmonary resuscitation. Time to ROSC and rate of ROSC were similar between piglets resuscitated with CC+SI_PIP_10, CC+SI_PIP_20, and CC+SI_PIP_30 cmH2O: median (IQR) 75 (63-193) sec, 94 (78-210) sec, and 85 (70-90) sec; 5/8 (63%), 7/8 (88%), and 3/8 (38%) (p=0.56 and p=0.12, respectively). All piglets that achieved ROSC survived to four hours post-resuscitation. Piglets resuscitated with CC+SI_PIP_30 cmH2O exhibited increased concentrations of pro-inflammatory cytokines interleukin-1β and tumour necrosis factor-α in the frontoparietal cerebral cortex (both p<0.05 vs. sham-operated controls).ConclusionsIn asphyxiated term newborn piglets resuscitated by CC+SI, the use of different PIPs resulted in similar time to ROSC, but PIP at 30 cmH2O showed a larger VT delivery, lower exhaled CO2 and increased tissue inflammatory markers in the brain.

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Chest compression and/or epinephrine at birth for preterm infants <32 weeks gestational age: matched cohort study of neonatal outcomes

Cited by 37 publications

References 19 publications

Epinephrine Use during Newborn Resuscitation

Epinephrine Use during Newborn Resuscitation

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

Effects of sustained inflation pressure during neonatal cardiopulmonary resuscitation of asphyxiated piglets

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