Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses

Shah, Prakeshkumar S

doi:10.1038/jp.2009.71

Cited by 67 publications

(38 citation statements)

References 32 publications

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“…However, only the risk of bronchopulmonary dysplasia remained significant when the data were adjusted for prognostic variables. Data from the Vermont Oxford Network (74) and a meta-analysis by Shah et al (75). showed that very-lowbirth-weight infants who received cardiopulmonary resuscitation had increased mortality and higher rates of IVH compared with infants who did not require resuscitation.…”

Section: Clinical Perspectivementioning

confidence: 99%

Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury

et al. 2014

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Section: Clinical Perspectivementioning

confidence: 99%

Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury

et al. 2014

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“…However, extensive cardiopulmonary resuscitation at birth is also associated with a higher risk of mortality for neonates at the limits of viability. 6 Perinatal treatment decisions at low gestational age are complex, because they affect both the mother and the fetus, and the balance between risk and benefit may be quite different for each of them. 7 Professional groups may perceive the desired outcome differently, which may cause discrepancies in their willingness to use interventions at borderline viability.…”

Section: Introductionmentioning

confidence: 99%

Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

et al. 2012

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Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.Study Design: Prospective cohort of 484 infants with 23 0/7 to 26 6/7 weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of X1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life.Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/ neonatal clinical conditions. Conclusion:In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. Keywords: fetal viability; steroids; cesarean section; cardiopulmonary resuscitation; infant newborn; neonatal mortality Introduction According to the International Liaison Group on Resuscitation, in 2010, 1 for neonates at the margins of viability or those with conditions that predict a high risk of mortality or morbidity, attitudes and practice vary according to region and availability of resources. 2 A systematic review 3 shows that at p22 weeks, no scientific society recommends active treatment for the mother to protect the fetus beyond offering compassionate care. A general agreement is also evident for week 25 0/7 to 25 6/7 : antenatal steroid administration are recommended, prenatal transport and Cesarean section are indicated to protect the fetus and resuscitation is offered to all infants without fatal anomalies. However, there exists a gray area for infants between 23 and 24 weeks, which, in some countries, extends through 25 weeks. 3 The active management of gestations at the limit of viability involves three important clinical decisions: the use of antenatal steroids, delivery method and resuscitation at birth. One prospective cohort study between 1993 and 2007 followed 5476 infants with 23 to 29 weeks gestation admitted for neonatal care. The overall mortality among infants exposed to maternal steroids was lower than in infants not exposed: 19% vs 35% at 24 to 29 weeks and 79% vs 89% at 23 weeks. 4 23, 24, 25 and 26 weeks, respectively. 5 In the same study, 8% of the 125 542 live births with 22 to 31 weeks of gestation had Apgar scores <4 at 5 min, which indicates that resuscitation procedures were frequently needed among preterm infants. However, extensive cardiopulmonary resuscitation at birth

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“…Fortunately, the need for chest compressions (CC) or medications in the delivery room is rare. Approximately 0.1% of term infants and 15% of preterm infants require CC at birth due to birth asphyxia [3,4,5,6,7]. Birth asphyxia will result in approximately 1 million newborn deaths annually worldwide.…”

Section: Introductionmentioning

confidence: 99%

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

Görens²,

Cheung³

et al. 2017

Neonatology

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Background: Recently, sustained inflations (SI) during chest compression (CC) (CC+SI) have been suggested as an alternative to the current approach during neonatal resuscitation. No previous study compared CC+SI using CC rates of 90/min to the current 3:1 compression:ventilation ratio (C:V). Objective: To determine whether CC+SI versus a 3:1 C:V reduces the time to the return of spontaneous circulation (ROSC) and improves hemodynamic recovery in newborn piglets with asphyxia-induced bradycardia. Intervention and Measurements: Term newborn piglets were anesthetized, intubated, instrumented, and exposed to 45-min normocapnic hypoxia followed by asphyxia. Cardiopulmonary resuscitation (CPR) was initiated when the heart rate decreased to 25% of baseline. Piglets were randomized into 3 groups: CC during SI at a rate of 90 CC/min (SI+CC 90, n = 8), a 3:1 C:V using 90 CC and 30 inflations (3:1, n = 8), or a sham group (n = 6). Cardiac function, carotid blood flow, cerebral oxygenation, and respiratory parameters were continuously recorded throughout the experiment. Results: CC+SI significantly reduced the median (IQR) time of ROSC, i.e., 34 s (28-156 s) versus 210 s (72-300 s) in the 3:1 group (p = 0.048). CC+SI also significantly reduced the requirement for 100% oxygen, improved respiratory parameters, and resulted in a similar hemodynamic recovery. Conclusions: CC+SI during CPR significantly improved ROSC in a porcine model of neonatal resuscitation. This is of considerable clinical relevance because improved respiratory and hemodynamic parameters potentially minimize morbidity and mortality in newborn infants.

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Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses

Cited by 67 publications

References 32 publications

Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury

Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury

Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

Chest Compressions during Sustained Inflations Improve Recovery When Compared to a 3:1 Compression:Ventilation Ratio during Cardiopulmonary Resuscitation in a Neonatal Porcine Model of Asphyxia

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