Use of adrenaline and atropine in neonatal resuscitation.

Abstract

Follow up studies showed that 13 infants were handicapped with nine severely handicapped. Extreme prematurity, the need for early or repeated resuscitation using these drugs, particularly for episodes of collapse without a clear precipitating cause, and asystole rather than bradycardia were associated with a worse outcome. Evidence is accumulating to support a view that the use of these drugs for resuscitation at birth and in the first week of life of extremely preterm infants may be inappropriate.

Intact Survival in Extremely Low Birth Weight Infants After Delivery Room Resuscitation

“…However, this study lacked the power to conclude that CPR was futile for such infants. More recently, Sims et al 6 noted that all 5 of their infants born at Յ28 weeks' gestation, who required adrenaline and atropine at delivery, either died (3 infants) or were severely handicapped (2 infants).…”

“…[3][4][5][6] During the period reviewed, parents delivering at our institution could elect to forego aggressive resuscitative efforts if the gestational age was Յ24 weeks, the birth weight was Ͻ500 g, and/or survival was unlikely. Therefore, it is probable that selection bias accounted for the higher survival rate of Ͻ750 g infants who received DR-CPR compared with that of Ͻ750 g infants who did not receive DR-CPR.…”

“…[2][3][4][5][6] Despite these observations, current clinical practice includes DR-CPR for ELBW infants. To determine whether ELBW infants survive DR-CPR without significant neurodevelopmental abnormality, we reviewed the neonatal and early childhood outcomes of ELBW infants born over a 4-year period in our institution who received CPR including epinephrine and/or chest compressions in the delivery room (DR).…”

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

“…Jankov et al 5 and Finer et al 8 reported no difference in the risk of mortality or neurological injury, whereas Lantos et al, 7 Finer et al, 3 Sims et al 15 and Davis 16 reported a higher risk of mortality and neurological morbidity after CPR at birth. All studies of CPR are retrospective and include the remaining admissions in their units as comparator.…”

ILCOR Advisory Statement: Resuscitation of the Newly Born Infant

“…61 Administration of epinephrine is not recommended unless the heart rate remains Ͻ60 bpm after a minimum of 30 seconds of adequate ventilation and chest compression. 62 Volume expansion should be considered when there has been suspected blood loss and/or the infant appears to be in shock (pale, poor perfusion, weak pulse) and has not responded adequately to other resuscitative measures. If the mother has received a narcotic drug and the infant's respiratory drive is considered inadequate, naloxone may be indicated after vital signs have been established.…”