Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Outcomes of neonates born at <26 weeks gestational age who receive extensive cardiopulmonary resuscitation compared with airway and breathing support

Journal of Perinatology volume 40, pages 481–487 (2020)Cite this article

Subjects

Abstract

Objective

To evaluate outcomes of preterm infants <26 weeks gestational age (GA) following postdelivery extensive cardiopulmonary resuscitation (ECPR) compared with airway and breathing support (ABS).

Study design

Retrospective review of Canadian Neonatal Network data during January 2010 to December 2016. The primary outcome was death or severe morbidity (intraventricular hemorrhage ≥grade 3 or periventricular leucomalacia, retinopathy of prematurity ≥stage 3, bronchopulmonary dysplasia, or necrotizing enterocolitis).

Result

Among 3633 infants analyzed, 433 (11.9%) received ECPR. In multivariable analysis, death or severe morbidity was higher in the ECPR versus ABS group [adjusted odds ratio 2.26 (95% confidence interval 1.49, 3.43)]. The majority of the difference was due to increased mortality, which occurred mostly during the first week of life.

Conclusion

These data from a recent cohort of infants near the limits of viability may be useful for prognostication for health care providers and counseling of parents.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Cummings J and Committee on Fetus and Newborn. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation. Pediatrics. 2015;136:588–95.

    Article  Google Scholar 

  2. Gallagher K, Martin J, Keller M, Marlow N. European variation in decision-making and parental involvement during preterm birth. Arch Dis Child Fetal Neonatal Ed. 2014;99:F245–249.

    Article  PubMed  Google Scholar 

  3. Rysavy MA, Li L, Bell EF, Das A, Hintz SR, Stoll BJ, et al. Between-hospital variation in treatment and outcomes in extremely preterm infants. N. Engl J Med. 2015;372:1801–11.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Finer NN, Horbar JD, Carpenter JH. Cardiopulmonary resuscitation in the very low birth weight infant: the Vermont Oxford Network experience. Pediatrics. 1999;104:428–34.

    Article  CAS  PubMed  Google Scholar 

  5. Shah PS. Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses. J Perinatol. 2009;29:655–61.

    Article  CAS  PubMed  Google Scholar 

  6. Wyckoff MH, Salhab WA, Heyne RJ, Kendrick DE, Stoll BJ, Laptook AR. Outcome of extremely low birth weight infants who received delivery room cardiopulmonary resuscitation. J Pediatr. 2012;160:239. e232

    Article  PubMed  Google Scholar 

  7. Soraisham AS, Lodha AK, Singhal N, Aziz K, Yang J, Lee SK, et al. Neonatal outcomes following extensive cardiopulmonary resuscitation in the delivery room for infants born at less than 33 weeks gestational age. Resuscitation. 2014;85:238–43.

    Article  PubMed  Google Scholar 

  8. Handley SC, Sun Y, Wyckoff MH, Lee HC. Outcomes of extremely preterm infants after delivery room cardiopulmonary resuscitation in a population-based cohort. J Perinatol. 2015;35:379–83.

    Article  CAS  PubMed  Google Scholar 

  9. Deulofeut R, Sola A, Lee B, Rogido M. Delivery room cardiopulmonary resuscitation of very preterm infant is associated with adverse short- and long-term outcomes. Pediatrics. 2007;66:31–7.

    CAS  Google Scholar 

  10. Sanchez-Torres AM, Garcia-Alix A, Cabanas F, Elorza MD, Madero R, Pérez J, et al. [Impact of cardiopulmonary resuscitation on extremely low birth weight infants]. Pediatrics. 2007;66:38–44.

    Google Scholar 

  11. Jankov RP, Asztalos EV, Skidmore MB. Favourable neurological outcomes following delivery room cardiopulmonary resuscitation of infants < or = 750 g at birth. J Paediatr Child Health. 2000;36:19–22.

    Article  CAS  PubMed  Google Scholar 

  12. Janvier A, Barrington KJ. The ethics of neonatal resuscitation at the margins of viability: informed consent and outcomes. J Pediatr. 2005;147:579–85.

    Article  PubMed  Google Scholar 

  13. Shah PS, Shah P, Tai KF. Chest compression and/or epinephrine at birth for preterm infants <32 weeks gestational age: matched cohort study of neonatal outcomes. J Perinatol. 2009;29:693–7.

    Article  CAS  PubMed  Google Scholar 

  14. Kono Y, Yonemoto N, Nakanishi H, Kusuda S, Fujimura M. Changes in survival and neurodevelopmental outcomes of infants born at <25 weeks’ gestation: a retrospective observational study in tertiary centres in Japan. BMJ Paediatrics Open. 2018;2:e000211. https://doi.org/10.1136/bmjpo-2017-000211.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Patel RM, Rysavy MA, Bell EF, Tyson JE. Survival of infants born at periviable gestational ages. Clin Perinatol. 2017;44:287–303.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Myrhaug HT, Brurberg KG, Hov L, Markestad T. Survival and impairment of extremely premature infants: a meta-analysis. Pediatrics. 2019;143:e20180933.

    Article  PubMed  Google Scholar 

  17. Lemyre B, Moore G. Counselling and management for anticipated extremely preterm birth. Paediatr Child Health. 2017;22:334–41.

    Article  PubMed  PubMed Central  Google Scholar 

  18. The Canadian Neonatal Network. Abstractor's manual v.3.3.0. The Canadian Neonatal Network: Toronto, Ontario, Canada. 2018. http://www.canadianneonatalnetwork.org/Portal/LinkClick.aspx?fileticket=0D_S5s0MEc0%3d&tabid=69.

  19. Lee SK, McMillan DD, Ohlsson A, Pendray M, Synnes A, Whyte R, et al. Variations in practice and outcomes in the Canadian NICU network: 1996-7. Pediatrics. 2000;106:1070–9.

    Article  CAS  PubMed  Google Scholar 

  20. Shah PSSW, Chan P, Yeh S, Musrap N, Lee SK, Data Abstractors of the Canadian Neonatal N. Internal audit of the Canadian Neonatal Network data collection system. Am J Perinatol. 2017;34:1241–9.

    Article  PubMed  Google Scholar 

  21. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179–201.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723–9.

    Article  CAS  PubMed  Google Scholar 

  23. Gole GA, Ells AL, Katz X, Holmstrom G, Fielder AR, Capone A Jr, et al. The international classification of retinopathy of prematurity revisited. JAMA Ophthalmol. 2005;123:991–9.

    Google Scholar 

  24. Papile LA, Munsick-Bruno G, Schaefer A. Relationship of cerebral intraventricular hemorrhage and early childhood neurologic handicaps. J Pediatr. 1983;103:273–7.

    Article  CAS  PubMed  Google Scholar 

  25. Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr. 2001;138:92–100.

    Article  CAS  PubMed  Google Scholar 

  26. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors gratefully acknowledge all site investigators and abstractors of the CNN. We also thank the staff at the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital, Toronto, ON, for organizational support of the CNN, CNFUN, and this project. In addition, we thank Sarah Hutchinson, PhD, and Iris Kulbatski, PhD, from MiCare for editorial assistance in the preparation of this manuscript. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CIHR) (CTP 87518), the Ontario Ministry of Health, and support from participating hospitals.

Funding

Although no specific funding has been received for this study, organizational support for the CNN was provided by the MiCare Research Centre at Mount Sinai Hospital in Toronto, ON, Canada. MiCare is supported by a CIHR Team Grant (CTP 87518), the Ontario Ministry of Health and individual participating centers. Dr Shah holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the CIHR (APR-126340). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Site Investigators of the Canadian Neonatal Network

Jaideep Kanungo5, Joseph Ting6, Zenon Cieslak7, Rebecca Sherlock8, Ayman Abou Mehrem9, Jennifer Toye10, Carlos Fajardo11, Zarin Kalapesi12, and Jaya Bodani12, Koravangattu Sankaran13, and Sibasis Daspal13, Mary Seshia14, Ruben Alvaro15, Amit Mukerji16, Orlando Da Silva17, Chuks Nwaesei18, Kyong-Soon Lee19, Michael Dunn20, Brigitte Lemyre21, Faiza Khurshid22, Ermelinda Pelausa23, Keith Barrington24, and Anie Lapointe24, Christine Drolet25, and Bruno Piedboeuf25, Martine Claveau26, and Marc Beltempo26, Valerie Bertelle27, and Edith Masse27, Roderick Canning28, Hala Makary29, Cecil Ojah30, and Luis Monterrosa30, Julie Emberley31, Jehier Afifi32, Andrzej Kajetanowicz33

Author contributions

VS conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. OE conceptualized and designed the study, and reviewed and revised the manuscript. PSS conceptualized and designed the study, and contributed to the analysis, and substantially reviewed and revised the manuscript. JY conducted the analysis and reviewed the manuscript for important intellectual content. K-SL conceptualized and designed the study, coordinated and supervised the analysis, and substantially reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Room 38102, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Vivek Shukla, Omar Elkhateeb & Kyong-Soon Lee

  2. Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada

    Prakesh S. Shah

  3. Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    Prakesh S. Shah & Kyong-Soon Lee

  4. Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada

    Prakesh S. Shah & Junmin Yang

  5. Victoria General Hospital, Victoria, BC, Canada

    Jaideep Kanungo

  6. Women’s Hospital and Health Centre, Vancouver, BC, Canada

    Joseph Ting

  7. Royal Columbian Hospital, New Westminster, BC, Canada

    Zenon Cieslak

  8. Surrey Memorial Hospital, Surrey, BC, Canada

    Rebecca Sherlock

  9. Foothills Medical Centre, Calgary, AB, Canada

    Ayman Abou Mehrem

  10. Royal Alexandra Hospital, Edmonton, AB, Canada

    Jennifer Toye

  11. Alberta Children’s Hospital, Calgary, AB, Canada

    Carlos Fajardo

  12. Regina General Hospital, Regina, SK, Canada

    Zarin Kalapesi & Jaya Bodani

  13. Royal University Hospital, Saskatoon, SK, Canada

    Koravangattu Sankaran & Sibasis Daspal

  14. Winnipeg Health Sciences Centre, Winnipeg, MB, Canada

    Mary Seshia

  15. St. Boniface General Hospital, Winnipeg, MB, Canada

    Ruben Alvaro

  16. Hamilton Health Sciences Centre, Hamilton, ON, Canada

    Amit Mukerji

  17. London Health Sciences Centre, London, ON, Canada

    Orlando Da Silva

  18. Windsor Regional Hospital, Windsor, ON, Canada

    Chuks Nwaesei

  19. Hospital for Sick Children, Toronto, ON, Canada

    Kyong-Soon Lee

  20. Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Michael Dunn

  21. Children’s Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, ON, Canada

    Brigitte Lemyre

  22. Kingston General Hospital, Kingston, ON, Canada

    Faiza Khurshid

  23. Jewish General Hospital, Montréal, QC, Canada

    Ermelinda Pelausa

  24. Hôpital Sainte-Justine, Montréal, QC, Canada

    Keith Barrington & Anie Lapointe

  25. Centre Hospitalier Universitaire de Québec, Sainte Foy, QC, Canada

    Christine Drolet & Bruno Piedboeuf

  26. Montreal Children’s Hospital at McGill University Health Centre, Montréal, QC, Canada

    Martine Claveau & Marc Beltempo

  27. Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Valerie Bertelle & Edith Masse

  28. Moncton Hospital, Moncton, NB, Canada

    Roderick Canning

  29. Dr. Everett Chalmers Hospital, Fredericton, NB, Canada

    Hala Makary

  30. Saint John Regional Hospital, Saint John, NB, Canada

    Cecil Ojah & Luis Monterrosa

  31. Janeway Children’s Health and Rehabilitation Centre, St. John’s, NF, Canada

    Julie Emberley

  32. IWK Health Centre, Halifax, NS, Canada

    Jehier Afifi

  33. Cape Breton Regional Hospital, Sydney, NS, Canada

    Andrzej Kajetanowicz

Authors
  1. Vivek Shukla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Omar Elkhateeb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prakesh S. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Junmin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kyong-Soon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Canadian Neonatal Network Investigators

  • Jaideep Kanungo
  • , Joseph Ting
  • , Zenon Cieslak
  • , Rebecca Sherlock
  • , Ayman Abou Mehrem
  • , Jennifer Toye
  • , Carlos Fajardo
  • , Zarin Kalapesi
  • , Jaya Bodani
  • , Koravangattu Sankaran
  • , Sibasis Daspal
  • , Mary Seshia
  • , Ruben Alvaro
  • , Amit Mukerji
  • , Orlando Da Silva
  • , Chuks Nwaesei
  • , Kyong-Soon Lee
  • , Michael Dunn
  • , Brigitte Lemyre
  • , Faiza Khurshid
  • , Ermelinda Pelausa
  • , Keith Barrington
  • , Anie Lapointe
  • , Christine Drolet
  • , Bruno Piedboeuf
  • , Martine Claveau
  • , Marc Beltempo
  • , Valerie Bertelle
  • , Edith Masse
  • , Roderick Canning
  • , Hala Makary
  • , Cecil Ojah
  • , Luis Monterrosa
  • , Julie Emberley
  • , Jehier Afifi
  •  & Andrzej Kajetanowicz

Corresponding author

Correspondence to Kyong-Soon Lee.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of the Canadian Neonatal Network Investigators are listed below Acknowledgements.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shukla, V., Elkhateeb, O., Shah, P.S. et al. Outcomes of neonates born at <26 weeks gestational age who receive extensive cardiopulmonary resuscitation compared with airway and breathing support. J Perinatol 40, 481–487 (2020). https://doi.org/10.1038/s41372-019-0570-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-019-0570-z

This article is cited by

Search

Advanced search

Quick links