¹Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada

Correspondence: Dr PS Shah, Department of Pediatrics, Mount Sinai Hospital, 775A–600 University Avenue, Toronto, Ontario, Canada M5G 1X5. E-mail: pshah@mtsinai.on.ca

Received 17 September 2008; Revised 26 January 2009; Accepted 15 February 2009; Published online 25 June 2009.

Abstract

Studies of the outcomes of preterm infants after the receipt of extensive cardiopulmonary resuscitation (CPR) at birth or in the neonatal intensive care units (NICUs) have yielded varied results. A systematic review of the outcomes of very low birth weight (VLBW) and extremely low birth weight (ELBW) infants who received extensive resuscitation at birth or in the NICU was carried out. MEDLINE, EMBASE, CINAHL databases were searched for studies of extensive CPR in the delivery room (DR-CPR) and in NICU (NICU-CPR) that have reported neonatal or long-term outcomes. A total of 20 eligible studies were identified (11 of DR-CPR, 7 of NICU-CPR and 2 had combined data). DR-CPR was associated with an increased risk of mortality (odds ratio (OR) 2.83, 95% confidence interval (CI) 1.92, 4.16) and severe neurological injury (OR 2.27, 95% CI 1.40, 3.67) compared with infants who did not receive extensive CPR. NICU-CPR was associated with an increased risk of mortality (OR 55, 95% CI 15, 195) compared with infants who did not receive CPR; however, confidence limits were wide. The long-term outcome of survivors was reported in a limited number of studies. Extensive CPR at birth or in the NICU for VLBW or ELBW infants was associated with higher risk of mortality.