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.

  • Original Article
  • Published:

Outcomes of extremely preterm infants after delivery room cardiopulmonary resuscitation in a population-based cohort

Abstract

Objective:

To describe the relationship of delivery room cardiopulmonary resuscitation (DR-CPR) to short-term outcomes of extremely preterm infants.

Study design:

This was a cohort study of 22 to 27+6/7 weeks gestational age (GA) infants during 2005 to 2011. DR-CPR was defined as chest compressions and/or epinephrine administration. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) associated with DR-CPR; analysis was stratified by GA.

Result:

Of the 13 758 infants, 856 (6.2%) received DR-CPR. Infants 22 to 23+6/7 weeks receiving DR-CPR had similar outcomes to non-recipients. Infants 24 to 25+6/7 weeks receiving DR-CPR had more severe intraventricular hemorrhage (OR 1.36, 95% CI 1.07, 1.72). Infants 26 to 27+6/7 weeks receiving DR-CPR were more likely to die (OR 1.81, 95% CI 1.30, 2.51) and have intraventricular hemorrhage (OR 2.10, 95% CI 1.56, 2.82). Adjusted hospital DR-CPR rates varied widely (median 5.7%).

Conclusion:

Premature infants receiving DR-CPR had worse outcomes. Mortality and morbidity varied by GA.

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

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

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Hack M, Friedman H, Fanaroff AA . Outcomes of extremely low birth weight infants. Pediatrics 1996; 98 (5): 931–937.

    CAS  PubMed  Google Scholar 

  2. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ et al. Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics 2001; 107 (1): E1.

    Article  CAS  Google Scholar 

  3. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196 (2): 147 e141–147 e148.

    Article  Google Scholar 

  4. Hintz SR, Kendrick DE, Vohr BR, Poole WK, Higgins RD . Changes in neurodevelopmental outcomes at 18 to 22 months' corrected age among infants of less than 25 weeks' gestational age born in 1993-1999. Pediatrics 2005; 115 (6): 1645–1651.

    Article  Google Scholar 

  5. Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M et al. Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics 2002; 110 (1 Pt 1): 143–151.

    Article  Google Scholar 

  6. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3): 443–456.

    Article  Google Scholar 

  7. Lantos JD, Miles SH, Silverstein MD, Stocking CB . Survival after cardiopulmonary resuscitation in babies of very low birth weight. Is CPR futile therapy? N Engl J Med 1988; 318 (2): 91–95.

    Article  CAS  Google Scholar 

  8. Shah PS . Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses. J Perinatol 2009; 29 (10): 655–661.

    Article  CAS  Google Scholar 

  9. 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 (10): 693–697.

    Article  CAS  Google Scholar 

  10. 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 (2): 239–244 e232.

    Article  Google Scholar 

  11. Frontanes A, Garcia-Fragoso L, Garcia I, Rivera J, Valcarcel M . Outcome of very-low-birth-weight infants who received epinephrine in the delivery room. Resuscitation 2011; 82 (4): 427–430.

    Article  Google Scholar 

  12. 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 (2): 238–243.

    Article  Google Scholar 

  13. Papile LA, Baley JE, Benitz W, Cummings J, Carlo WA, Kumar P et al. Levels of neonatal care. Pediatrics 2012; 130 (3): 587–597.

    Article  Google Scholar 

  14. Lee HC, Bennett MV, Schulman J, Gould JB . Accounting for variation in length of NICU stay for extremely low birth weight infants. J Perinatol 2013; 33 (11): 872–876.

    Article  CAS  Google Scholar 

  15. Perinatal Services Guidelines for Care: A Compilation of Current Standards. 2011 (cited 3 August 2014). Available from http://www.cdph.ca.gov/programs/rppc/Documents/MO-RPPC-PerinatalServicesGuidelines-CompilationofStandards-2011.pdf.

  16. CPQCC Network Database 2008 Member Instructions for Electronic Data Submission (online). 2009 (cited 25 December 2013); Version 03.09. Available from http://cpqcc.org/data/cpqcc_downloads.

  17. Vermont Oxford Network Database Manual of Operations for Infants Born in 2010 (manual online). 2009 (cited 25 December 2013); Release 14.0. Available from http://www.vtoxford.org/tools/2010ManualofOperationswithindex14.pdf.

  18. Tyson JE, Parikh NA, Langer J, Green C, Higgins RD . Intensive care for extreme prematurity—moving beyond gestational age. N Engl J Med 2008; 358 (16): 1672–1681.

    Article  CAS  Google Scholar 

  19. Lee HC, Green C, Hintz SR, Tyson JE, Parikh NA, Langer J et al. Prediction of death for extremely premature infants in a population-based cohort. Pediatrics 2010; 126 (3): e644–e650.

    Article  Google Scholar 

  20. Bada HS . Prevention of intracranial hemorrhage. NeoReviews 2000; 1 (3): e48–e52.

    Article  Google Scholar 

  21. Bolisetty S, Dhawan A, Abdel-Latif M, Bajuk B, Stack J, Lui K . Intraventricular hemorrhage and neurodevelopmental outcomes in extreme preterm infants. Pediatrics 2014; 133: 55–62.

    Article  Google Scholar 

  22. Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH . Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med 2007; 356 (21): 2165–2175.

    Article  CAS  Google Scholar 

  23. Watson SI, Arulampalam W, Petrou S, Marlow N, Morgan AS, Draper ES et al. The effects of designation and volume of neonatal care on mortality and morbidity outcomes of very preterm infants in England: retrospective population-based cohort study. BMJ Open 2014; 4 (7): e004856.

    Article  CAS  Google Scholar 

  24. Textbook of Neonatal Resuscitation6th edn.American Academy of Pediatrics and American Heart Association: United States of America, 2011.

Download references

Acknowledgements

The project was supported by the University of California, San Francisco’s Clinical and Translational Science Institute Resident Research Funding Program and grant number K23HD068400, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver NICHD or NIH.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S C Handley.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Handley, S., Sun, Y., Wyckoff, M. et al. Outcomes of extremely preterm infants after delivery room cardiopulmonary resuscitation in a population-based cohort. J Perinatol 35, 379–383 (2015). https://doi.org/10.1038/jp.2014.222

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2014.222

This article is cited by

Search

Quick links