Introduction: Neonatal literature asserts that in the ELBW infant survival following an episode of cardiopulmonary resuscitation (CPR) is very low and is more likely after an acute precipitating event. We assessed the validity of this assertion in the ELBW population of the 1990's post Surfactant era.

Methods: We retrospectively reviewed the records of all infants≤ 750 g birthweight admitted to our level III NICU between 1/1/1990 and 31/12/1994 who received intensive care. CPR was defined as the requirement for chest compressions and bolus dose epinephrine (EPI). Precipitating events(PE's) were described as acute when a clear precipitating event was documented in the record, all other events were non-acute.

Results: 91 infants of ≤750 g birthweight who received intensive care were identified during the study period. A total of 16 PE's leading to CPR were identified in 15 infants (2 PE's having occurred in one infant). None of the 15 infants who had an episode of CPR survived to discharge Six infants died at the time of CPR, 8 infants had later withdrawal of intensive support and 1 infant had a no code ascribed. Overall survival to discharge in infants ≤750 g birthweight during the study period was 35/91(38.5%).

Conclusions: Despite advances in neonatal intensive care the outcome for infants ≤750 g birthweight following an episode of CPR of either acute or non-acute etiology remains extremely poor. These results question the current clinical practice of routine CPR for ELBW infants by suggesting it may be futile. Table

Table 1
Full size table