Extensive cardiopulmonary resuscitation of preterm neonates at birth and mortality and developmental outcomes

Fischer, Nicole; Soraisham, Amuchou; Shah, Prakesh S.; Synnes, Anne; Rabi, Yacov; Singhal, Nalini; Creighton, Dianne; Dewey, Deborah; Ballantyne, Marilyn; Lodha, Abhay; Kanungo, Jaideep; Ting, Joseph; Yee, Wendy; Toye, Jennifer; Fajardo, Carlos; Kalapesi, Zarin; Sankaran, Koravangattu; Daspal, Sibasis; Seshia, Mary; Alvaro, Ruben; Mukerji, Amit; Silva, Orlando da; Nwaesei, Chuks; Lee, Kyong-Soon; Dunn, Michael; Lemyre, Brigitte; Dow, Kimberly; Pelausa, Ermelinda; Lapoint, Anie; Drolet, Christine; Piedboeuf, Bruno; Claveau, Martine; Beltempo, Marc; Bertelle, Valérie; Massé, Édith; Canning, Roderick; Makary, Hala; Ojah, Cecil; Monterrosa, Luis; Emberley, Julie; Afifi, Jehier; Kajetanowicz, Andrzej; Lee, Shoo K.; Pillay, Thevanisha; Sauvé, Reg; Hendson, Leonora; Reichert, Amber; Bodani, Jaya; Moddemann, Diane; Daboval, Thierry; Lee, David; Coughlin, Kevin; Ly, Linh; Kelly, Edmond; Saigal, Saroj; Church, Paige; Riley, Patricia; Luu, Thuy Mai; Lefebvre, Françine; Demers, Charlotte; Bélanger, Sylvie; Vincer, Michael; Murphy, Phil

doi:10.1016/j.resuscitation.2019.01.003

Cited by 18 publications

(24 citation statements)

References 24 publications

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“…A recent study from the Canadian Neonatal Network reported on the outcome of 2068 extremely preterm infants, of whom 190 received DR-CPR. That study found that those infants who received DR-CPR had a higher risk of mortality and, if they survived, of neurodevelopmental impairment 5…”

Section: Evidencementioning

confidence: 93%

“…Second, publications since the 1990s have challenged the notion that it is futile to provide DR-CPR to extremely preterm infants. Sixty per cent of extremely low birthweight infants who received DR-CPR in the Canadian cohort survived, and 78% of survivors were not severely impaired 5…”

Section: Argumentmentioning

confidence: 94%

“…It is hardly surprising that as a group they have worse outcomes. In the Canadian cohort, infants who received DR-CPR were smaller, more likely to be outborn and less likely to have received antenatal steroids 5. The authors performed a multivariate analysis to account for such risk factors, but residual confounding is likely.…”

Section: Argumentmentioning

confidence: 99%

See 2 more Smart Citations

Recommendations in the face of uncertainty: should extremely preterm infants receive chest compressions and/or epinephrine in the delivery room?

Wilkinson

Marlow

Hayden

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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Section: Evidencementioning

confidence: 93%

Section: Argumentmentioning

confidence: 94%

See 1 more Smart Citation

Recommendations in the face of uncertainty: should extremely preterm infants receive chest compressions and/or epinephrine in the delivery room?

Wilkinson

Marlow

Hayden

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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“…However, approximately 10-20% of newborns (13-26 million worldwide) need some degree of respiratory support at birth [2][3][4], which remains the most critical step of neonatal resuscitation. Furthermore, an estimated 0.1% of term infants and up to 15% of preterm infants (2-3 million worldwide) requires extensive cardiopulmonary resuscitation (CPR) at birth, which entails chest compressions (CC) and 100% oxygen with or without administration of epinephrine [5][6][7][8][9]. Despite receiving CPR, approximately 1 million newborns die annually worldwide.…”

Section: Introductionmentioning

confidence: 99%

“…Even with successful resuscitation, infants receiving extensive CPR in the delivery room have a high incidence of mortality (40-80%) and neurologic morbidity (e.g. 57% hypoxic-ischemic encephalopathy and seizures) [5,6,9]. Therefore, resuscitation techniques require further refinement to provide better outcomes.…”

Section: Introductionmentioning

confidence: 99%

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

O’Reilly¹,

Cheung²,

Lee³

et al. 2020

Animal Models in Medicine and Biology

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Two to three million newborn infants worldwide need extensive cardiopulmonary resuscitation (CPR), and approximately one million of these infants die annually worldwide. Therefore, resuscitation techniques require further refinement to provide better outcomes. To investigate the effectiveness of various interventions and to understand the pathophysiology and pharmacology of neonatal CPR, it is important to have animal models that reliably reproduce features observed in neonates who require resuscitation. Herein, we describe an experimental animal model in newborn piglets that simulates neonatal asphyxia and enables us to examine resuscitation interventions, reoxygenation, and recovery processes. The newborn piglet has several advantages including similar development to a human fetus at 36-38 week's gestation, and comparable body systems and body size, allowing for surgical instrumentation, monitoring, and collection of biological samples. Furthermore, using this model of neonatal asphyxia, we are also able to describe an increasingly important clinical situation in the laboratory setting-pulseless electrical activity (PEA). Since the integration of electrocardiogram into the neonatal resuscitation guidelines, there has been an increased awareness of PEA in newborn infants. The animal model we describe can therefore serve as a valuable tool to bridge the knowledge gap and improve the outcome of asphyxiated newborns in the delivery room.

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Delivery room resuscitation intensity and associated neonatal outcomes of 24+0–31+6 weeks’ preterm infants in China: a retrospective cross-sectional study

Wang

Chen

et al. 2023

World J Pediatr

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Background The aim of this study was to review current delivery room (DR) resuscitation intensity in Chinese tertiary neonatal intensive care units and to investigate the association between DR resuscitation intensity and short-term outcomes in preterm infants born at 24+0–31+6 weeks’ gestation age (GA). Methods This was a retrospective cross-sectional study. The source population was infants born at 24+0–31+6 weeks’ GA who were enrolled in the Chinese Neonatal Network 2019 cohort. Eligible infants were categorized into five groups: (1) regular care; (2) oxygen supplementation and/or continuous positive airway pressure (O2/CPAP); (3) mask ventilation; (4) endotracheal intubation; and (5) cardiopulmonary resuscitation (CPR). The association between DR resuscitation and short-term outcomes was evaluated by inverse propensity score-weighted logistic regression. Results Of 7939 infants included in this cohort, 2419 (30.5%) received regular care, 1994 (25.1%) received O2/CPAP, 1436 (18.1%) received mask ventilation, 1769 (22.3%) received endotracheal intubation, and 321 (4.0%) received CPR in the DR. Advanced maternal age and maternal hypertension correlated with a higher need for resuscitation, and antenatal steroid use tended to be associated with a lower need for resuscitation (P < 0.001). Severe brain impairment increased significantly with increasing amounts of resuscitation in DR after adjusting for perinatal factors. Resuscitation strategies vary widely between centers, with over 50% of preterm infants in eight centers requiring higher intensity resuscitation. Conclusions Increased intensity of DR interventions was associated with increased mortality and morbidities in very preterm infants in China. There is wide variation in resuscitative approaches across delivery centers, and ongoing quality improvement to standardize resuscitation practices is needed.

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Extensive cardiopulmonary resuscitation of preterm neonates at birth and mortality and developmental outcomes

Cited by 18 publications

References 24 publications

Recommendations in the face of uncertainty: should extremely preterm infants receive chest compressions and/or epinephrine in the delivery room?

Recommendations in the face of uncertainty: should extremely preterm infants receive chest compressions and/or epinephrine in the delivery room?

A Porcine Model of Neonatal Hypoxia-Asphyxia to Study Resuscitation Techniques in Newborn Infants

Delivery room resuscitation intensity and associated neonatal outcomes of 24+0–31+6 weeks’ preterm infants in China: a retrospective cross-sectional study

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