Outcome of very-low-birth-weight infants who received epinephrine in the delivery room

Frontanes, Abymael; García-Fragoso, Lourdes; García, Inés; Rivera, Jorge Isaac Ramírez; Valcárcel, Marta

doi:10.1016/j.resuscitation.2010.11.020

Cited by 16 publications

(12 citation statements)

References 17 publications

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“…In preterm infants due to lack of good evidence for use of epinephrine and its adverse effects of epinephrine especially postresuscitation hypertension, outcome data become even more important. Multiple retrospective observational studies have noted that preterm neonates requiring CPR and epinephrine have significantly lower survival, higher incidence of early onset sepsis, NEC, grade 3–4 intraventricular hemorrhage, cystic periventricular leukomalacia, bronchopulmonary dysplasia, and neurodevelopmental impairment (7, 74–76). These studies frequently suffer from small numbers and selection bias as the most compromised and sicker preterm neonates may require CPR but all studies point toward worse outcomes associated with extensive delivery room CPR.…”

Section: Outcomes In Newborns Who Require Epinephrine In the Deliverymentioning

confidence: 99%

Epinephrine Use during Newborn Resuscitation

Kapadia

Wyckoff

2017

Front. Pediatr.

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Epinephrine use in the delivery room for resuscitation of the newborn is associated with significant morbidity and mortality. Evidence for optimal dose, timing, and route of administration of epinephrine during neonatal resuscitation comes largely from extrapolated adult or animal literature. In this review, we provide the current recommendations for use of epinephrine during neonatal resuscitation and also the evidence behind these recommendations. In addition, we review the current proposed mechanism of action of epinephrine during neonatal resuscitation, review its adverse effects, and identify gaps in knowledge requiring urgent research.

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Section: Outcomes In Newborns Who Require Epinephrine In the Deliverymentioning

confidence: 99%

Epinephrine Use during Newborn Resuscitation

Kapadia

Wyckoff

2017

Front. Pediatr.

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“…The focus of CC research has been on systemic and coronary hemodynamics with the primary endpoint often being ROSC. Even though neurological adverse effects of epinephrine in preterm infants have been described (43, 44), less attention has been given to the effects of CC alone on cerebral circulation in asphyxiated term infants.…”

Section: Discussionmentioning

confidence: 99%

Optimal Chest Compression Rate and Compression to Ventilation Ratio in Delivery Room Resuscitation: Evidence from Newborn Piglets and Neonatal Manikins

Solevåg

Schmölzer

2017

Front. Pediatr.

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Cardiopulmonary resuscitation (CPR) duration until return of spontaneous circulation (ROSC) influences survival and neurologic outcomes after delivery room (DR) CPR. High quality chest compressions (CC) improve cerebral and myocardial perfusion. Improved myocardial perfusion increases the likelihood of a faster ROSC. Thus, optimizing CC quality may improve outcomes both by preserving cerebral blood flow during CPR and by reducing the recovery time. CC quality is determined by rate, CC to ventilation (C:V) ratio, and applied force, which are influenced by the CC provider. Thus, provider performance should be taken into account. Neonatal resuscitation guidelines recommend a 3:1 C:V ratio. CCs should be delivered at a rate of 90/min synchronized with ventilations at a rate of 30/min to achieve a total of 120 events/min. Despite a lack of scientific evidence supporting this, the investigation of alternative CC interventions in human neonates is ethically challenging. Also, the infrequent occurrence of extensive CPR measures in the DR make randomized controlled trials difficult to perform. Thus, many biomechanical aspects of CC have been investigated in animal and manikin models. Despite mathematical and physiological rationales that higher rates and uninterrupted CC improve CPR hemodynamics, studies indicate that provider fatigue is more pronounced when CC are performed continuously compared to when a pause is inserted after every third CC as currently recommended. A higher rate (e.g., 120/min) is also more fatiguing, which affects CC quality. In post-transitional piglets with asphyxia-induced cardiac arrest, there was no benefit of performing continuous CC at a rate of 90/min. Not only rate but duty cycle, i.e., the duration of CC/total cycle time, is a known determinant of CC effectiveness. However, duty cycle cannot be controlled with manual CC. Mechanical/automated CC in neonatal CPR has not been explored, and feedback systems are under-investigated in this population. Evidence indicates that providers perform CC at rates both higher and lower than recommended. Video recording of DR CRP has been increasingly applied and observational studies of what is actually done in relation to outcomes could be useful. Different CC rates and ratios should also be investigated under controlled experimental conditions in animals during perinatal transition.

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“…However, large cohort studies have shown that extensive DR CPR is associated with intraventricular haemorrhage grades 3-4 in extremely preterm infants [1,2,71] potentially caused by blood pressure fluctuations aggravated by adrenaline administration [72]. Also, there is a theoretical possibility that adrenaline, through its vasoconstrictive effects, may cause major organ injury including renal failure and NEC in vulnerable individuals [73,74].…”

Section: Areas Of Controversymentioning

confidence: 99%

“…Frontanes et al [71] compared the outcomes of 80 very low birth weight infants (i.e. <1,500 g) who required extensive DR CPR to 221 GA- and birth weight-matched infants without CPR.…”

Section: Areas Of Controversymentioning

confidence: 99%

“…<1,500 g) who required extensive DR CPR to 221 GA- and birth weight-matched infants without CPR. Not surprisingly, infants receiving CPR interventions had significantly lower survival (26 vs. 43%, p < 0.01) and survival without brain injury (17 vs. 32%, p = 0.011), as well as higher rates of respiratory distress syndrome (p < 0.01) and NEC (20 vs. 9%, p = 0.018) [71]. …”

Section: Areas Of Controversymentioning

confidence: 99%

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Evidence on Adrenaline Use in Resuscitation and Its Relevance to Newborn Infants: A Non-Systematic Review

et al. 2016

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Aim: Guidelines for newborn resuscitation state that if the heart rate does not increase despite adequate ventilation and chest compressions, adrenaline administration should be considered. However, controversy exists around the safety and effectiveness of adrenaline in newborn resuscitation. The aim of this review was to summarise a selection of the current knowledge about adrenaline during resuscitation and evaluate its relevance to newborn infants. Methods: A search in PubMed, Embase, and Google Scholar until September 1, 2015, using search terms including adrenaline/epinephrine, cardiopulmonary resuscitation, death, severe brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and adrenaline versus vasopressin/placebo. Results: Adult data indicate that adrenaline improves the return of spontaneous circulation (ROSC) but not survival to hospital discharge. Newborn animal studies reported that adrenaline might be needed to achieve ROSC. Intravenous administration (10-30 μg/kg) is recommended; however, if there is no intravenous access, a higher endotracheal dose (50-100 μg/kg) is needed. The safety and effectiveness of intraosseous adrenaline remain undetermined. Early and frequent dosing does not seem to be beneficial. In fact, negative hemodynamic effects have been observed, especially with doses ≥30 μg/kg intravenously. Little is known about adrenaline in birth asphyxia and in preterm infants, but observations indicate that hemodynamics and neurological outcomes may be impaired by adrenaline administration in these conditions. However, a causal relationship between adrenaline administration and outcomes cannot be established from the few available retrospective studies. Alternative vasoconstrictors have been investigated, but the evidence is scarce. Conclusion: More research is needed on the benefits and risks of adrenaline in asphyxia-induced bradycardia or cardiac arrest during perinatal transition.

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Outcome of very-low-birth-weight infants who received epinephrine in the delivery room

Cited by 16 publications

References 17 publications

Epinephrine Use during Newborn Resuscitation

Epinephrine Use during Newborn Resuscitation

Optimal Chest Compression Rate and Compression to Ventilation Ratio in Delivery Room Resuscitation: Evidence from Newborn Piglets and Neonatal Manikins

Evidence on Adrenaline Use in Resuscitation and Its Relevance to Newborn Infants: A Non-Systematic Review

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