Outcomes of delivery room resuscitation of bradycardic preterm infants: A retrospective cohort study of randomised trials of high vs low initial oxygen concentration and an individual patient data analysis

Kapadia, Vishal; Oei, Ju Lee; Finer, Neil N.; Rich, Wade; Rabi, Yacov; Wright, Ian; Rook, Denise; Vermeulen, Marijn J.; Tarnow‐Mordi, William; Smyth, John; Lui, Kei; Brown, Steven L.; Saugstad, Ola Didrik; Vento, Máximo

doi:10.1016/j.resuscitation.2021.08.023

Cited by 19 publications

(14 citation statements)

References 62 publications

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“…A metanalysis by Oei et al has shown that preterm neonates who do not achieve saturations of >80% by 5 min and bradycardic are at risk of IVH and death 17 . In another retrospective analysis, preterm neonates remaining bradycardic for 5 min (with HR < 60 bpm) with SpO 2 <80% were at 18 times higher risk of mortality 18 . Thus, avoiding delays in ventilation with simultaneous placental transfusion in preterm neonates may potentially lead to better outcomes.…”

Section: Discussionmentioning

confidence: 94%

Placental transfusion during neonatal resuscitation in an asphyxiated preterm model

et al. 2022

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Background: Neonatal Resuscitation Program does not recommend placental transfusion in depressed preterm neonates. Methods: Our objectives were to study the effect of delayed cord clamping (DCC) with ventilation for 5 minutes (DCCV, n-5), umbilical cord milking (UCM) without ventilation (n-6), UCM with ventilation (UCMV, n-6), early cord clamping followed by ventilation (ECCV, n-6) on red cell volume (RCV), and hemodynamic changes in asphyxiated preterm lambs. Twenty-three preterm lambs at 127–128d gestation were randomized to DCCV, UCM, UCMV, and ECCV. We defined asphyxia as heart rate < 100/minute. Results: The UCMV had the highest neonatal RCV as a percentage of fetoplacental volume compared to the other groups (UCMV 85.5±10%, UCM 72±10%, ECCV 65±14%, DCCV 61±10%, p<0.01). The DCCV led to better ventilation (66±1 mmHg) and higher pulmonary blood flow (75±24 ml/kg/min). The carotid flow was significantly higher in UCM without ventilation. The fluctuations in carotid flow with milking were 25±6% higher from baseline during UCM, compared to 6±3% in UCMV (p<0.01). Conclusion: Cord milking with ventilation led to higher RCV than other interventions. Ventilation during cord milking reduced fluctuation in carotid flow compared to UCM alone. DCCV led to better ventilation and pulmonary blood flow but did not increase RCV.

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Section: Discussionmentioning

confidence: 94%

Placental transfusion during neonatal resuscitation in an asphyxiated preterm model

et al. 2022

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“…However, they observed that the mortality and necrotizing enterocolitis was increased, and severe retinopathy of prematurity was reduced in the low-oxygen saturation-targeted infants [68]. Additionally, the risk of mortality and severe intraventricular hemorrhage is significantly increased in preterm infants if their oxygen saturation remains below 80% in the first 5 min of life [69,70]. These findings suggest the importance of avoiding hypoxia and hyperoxia, both of which can cause oxidative stress, during the neonatal period.…”

Section: Oxidative Stressmentioning

confidence: 99%

Ventilation-Induced Lung Injury (VILI) in Neonates: Evidence-Based Concepts and Lung-Protective Strategies

Thekkeveedu

El-Saie

Prakash

et al. 2022

JCM

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Supportive care with mechanical ventilation continues to be an essential strategy for managing severe neonatal respiratory failure; however, it is well known to cause and accentuate neonatal lung injury. The pathogenesis of ventilator-induced lung injury (VILI) is multifactorial and complex, resulting predominantly from interactions between ventilator-related factors and patient-related factors. Importantly, VILI is a significant risk factor for developing bronchopulmonary dysplasia (BPD), the most common chronic respiratory morbidity of preterm infants that lacks specific therapies, causes life-long morbidities, and imposes psychosocial and economic burdens. Studies of older children and adults suggest that understanding how and why VILI occurs is essential to developing strategies for mitigating VILI and its consequences. This article reviews the preclinical and clinical evidence on the pathogenesis and pathophysiology of VILI in neonates. We also highlight the evidence behind various lung-protective strategies to guide clinicians in preventing and attenuating VILI and, by extension, BPD in neonates. Further, we provide a snapshot of future directions that may help minimize neonatal VILI.

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“…The relevance of the association between Apgar score at 5 min and mortality was recently confirmed in an international neonatal network. 26 These and our findings align with reports on oxygen saturation values >80%, or heart rate >100 bpm at 5 min of postnatal age, as being significantly associated with reduced mortality in infants <32 weeks of GA. 27,28 Antenatal corticosteroid treatment has not been included in CRIB or SNAP-II, or in some previous studies assessing risk factors for mortality. 6,22,26 In crude analysis, lack of antenatal corticosteroid treatment was significantly associated with mortality, but not in OPLS-DA.…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

Perinatal risk factors for mortality in very preterm infants—A nationwide, population‐based discriminant analysis

et al. 2022

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Aim To assess the strength of associations between interrelated perinatal risk factors and mortality in very preterm infants. Methods Information on all live‐born infants delivered in Sweden at 22–31 weeks of gestational age (GA) from 2011 to 2019 was gathered from the Swedish Neonatal Quality Register, excluding infants with major malformations or not resuscitated because of anticipated poor prognosis. Twenty‐seven perinatal risk factors available at birth were exposures and in‐hospital mortality outcome. Orthogonal partial least squares discriminant analysis was applied to assess proximity between individual risk factors and mortality, and receiver operating characteristic (ROC) curves were used to estimate discriminant ability. Results In total, 638 of 8,396 (7.6%) infants died. Thirteen risk factors discriminated reduced mortality; the most important were higher Apgar scores at 5 and 10 min, GA and birthweight. Restricting the analysis to preterm infants <28 weeks’ GA (n = 2939, 16.9% mortality) added antenatal corticosteroid therapy as significantly associated with lower mortality. The area under the ROC curve (the C‐statistic) using all risk factors was 0.86, as determined after both internal and external validation. Conclusion Apgar scores, gestational age and birthweight show stronger associations with mortality in very preterm infants than several other perinatal risk factors available at birth.

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Outcomes of delivery room resuscitation of bradycardic preterm infants: A retrospective cohort study of randomised trials of high vs low initial oxygen concentration and an individual patient data analysis

Cited by 19 publications

References 62 publications

Placental transfusion during neonatal resuscitation in an asphyxiated preterm model

Placental transfusion during neonatal resuscitation in an asphyxiated preterm model

Ventilation-Induced Lung Injury (VILI) in Neonates: Evidence-Based Concepts and Lung-Protective Strategies

Perinatal risk factors for mortality in very preterm infants—A nationwide, population‐based discriminant analysis

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