Impact of delivery room resuscitation on outcomes up to 18 months in very low birth weight infants.

Abstract

OBJECTIVE:

To examine the relationships between intensity of delivery room resuscitation and short- and long-term outcomes of very low birth weight infants enrolled in the Caffeine for Apnea of Prematurity (CAP) Trial.

STUDY DESIGN:

The CAP Trial enrolled 2006 infants with birthweights between 500 and 1250 g who were eligible for caffeine therapy. All levels of delivery room resuscitation were recorded in study participants. We divided infants in 4 groups of increasing intensity of resuscitation: minimal, n = 343; bag-mask ventilation, n = 372; endotracheal intubation, n = 1205; and cardiopulmonary resuscitation (chest compressions/epinephrine), n = 86. We used multivariable logistic regression models to compare outcomes across the 4 groups.

RESULTS:

The observed rates of death or disability, death, cerebral palsy, cognitive deficit, and hearing loss at 18 months increased with higher levels of resuscitation. Risk of bronchopulmonary dysplasia, severe retinopathy of prematurity, and brain injury also increased with higher levels of resuscitation. Adjustment for prognostic variables reduced the differences between the groups for most outcomes. Only the adjusted rates of bronchopulmonary dysplasia and severe retinopathy remained significantly higher after more intense resuscitation.

CONCLUSIONS:

In CAP Trial participants, the risk of death or neurodevelopmental disability at 18 months did not increase substantially with increasing intensity of delivery room resuscitation.

• Authors: Sara B DeMauro, Robin S Roberts, Peter Davis, Ruben Alvaro, Aida Bairam, Barbara Schmidt, Caffeine for Apnea of Prematurity Trial Investigators
• Journal: The Journal of pediatrics (J Pediatr) Vol. 159 Issue 4 Pg. 546-50.e1 (Oct 2011) ISSN: 1097-6833 [Electronic] United States
• PMID: 21592510 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 Mosby, Inc. All rights reserved.

Topics

• Brain Injuries (epidemiology)
• Bronchopulmonary Dysplasia (epidemiology)
• Cardiopulmonary Resuscitation (adverse effects)
• Cerebral Palsy (epidemiology)
• Delivery Rooms
• Developmental Disabilities (epidemiology)
• Enterocolitis, Necrotizing (epidemiology)
• Female
• Hearing Loss (epidemiology)
• Humans
• Infant Mortality
• Infant, Newborn
• Infant, Premature
• Infant, Very Low Birth Weight
• Intubation, Intratracheal (adverse effects)
• Male
• Masks
• Multivariate Analysis
• Respiration, Artificial (adverse effects)
• Retinopathy of Prematurity (epidemiology)