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J Pediatr. 2018 Apr;195:33-38.e2. doi: 10.1016/j.jpeds.2017.11.039. Epub 2018 Jan 3.

Delivery Room Resuscitation and Short-Term Outcomes in Moderately Preterm Infants.

Collaborators (111)

Polin RA14, Keszler M15, Hensman AM15, Vieira E15, Hibbs AM16, Siner BS16, Truog WE17, Pallotto EK17, Kilbride HW17, Gauldin C17, Holmes A17, Johnson K17, Poindexter BB18, Schibler K18, Kallapur SG18, Grisby C18, Alexander B18, Fischer EE18, Jackson L18, Kirker K18, Jennings J18, Wuertz S18, Muthig G18, Cotten CM19, Goldberg RN19, Finkle J19, Fisher KA19, Laughon MM19, Bose CL19, Bernhardt J19, Clark C19, Carlton DP20, Hale EC20, Loggins Y20, Bottcher DI20, Archer SW21, Sokol G22, Herron DE22, Nelin LD23, Jadcherla SR23, Luzader P23, Parikh NA23, Nist MD23, Fuller J23, Gutentag J23, Jones ME23, McGregor S23, Rodgers E23, Ulloa JA23, Wolfe T23, Wallace D24, Zaterka-Baxter KM24, Crawford M24, Gabrio J24, Kandefer S24, O'Donnell Auman J24, Stevenson DK25, Ball MB25, Proud MS25, Ambalavanan N26, Collins MV26, Cosby SS26, Devaskar U27, Garg M27, Chanlaw T27, Geller R27, Colaizy TT28, Ellsbury DL28, Brumbaugh JE28, Johnson KJ28, Campbell DB28, Walker JR28, Watterberg KL29, Ohls RK29, Lacy CB29, Beauman SS29, Hartenberger C29, Schmidt B30, Kirpalani H30, DeMauro SB30, Cook N30, Chaudhary AS30, Abbasi S30, Mancini T30, Cucinotta D30, Lakshminrusimha S31, Guillet R31, Scorsone AM31, Hunn J31, Jensen R31, Wadkins HIM31, Guilford S31, Williams A31, Brion LP32, Vasil DM32, Chen L32, Torres LE32, Kennedy KA33, Tyson JE33, Arldt-McAlister J33, Garcia C33, Martin K33, McDavid GE33, Wright SL33, Pappas A34, Barks J34, Bara R34, Handel S34, White DF34, Christensen M34, Wiggins SA34.

Author information

1
Department of Pediatrics, Wayne State University, Detroit, MI. Electronic address: mbajaj@dmc.org.
2
Department of Pediatrics, Wayne State University, Detroit, MI.
3
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
4
Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, RI.
5
Department of Pediatrics, University of Iowa, Iowa City, IA.
6
Department of Pediatrics, University of Texas Health Science Center, Houston, TX.
7
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
8
Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD.
9
Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA.
10
Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
11
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
12
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
13
Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH.
14
Division of Neonatology, College of Physicians and Surgeons, Columbia University.
15
Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island.
16
Case Western Reserve University, Rainbow Babies and Children's Hospital.
17
Children's Mercy Hospital.
18
Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, and Good Samaritan Hospital.
19
Duke University School of Medicine, University Hospital, University of North Carolina, and Duke Regional Hospital.
20
Emory University, Children's Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown.
21
Eunice Kennedy Shriver National Institute of Child Health and Human Development.
22
Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children at Indiana University Health, and Eskenazi Health.
23
Nationwide Children's Hospital and the Ohio State University Medical Center.
24
RTI International.
25
Stanford University and Lucile Packard Children's Hospital.
26
University of Alabama at Birmingham Health System and Children's Hospital of Alabama.
27
University of California - Los Angeles, Mattel Children's Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, and Olive View Medical Center.
28
University of Iowa and Mercy Medical Center.
29
University of New Mexico Health Sciences Center.
30
University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Children's Hospital of Philadelphia.
31
University of Rochester Medical Center, Golisano Children's Hospital, and the University of Buffalo Women's and Children's Hospital of Buffalo.
32
University of Texas Southwestern Medical Center at Dallas, Parkland Health and Hospital System, and Children's Medical Center Dallas.
33
University of Texas Health Science Center at Houston Medical School and Children's Memorial Hermann Hospital.
34
Wayne State University, University of Michigan, Hutzel Women's Hospital, and Children's Hospital of Michigan.

Abstract

OBJECTIVES:

To describe the frequency and extent of delivery room resuscitation and evaluate the association of delivery room resuscitation with neonatal outcomes in moderately preterm (MPT) infants.

STUDY DESIGN:

This was an observational cohort study of MPT infants delivered at 290/7 to 336/7 weeks' gestational age (GA) enrolled in the Neonatal Research Network MPT registry. Infants were categorized into 5 groups based on the highest level of delivery room intervention: routine care, oxygen and/or continuous positive airway pressure, bag and mask ventilation, endotracheal intubation, and cardiopulmonary resuscitation including chest compressions and/or epinephrine use. The association of antepartum and intrapartum risk factors and discharge outcomes with the intensity of resuscitation was evaluated.

RESULTS:

Of 7014 included infants, 1684 (24.0%) received routine care and no additional resuscitation, 2279 (32.5%) received oxygen or continuous positive airway pressure, 1831 (26.1%) received bag and mask ventilation, 1034 (14.7%) underwent endotracheal intubation, and 186 (2.7%) received cardiopulmonary resuscitation. Among the antepartum and intrapartum factors, increasing GA, any exposure to antenatal steroids and prolonged rupture of membranes decreased the likelihood of receipt of all levels of resuscitation. Infants who were small for GA (SGA) had increased risk of delivery room resuscitation. Among the neonatal outcomes, respiratory support at 28 days, days to full oral feeds and length of stay were significantly associated with the intensity of delivery room resuscitation. Higher intensity of resuscitation was associated with increased risk of mortality.

CONCLUSIONS:

The majority of MPT infants receive some level of delivery room resuscitation. Increased intensity of delivery room interventions was associated with prolonged respiratory and nutritional support, increased mortality, and a longer length of stay.

KEYWORDS:

CPR; delivery room; endotracheal intubation; moderate Preterm; oxygen; resuscitation

PMID:
29306493
PMCID:
PMC5869086
[Available on 2019-04-01]
DOI:
10.1016/j.jpeds.2017.11.039

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