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Resuscitation. 2019 Feb;135:57-65. doi: 10.1016/j.resuscitation.2019.01.003. Epub 2019 Jan 7.

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

Author information

1
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. Electronic address: nfischer@hollandbloorview.ca.
2
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada. Electronic address: amuchou.soraisham@ahs.ca.
3
Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
4
B.C. Women's Hospital and Health Centre, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: asynnes@cw.bc.ca.
5
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada. Electronic address: jack.rabi@ahs.ca.
6
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada. Electronic address: Nalini.Singhal@albertahealthservices.ca.
7
B.C. Women's Hospital and Health Centre, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: Jting2-02@cw.bc.ca.
8
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada. Electronic address: diter@telusplanet.net.
9
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada. Electronic address: dmdewey@ucalgary.ca.
10
Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: MBallantyne@hollandbloorview.ca.
11
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Electronic address: aklodha@ucalgary.ca.

Abstract

OBJECTIVE:

To compare mortality and neurodevelopmental outcomes of extremely low gestational age neonates who received delivery room extensive cardiopulmonary resuscitation (DR-CPR) to those who did not require DR-CPR.

METHODS:

Preterm neonates born at <29 weeks' gestational age between January 2010 and September 2011 and assessed at Canadian Neonatal Follow-Up Network centers were studied. Neonates who received DR-CPR were compared to those who did not require DR-CPR using univariate and multivariable analyses. The primary outcome was a composite of mortality or any neurodevelopmental impairment at 18 to 24 months corrected age defined as the presence of any one or more of the following: cerebral palsy; Bayley-III cognitive, language, or motor composite scores <85 on any one of the components; sensorineural/mixed hearing loss or unilateral or bilateral visual impairment. Secondary outcomes were the individual components of the composite outcomes.

RESULTS:

Of the 2760 neonates born, 173 were excluded and remaining 2587 eligible neonates were included in our study. Of these 2068 had outcome data (80%) of whom 190 (9.2%) received DR-CPR. DR-CPR was independently associated with mortality or neurodevelopmental impairment (adjusted odds ratio [aOR] 1.76; 95% CI 1.21-2.55) and mortality alone (aOR1.94; 95% CI 1.33-2.83). DR-CPR was also associated with increased odds of motor impairment (aOR 2.03; 95% CI 1.28-3.23).

CONCLUSION:

In extremely low gestational age neonates, DR-CPR was associated with higher odds of the composite outcome of mortality or neurodevelopmental impairment, mortality alone, and lower motor scores at 18 to 24 months' corrected age.

KEYWORDS:

Delivery room; Developmental outcomes; Neonatal resuscitation; Neonates; Preterm infant

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