Background Delivery room cardiopulmonary resuscitation (DR-CPR) is used in VLBW infants, but its impact on long-term outcome has not been studied or accounted for in follow up studies.
Objective To identify if DR-CPR in infants < 1251 g is a risk factor for poor neurodevelopmental outcome.
Methods Live-born infants < 1251 g who survived to discharge between 1999 and 2002 at two Emory University perinatal centers (Grady Memorial Hospital and Emory Crawford Long Hospital) were included in the study; DR-CPR was defined as chest compressions and/or epinephrine use in the DR; infants were followed by neurologic examinations and tested using the Bayley Scales of Infant Development at 18 months corrected age (CA). Chi square and Student t-test were used as appropriate to compare DR-CPR and no-CPR groups; multivariate analysis was done to control for significant differences. Statistical difference was if p < .05.
Results A total of 253 inborn infants survived; 28 (11%) received DR-CPR, 14 of them (50%) were evaluated at 18 months of age (19.4 ± 1.9) CA. Of the 225 infants that did not receive DR-CPR, 82 (36.4%) had an evaluation at 18 months of age (19.3 ± 2.1) CA. The mean gestational age and birth weight were not significant between the DR-CPR and no-CPR groups (26.9 ± 2.7 weeks vs. 26.7 ± 1.9 weeks [p = .79]; 808 ± 156 vs. 886 ± 189 g [p = .15]). Infants who were lost to follow-up did not differ from these two groups in demographic variables or clinical indicators of illness severity. The Bayley Mental Developmental Index (MDI) scores were different in the groups (DR-CPR: 69.1 ± 14.0 vs 80.6. ± 18.8 in no-CPR; p = .038). Psychomotor development (PDI) was also different (74.2 ± 20.8 vs 84.3 ± 15.9 respectively; p = .049). The proportion of infants with MDI ≤ 70 in DR-CPR was 53.8% vs. 21.3% (p = .021); for PDI ≤ 70 it was 38.5% vs 13.5% (p = .043).
Conclusion These findings indicate that the need for DR-CPR markedly increases the risk for poor neuromotor and cognitive delay at 18 months CA in surviving infants < 1251 g. This needs to be informed to parents and accounted for in long-term outcome data analysis.