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325 POOR LONG-TERM NEUROMOTOR AND COGNITIVE DELAY IN INFANTS < 1251 GRAMS IS ASSOCIATED WITH DELIVERY ROOM CARDIOPULMONARY RESUSCITATION
  1. R. Deulofeut,
  2. A. Sola,
  3. I. Adams,
  4. M. Larossa,
  5. S. Carter,
  6. L. Black,
  7. M. Rogido
  1. Emory University, Atlanta

Abstract

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.

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