Delivery Room Resuscitation at the Limits of Viability and Short and Long Term Outcomes

This submission has open access
Submission ID :
ESPR406
Submission Type
Submission Topic
Abstract: :

Background: Infants born at the limits of viability (LoV:23+0/7-25+6/7 weeks gestation) have lower survival rates, and their potential for intact survival at the time of birth is unknown.  For these reasons, the prevalence of delivery room cardiopulmonary resuscitation (DR-CPR) in neonates born at the LoV varies between countries, states and institutions.   A clearer understanding at the time of delivery for survival and intact survival potential would be useful for decisions made in the delivery room (DR) regarding resuscitation 

Objectives: To assess the association of escalation of DR-CPR with mortality and morbidity in neonates born at the LoV. 

Methods: Retrospective cohort study of infants born at the LoV in a single center between the years of 2011 and 2018. Charts were reviewed to document the following levels of DR-CPR: 1) respiratory support only, 2) chest compressions, 3) epinephrine administration. Outcomes observed included: survival to discharge (D/C), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), Patent ductus arteriosus (PDA) requiring treatment, high grade intraventricular hemorrhage (IVH: grade 3 or 4), hydrocephalus, periventricular leukomalacia (PVL), sepsis. Maximal type of DR-CPR was compared to outcomes via chi square analysis for categorical variables, and t-test for continuous variables. P<0.05 was statistically significant. 

Results: Data collection and analysis is ongoing.  DR-CPR and associated outcomes is reported for 169 of 424 infants. As DR-CPR escalated, there was a significant increase in mortality (table 1), with the median time to death of 3 days (IQR: 1, 8). Level of DR-CPR was not associated with any fetal or antenatal conditions investigated (table 2). Among those who survived past 1 day of life, as DR-CPR escalated, so did high grade IVH (table 3).

Conclusions: Escalation of  DR-CPR is associated with increased mortality. Among those who survive past 24 hours of life, as DR-CPR escalates, so does the incidence of high grade  IVH. These findings, can assist in an informed discussion with parents when considering potential survival prognosis and outcomes based on DR presentation and infant response to treatment.

Optional insertion of tables and or figures :
If the file does not load, click here to open/download the file.
If the file does not load, click here to open/download the file.
The Regional Neonatal ICU Maria Fareri Children’s Hospital at Westchester Medical Center-NYMC Valhalla, NY, White Plains, NY, US
Maria Fareri Children's Hospital

Similar Abstracts by Type

Submission ID
Submission Title
Submission Topic
Submission Type
Corresponding Author
ESPR157
Clinical Research
Original science
Aditya Chhikara
ESPR302
Epidemiology
Original science
Natasha Jouk
ESPR74
Clinical Research
Original science
Alexandra Mazo
27 hits