Aggressive resuscitation at delivery does not adversely affect long-term outcome

For very-low-birth-weight (VLBW) infants who receive intense resuscitation at delivery, long-term prognosis for neurodevelopmental disability remains low despite elevated risk for bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), according to a new study.

Researchers evaluated a cohort of 2,006 multinational infants with birth weights of 500 g to 1,250 g from the Caffeine for Apnea of Prematurity (CAP) Trial and collected baseline data at a median age of 3 days of life for level of delivery-room resuscitation and again at a corrected age of 18 months for primary outcome of death or neurodevelopmental disability.

Infants were divided into 4 groups: minimal resuscitation (oxygen and continuous positive airway pressure); bag-mask ventilation with oxygen; endotracheal intubation; and cardiopulmonary resuscitation (CPR) with chest compression and adrenaline/epinephrine. Analysis was adjusted for multiple gestation, sex, antenatal steroid exposure, gestational age, maternal education, and use of caffeine for apnea of prematurity (shown in the CAP Trial to improve neurodevelopmental outcomes).

Disability was defined as presence at 18 months of cerebral palsy, cognitive delay, hearing loss requiring amplification, and bilateral blindness. Absence of the primary outcome was documented when the infant was confirmed to have survived without any disabilities present.

Among the study participants, 343 infants (17%) received minimal resuscitation; 372 (19%) received bag-mask ventilation; and 1,205 were intubated (60%). Of 86 infants (4%) who received CPR at delivery, 53 (62%) received only chest compression, 8 (I9%) received only epinephrine or adrenaline, and 25 (29%) received both interventions.

Data for primary outcome at age 18 months showed that 808 infants (43.2%) died or survived with at least 1 disability, with rate of death or disability increasing with the level of resuscitation (PP=.13). Similarly, rates of BPD and severe ROP increased significantly with higher levels of resuscitation (P

The researchers note that contrary to their hypothesis, most CAP Trial participants who survived to the corrected age of 18 months after receiving more intense levels of resuscitation at delivery were free of neurodevelopmental disability. However, they stress that the increased risk of important morbidities such as BPD and severe ROP remained. “Although intensive resuscitation may confer some additional risk, it does not guarantee a poor long-term outcome,” they conclude.

Demauro SB, Roberts RD, Davis P, et al. Impact of delivery room resuscitation on outcomes up to 18 months in very low birth weight infants. J Pediatr. 2011. Epub ahead of print.