116 Outcome at the Limit of Viability. Do guidelines work?

Abstract

To report the mortality, morbidity, and long term outcome of VLBW infants born at the limit of viability before and after implementing local resuscitation Guidelines. The Guidelines restrict aggressive resuscitation (Chest compressions and Epinephrine) of infants with birth weight <750 gm. Retrospective chart review of all infants born between 22–25 weeks gestation and infants with BW <750 gm from Jan 1998 to Dec 2003. The neonatal mortality, neonatal morbidity (IVH, PVL, BPD, and ROP) and outcome at 2 years of corrected age of survivors is reported prior and after implementing unit Resuscitation Guidelines. A total of 180 infants were studied. 93/180 (51.7%) survived until discharge. Survival improved with increasing gestational age. 20/180 (11.1%) infants were <500 gm birth weight. 2/20 (10%) survived until discharge. 157/180 (87.2%) infants were 501–750 gm birth weight. 91/160 (56.8%) survived until discharge. Use of chest compressions had no effect on short-term survival, but shifted deaths from the delivery room to NICU. Mortality was 8/12 (66.6%) in infants who received chest compressions + epinephrine. Use of chest compressions was less as compared to the period from 1994–1997, 6.6% vs 14%. Infants weighing <750 grams at birth who do not respond to intubation and ventilation should then receive comfort measures. Compressions should only be given under research study conditions, or if fully informed consent has been given by the parents, because of the high morbidity and mortality rates.