Abstract
BackgroundAdvanced levels of delivery room resuscitation in very low birth weight infants are reported to be associated with death and complications of prematurity. In resource limited settings, the need for delivery room resuscitation is often used as a reason to limit care in these infants.MethodsThis was a review of delivery room resuscitation in very low birth weight infants born in a tertiary hospital in South Africa between 01 January 2013 and 30 June 2016. Outcomes included death and serious complications of prematurity. Advanced delivery room resuscitation was defined as the need for intubation, chest compressions or the administration of adrenaline.ResultsA total of 1511 very low birth weight infants were included in the study. The majority (1332/1511 (88.2%) required oxygen in the delivery room. Face mask ventilation was needed in 45.2% (683/1511). Advanced delivery room resuscitation was only required in 10.6% (160/1511). More than half the infants who required advanced delivery room resuscitation died (89/160; 55.6%). Advanced delivery room resuscitation was required in significantly more infants <1000 grams at birth than those infants >1000 grams (83/539 (15.4%) vs 77/972 (7.9%) p < 0.001). Advanced delivery room resuscitation was significantly associated with a 5 minute Apgar score < 6 (OR 13.8 (95%CI 8.6–22.0), supplemental oxygen at day 28 (OR 2.2 (95% CI 1.4–3.9), metabolic acidosis (OR 2.3 (95% CI 1.1–4.8) and death (OR 1.9 95% CI 1.1–3.3). Other serious complications of prematurity were not associated with advanced delivery room resuscitation. Mortality was increased in infants with a low admission temperature (35.1 °C (SD 0.92) vs 36.1 °C (SD 1.4) (p < 0.001).ConclusionThere was a high mortality rate associated with advanced delivery room resuscitation; however complications of prematurity were not increased in survivors..The need for advanced delivery room resuscitation alone should not be used as a predictor of poor outcome in very low birth weight infants. Survivors of advanced delivery room resuscitation should be afforded ventilatory support if required. Special care must be taken to avoid hypothermia in very low birth weight infants requiring resuscitation at birth.
Highlights
Advanced levels of delivery room resuscitation in very low birth weight infants are reported to be associated with death and complications of prematurity
The present study showed that mortality increased with advancing levels of delivery room resuscitation in Very low birthweight infants (VLBWI)
Major complications of prematurity were not increased in those VLBWI who survived Advanced delivery room resuscitation (ADRR)
Summary
Advanced levels of delivery room resuscitation in very low birth weight infants are reported to be associated with death and complications of prematurity. In a review in South Africa in 2007, one third of neonatal deaths were due to asphyxia – hypoxia [1]. Perinatal asphyxia may result in neonatal encephalopathy, with possible long term neurological sequelae such as tetraplegic cerebral palsy [2]. Therapeutic hypothermia has been shown to reduce rates of both mortality and long term handicap in term infants with moderate to severe hypoxic ischaemic encephalopathy [4]. Advanced delivery room resuscitation (ADRR), defined as chest compressions, intubation or the administration of adrenaline, is significantly more likely in infants of low birth weight and gestational age [6,7,8,9,10]. Serious complications of prematurity, including severe intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP), respiratory distress syndrome (RDS), pneumothorax, late onset sepsis (LOS), pulmonary haemorrhage, bronchopulmonary dysplasia (BPD) and use of postnatal steroids, are more common in VLBWI who had ADRR [6,7,8,9]
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