Characteristics and outcomes of very low birth weight infants receiving epinephrine during delivery room resuscitation

Abstract

BackgroundDelivery room resuscitation of very low birth weight infants can involve use of endotracheal or intravenous epinephrine. Data of the past 19 years were reviewed to identify the usage of epinephrine in delivery room and identify characteristics of these babies. MethodsNeonates with ≤1500g birthweight from January 1996 to August 2014 were reviewed. Infants born alive and admitted to NICU were eligible. Characteristics such as demographics, survival and outcomes were recorded. Variables significant at p≤0.1 among neonates receiving epinephrine were further analyzed via multiple logistic regressions. ResultsOut of 5868 eligible neonates, 416 (7%) received epinephrine in the delivery room. The infants who received epinephrine were of lower estimated gestational age (25 vs. 28wk) and lower birth weight (746 vs. 980g). Gender, race and mode of delivery were comparable between the two cohorts. Survival was higher in non-epinephrine group (89.4 vs. 61.1%). Bacterial infection (24.3 vs. 18.4%) and combined grade 3 and 4 intraventricular hemorrhage (18.4 vs. 8.4%) were higher in epinephrine group. Use of epinephrine in the delivery room was associated with decreased survival even after controlling for birth weight, gestational age and low Apgar scores [Odd ratio – 0.48 with 95% CI (0.37–0.62), p<0.001]. ConclusionNeonates with lower birth weight and younger gestational age were more likely to receive epinephrine during resuscitation at birth. Use of epinephrine in delivery room was associated with lower survival and severe intraventricular hemorrhage among very low birth weight infants.