Outcome following cardiopulmonary resuscitation in the neonate requiring ventilatory assistance

Abstract

Background: there is limited data regarding the clinical characteristics and outcome of the neonate requiring ventilatory assistance who develops persistent bradycardia (PB) requiring cardiopulmonary resuscitation (CPR). Objectives: (1) to determine the percentage of newborn infants requiring respiratory assistance who develop PB and require CPR as part of resuscitation; (2) the associated clinical events; and (3) the short term outcome. Methods: the medical charts of infants admitted to a neonatal intensive care unit who developed PB, defined as a heart rate <80 beats/min requiring CPR, were retrospectively reviewed. Results: for 3 years, 39 (2.6%) of 1485 infants exhibited 62 episodes of PB requiring CPR; this represents 5.6% of 695 intubated infants. Fourteen (36%) infants rapidly responded to chest compressions only with restoration of heart rate within 2 min; termed brief CPR. None died in-hospital. Twenty-five (64%) infants required prolonged chest compressions, i.e. >2 min (termed prolonged CPR); 21 also received epinephrine. The median postnatal age at onset of CPR was 20 days (range 1–148 days) and the duration of CPR was 10 min (range 3–73 min). The more common medical conditions that may have contributed to the PB included severe bronchospasm associated with chronic lung disease (CLD) ( n=6), shock associated with sepsis ( n=4) and necrotizing enterocolitis (NEC) ( n=2), pneumothorax ( n=2), inadequate or improper ventilation ( n=3), other ( n=8). Nineteen (76%) infants died: 13 within 24 h of the event and six from 3 to 194 days following CPR. At 18 months follow-up, four of the six infants evaluated have a moderate to severe neurodevelopmental deficit. Of the nine infants requiring brief CPR who were evaluated, five are developing normally and four have a moderate to severe neurodevelopmental deficit. Conclusion: CPR in the neonate who requires ventilatory assistance is not uncommon. When brief in nature, mortality is low and short-term outcome is likely to be determined by the underlying medical condition. When CPR is prolonged, mortality is high and short-term outcome is poor.