title: Neonatal outcomes following extensive cardiopulmonary resuscitation in the delivery room for infants born at less than 33 weeks gestational age.
abstract: OBJECTIVE
  To examine the neonatal mortality and morbidity of infants born at <33 weeks gestational age (GA) who received extensive delivery room cardiopulmonary resuscitation (DR-CPR) immediately after birth.
  
  
  METHODS
  In this retrospective cohort study, we performed secondary analyses of data from infants born at <33 weeks GA and admitted to participating NICUs in the Canadian Neonatal Network between January 2010 and December 2011. Infants were divided into two groups based on birth weight (<1000 g and ≥1000 g) and neonatal morbidity and mortality compared using bivariate and multivariate analyses.
  
  
  RESULTS
  Of the 8033 eligible infants, 419 (5.2%) received DR-CPR. For infants weighing <1000 g at birth, 10.9% (outborn: 21.6%, inborn: 7.6%) received DR-CPR, whereas 3.4% (outborn: 9.6%, inborn: 2.2%) of those weighing ≥1000 g received DR-CPR. If infants received DR-CPR there was increased risk of mortality, bronchopulmonary dysplasia (BPD) and severe brain injury. Logistic regression analysis showed DR-CPR was associated with increased mortality (adjusted odds ratio [aOR]: 2.09, 95% CI [1.39, 3.14]) in infants born weighing <1000 g. Among infants born weighing ≥1000 g, DR-CPR was associated with increased mortality (aOR: 7.16, 95% CI [3.88, 13.2]), severe brain injury (aOR: 3.08, 95% CI [1.82, 5.22]), BPD (aOR: 2.14, 95% CI [1.25, 3.65]), pneumothorax (aOR: 3.11, 95% CI [1.53, 6.31]) and intestinal perforation (aOR: 3.47, 95% CI [1.46, 8.24]).
  
  
  CONCLUSIONS
  DR-CPR is associated with increased risk of mortality and morbidity especially in preterm infants born weighing ≥1000 g. Long-term neurodevelopmental follow up is warranted for these infants.
authors: Amuchou Singh
authors: AS
authors: Soraisham
authors: Abhay Kumar
authors: AK
authors: Lodha
authors: Nalini
authors: N
authors: Singhal
authors: Khalid
authors: K
authors: Aziz
authors: Junmin
authors: J
authors: Yang
authors: Shoo K
authors: SK
authors: Lee
authors: Prakesh S
authors: PS
authors: Shah
mesh_terms: D001724:Birth Weight; D002170:Canada / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D003696:Delivery Rooms; D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome