title: Initial Resuscitation at Delivery and Short Term Neonatal Outcomes in Very-Low-Birth-Weight Infants.
abstract: Survival of very-low-birth-weight infants (VLBWI) depends on professional perinatal management that begins at delivery. Korean Neonatal Network data on neonatal resuscitation management and initial care of VLBWI of less than 33 weeks gestation born from January 2013 to June 2014 were reviewed to investigate the current practice of neonatal resuscitation in Korea. Antenatal data, perinatal data, and short-term morbidities were analyzed. Out of 2,132 neonates, 91.7% needed resuscitation at birth, chest compression was performed on only 104 infants (5.4%) and epinephrine was administered to 80 infants (4.1%). Infants who received cardiac compression and/or epinephrine administration at birth (DR-CPR) were significantly more acidotic (P < 0.001) and hypothermic (P < 0.001) than those who only needed positive pressure ventilation (PPV). On logistic regression, DR-CPR resulted in greater early mortality of less than 7 days (OR, 5.64; 95% CI 3.25-9.77) increased intraventricular hemorrhage ≥ grade 3 (OR, 2.71; 95% CI 1.57-4.68), periventricular leukomalacia (OR, 2.94; 95% CI 1.72-5.01), and necrotizing enterocolitis (OR, 2.12; 95% CI 1.15-3.91) compared with those infants who needed only PPV. Meticulous and aggressive management of infants who needed DR-CPR at birth and quality improvement of the delivery room management will result in reduced morbidities and early death for the vulnerable VLBWI.
authors.affiliation: Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea.
authors.forename: Jeonghee
authors.initials: J
authors.lastname: Shin
authors.affiliation: Department of Pediatrics, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Ran
authors.initials: R
authors.lastname: Namgung
mesh_terms: D001034:Apgar Score; D016887:Cardiopulmonary Resuscitation; D016208:Databases, Factual; D003696:Delivery Rooms; D020345:Enterocolitis, Necrotizing / Q000150:complications; D004837:Epinephrine / Q000008:administration & dosage; D005865:Gestational Age; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D007223:Infant; D066088:Infant Death; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007969:Leukomalacia, Periventricular / Q000150:complications; D016015:Logistic Models; D016017:Odds Ratio; D011175:Positive-Pressure Respiration; D012189:Retrospective Studies
chemical_list: D004837:Epinephrine
keywords: Apgar Score; Cardiopulmonary Resuscitation; Infant, Premature; Infant, Very-Low-Birth-Weight