Clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation: a multicenter retrospective analysis
QIAN Miao1, YU Zhang-Bin1, CHEN Xiao-Hui1, XU Yan2, MA Yue-Lan3, JIANG Shan-Yu4, WANG Huai-Yan5, WANG Zeng-Qin6, HAN Liang-Rong7, LI Shuang-Shuang8, LU Hong-Yan9, WAN Jun10, GAO Yan11, CHEN Xiao-Qing12, ZHAO Li13, WU Ming-Fu14, ZHANG Hong-Juan15, XUE Mei16, ZHU Ling-Ling17, TIAN Zhao-Fang18, TU Wen-Juan19, WU Xin-Ping20, HAN Shu-Ping1, GU Xiao-Qi1
Department of Neonatology, Women's Hospital of Nanjing Medical University/Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China
Abstract：Objective To evaluate the clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation. Methods A retrospective analysis was performed for the preterm infants with a birth weight less than 1 500 g and a gestational age less than 32 weeks who were treated in the neonatal intensive care unit of 20 hospitals in Jiangsu, China from January 2018 to December 2019. According to the intensity of resuscitation in the delivery room, the infants were divided into three groups:non-tracheal intubation (n=1 184), tracheal intubation (n=166), and extensive cardiopulmonary resuscitation (ECPR; n=116). The three groups were compared in terms of general information and clinical outcomes. Results Compared with the non-tracheal intubation group, the tracheal intubation and ECPR groups had significantly lower rates of cesarean section and use of antenatal corticosteroid (P < 0.05). As the intensity of resuscitation increased, the Apgar scores at 1 minute and 5 minutes gradually decreased (P < 0.05), and the proportion of infants with Apgar scores of 0 to 3 at 1 minute and 5 minutes gradually increased (P < 0.05). Compared with the non-tracheal intubation group, the tracheal intubation and ECPR groups had significantly higher mortality rate and incidence rates of moderate-severe bronchopulmonary dysplasia and serious complications (P < 0.05). The incidence rates of grade Ⅲ-Ⅳ intracranial hemorrhage and retinopathy of prematurity (stage Ⅲ or above) in the tracheal intubation group were significantly higher than those in the non-tracheal intubation group (P < 0.05). Conclusions For preterm infants with a birth weight less than 1 500 g, the higher intensity of resuscitation in the delivery room is related to lower rate of antenatal corticosteroid therapy, lower gestational age, and lower birth weight. The infants undergoing tracheal intubation or ECRP in the delivery room have an increased incidence rate of adverse clinical outcomes. This suggests that it is important to improve the quality of perinatal management and delivery room resuscitation to improve the prognosis of the infants.
QIAN Miao,YU Zhang-Bin,CHEN Xiao-Hui et al. Clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation: a multicenter retrospective analysis[J]. CJCP, 2021, 23(6): 593-598.
Bajaj M, Natarajan G, Shankaran S, et al. Delivery room resuscitation and short-term outcomes in moderately preterm infants[J]. J Pediatr, 2018, 195:33-38.e2. DOI:10.1016/j.jpeds.2017.11.039. PMID:29306493.
[3]
Bashir A, Bird B, Wu L, et al. Neonatal outcomes based on mode and intensity of delivery room resuscitation[J]. J Perinatol, 2017, 37(10):1103-1107. DOI:10.1038/jp.2017.102. PMID:28682316.
[4]
Shukla V, Elkhateeb O, Shah PS, et al. Outcomes of neonates born at <26 weeks gestational age who receive extensive cardiopulmonary resuscitation compared with airway and breathing support[J]. J Perinatol, 2020, 40(3):481-487. DOI:10.1038/s41372-019-0570-z. PMID:31911647.
[5]
Arnon S, Dolfin T, Reichman B, et al. Delivery room resuscitation and adverse outcomes among very low birth weight preterm infants[J]. J Perinatol, 2017, 37(9):1010-1016. DOI:10.1038/jp.2017.99. PMID:28661514.
[6]
DeMauro SB, Roberts RS, Davis P, et al. Impact of delivery room resuscitation on outcomes up to 18 months in very low birth weight infants[J]. J Pediatr, 2011, 159(4):546-550.e1. DOI:10.1016/j.jpeds.2011.03.025. PMID:21592510.
[7]
Fischer N, Soraisham A, Shah PS, et al. Extensive cardiopulmonary resuscitation of preterm neonates at birth and mortality and developmental outcomes[J]. Resuscitation, 2019, 135:57-65. DOI:10.1016/j.resuscitation.2019.01.003. PMID:30629993.
[8]
Shah PS. Extensive cardiopulmonary resuscitation for VLBW and ELBW infants:a systematic review and meta-analyses[J]. J Perinatol, 2009, 29(10):655-661. DOI:10.1038/jp.2009.71. PMID:19554016.
[9]
Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome-2019 update[J]. Neonatology, 2019, 115(4):432-450. DOI:10.1159/000499361. PMID:30974433.
Lee J, Lee JH. A clinical scoring system to predict the need for extensive resuscitation at birth in very low birth weight infants[J]. BMC Pediatr, 2019, 19(1):197. DOI:10.1186/s12887-019-1573-9. PMID:31200679.
[14]
McGoldrick E, Stewart F, Parker R, et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth[J]. Cochrane Database Syst Rev, 2020, 12:CD004454. DOI:10.1002/14651858.CD004454.pub4. PMID:33368142.
Debay A, Patel S, Wintermark P, et al. Association of delivery room and neonatal intensive care unit intubation, and number of tracheal intubation attempts with death or severe neurological injury among preterm infants[J]. Am J Perinatol, 2020. DOI:10.1055/s-0040-1718577. PMID:33075843. Epub ahead of print.
[17]
Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary dysplasia:executive summary of a workshop[J]. J Pediatr, 2018, 197:300-308. DOI:10.1016/j.jpeds.2018.01.043. PMID:29551318.
Foglia EE, Jensen EA, Wyckoff MH, et al. Survival after delivery room cardiopulmonary resuscitation:a national registry study[J]. Resuscitation, 2020, 152:177-183. DOI:10.1016/j.resuscitation.2020.01.010. PMID:31982507.
[20]
Halling C, Raymond T, Brown LS, et al. Neonatal delivery room CPR:an analysis of the Get with the Guidelines®-Resuscitation registry[J]. Resuscitation, 2021, 158:236-242. DOI:10.1016/j.resuscitation.2020.10.007. PMID:33080368.
[21]
Foglia EE, Te Pas AB. Effective ventilation:the most critical intervention for successful delivery room resuscitation[J]. Semin Fetal Neonatal Med, 2018, 23(5):340-346. DOI:10.1016/j.siny.2018.04.001. PMID:29705089.
[22]
Aziz K, Lee HC, Escobedo MB, et al. Part 5:neonatal resuscitation:2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2020, 142(16_suppl_2):S524-S550. DOI:10.1161/CIR.0000000000000902. PMID:33081528.
[23]
Moshiro R, Perlman JM, Kidanto H, et al. Predictors of death including quality of positive pressure ventilation during newborn resuscitation and the relationship to outcome at seven days in a rural Tanzanian hospital[J]. PLoS One, 2018, 13(8):e0202641. DOI:10.1371/journal.pone.0202641. PMID:30118519.
[24]
Kakkilaya V, Jubran I, Mashruwala V, et al. Quality improvement project to decrease delivery room intubations in preterm infants[J]. Pediatrics, 2019, 143(2):e20180201. DOI:10.1542/peds.2018-0201. PMID:30602545.
