Chest compression and/or epinephrine at birth for preterm infants <32 weeks gestational age: matched cohort study of neonatal outcomes.

BACKGROUND: Studies of outcomes of preterm infants after the receipt of extensive cardiopulmonary resuscitation (CPR) at birth have yielded varied results.
OBJECTIVE: To compare adverse outcome (death or severe morbidities) of preterm infants <32 weeks gestational age (GA) who received chest compressions with or without administration of epinephrine at birth with those who did not receive either. DESIGN/
METHOD: Data were retrospectively analyzed from a database for preterm infants <32 weeks GA discharged from hospital between July 2004 and October 2007. CASES: Infants who received chest compression with or without administration of epinephrine during the initial resuscitation. Matched cohort: Infants who did not receive extensive CPR at birth (matched for GA, sex and admission date). PRIMARY OUTCOME: Death or any of three severe morbidities (grade 3 or 4 intraventricular hemorrhage or periventricular leukomalacia; retinopathy of prematurity > stage 2 or chronic lung disease). RESULT: Sixty-six cases and 156 matched infants were identified. There were no baseline differences between groups except Apgar and severity of illness scores. Median (interquartile range) duration for chest compression (n=66) was 60 (30 to 180 s) and number of epinephrine doses (n=29) was 1 (1 to 3). Logistic regression confirmed significantly higher risk of adverse outcome among cases compared with matched controls (58 vs 37%; P=0.04, adjusted odds ratio 2.23, 95% confidence interval 1.04, 4.77).
CONCLUSION: Infants born prematurely who met criteria for extensive CPR at birth experienced higher risk of combined adverse outcome, including death or severe neurological injury, severe retinopathy of prematurity or bronchopulmonary dysplasia.