Vishal Kapadia1, Ju Lee Oei2, Neil Finer3, Wade Rich3, Yacov Rabi4, Ian M Wright5, Denise Rook6, Marijn J Vermeulen6, William O Tarnow-Mordi7, John P Smyth8, Kei Lui8, Steven Brown9, Ola D Saugstad10, Maximo Vento11. 1. Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center at Dallas, TX, USA. Electronic address: Vishal.kapadia@utsouthwestern.edu. 2. Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia. 3. Department of Neonatology, University of California San Diego, San Diego, CA, USA. 4. University of Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Alberta, Canada. 5. Illawarra Health and Medical Research Institute and Graduate Medicine, The University of Wollongong, Wollongong, NSW, Australia. 6. Department of Pediatrics, Division of Neonatology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, the Netherlands. 7. NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia. 8. Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia. 9. Parkland Health and Hospital System, Dallas, TX, USA. 10. Department of Pediatric Research, University of Oslo, Oslo University Hospital, Norway; Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, USA. 11. Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain.
Abstract
OBJECTIVE: To determine whether hospital mortality (primary outcome) is associated with duration of bradycardia without chest compressions during delivery room (DR) resuscitation in a retrospective cohort study of randomized controlled trials (RCTs) in preterm infants assigned low versus high initial oxygen concentration. METHODS: Medline and EMBASE were searched from 01/01/1990 to 12/01/2020. RCTs of low vs high initial oxygen concentration which recorded serial heart rate (HR) and oxygen saturation (SpO2) during resuscitation of infants <32 weeks gestational age were eligible. Individual patient level data were requested from the authors. Newborns receiving chest compressions in the DR and those with no recorded HR in the first 2 min after birth were excluded. Prolonged bradycardia (PB) was defined as HR < 100 bpm for ≥2 min. Individual patient data analysis and pooled data analysis were conducted. RESULTS: Data were collected from 720 infants in 8 RCTs. Neonates with PB had higher odds of hospital death before [OR 3.8 (95% CI 1.5, 9.3)] and after [OR 1.7 (1.2, 2.5)] adjusting for potential confounders. Bradycardia occurred in 58% infants, while 38% had PB. Infants with bradycardia were more premature and had lower birth weights. The incidence of bradycardia in infants resuscitated with low (≤30%) and high (≥60%) oxygen was similar. Neonates with both, PB and SpO2 < 80% at 5 min after birth had higher odds of hospital mortality. [OR 18.6 (4.3, 79.7)]. CONCLUSION: In preterm infants who did not receive chest compressions in the DR, prolonged bradycardia is associated with hospital mortality.
OBJECTIVE: To determine whether hospital mortality (primary outcome) is associated with duration of bradycardia without chest compressions during delivery room (DR) resuscitation in a retrospective cohort study of randomized controlled trials (RCTs) in preterm infants assigned low versus high initial oxygen concentration. METHODS: Medline and EMBASE were searched from 01/01/1990 to 12/01/2020. RCTs of low vs high initial oxygen concentration which recorded serial heart rate (HR) and oxygen saturation (SpO2) during resuscitation of infants <32 weeks gestational age were eligible. Individual patient level data were requested from the authors. Newborns receiving chest compressions in the DR and those with no recorded HR in the first 2 min after birth were excluded. Prolonged bradycardia (PB) was defined as HR < 100 bpm for ≥2 min. Individual patient data analysis and pooled data analysis were conducted. RESULTS: Data were collected from 720 infants in 8 RCTs. Neonates with PB had higher odds of hospital death before [OR 3.8 (95% CI 1.5, 9.3)] and after [OR 1.7 (1.2, 2.5)] adjusting for potential confounders. Bradycardia occurred in 58% infants, while 38% had PB. Infants with bradycardia were more premature and had lower birth weights. The incidence of bradycardia in infants resuscitated with low (≤30%) and high (≥60%) oxygen was similar. Neonates with both, PB and SpO2 < 80% at 5 min after birth had higher odds of hospital mortality. [OR 18.6 (4.3, 79.7)]. CONCLUSION: In preterm infants who did not receive chest compressions in the DR, prolonged bradycardia is associated with hospital mortality.
Authors: Myra H Wyckoff; Khalid Aziz; Marilyn B Escobedo; Vishal S Kapadia; John Kattwinkel; Jeffrey M Perlman; Wendy M Simon; Gary M Weiner; Jeanette G Zaichkin Journal: Circulation Date: 2015-11-03 Impact factor: 29.690
Authors: J A Dawson; C O F Kamlin; C Wong; A B te Pas; M Vento; T J Cole; S M Donath; S B Hooper; P G Davis; C J Morley Journal: Arch Dis Child Fetal Neonatal Ed Date: 2010-05 Impact factor: 5.747
Authors: Denise Rook; Henk Schierbeek; Maximo Vento; Hester Vlaardingerbroek; Anne C van der Eijk; Mariangela Longini; Giuseppe Buonocore; Javier Escobar; Johannes B van Goudoever; Marijn J Vermeulen Journal: J Pediatr Date: 2014-03-18 Impact factor: 4.406
Authors: Barbara J Stoll; Nellie I Hansen; Edward F Bell; Seetha Shankaran; Abbot R Laptook; Michele C Walsh; Ellen C Hale; Nancy S Newman; Kurt Schibler; Waldemar A Carlo; Kathleen A Kennedy; Brenda B Poindexter; Neil N Finer; Richard A Ehrenkranz; Shahnaz Duara; Pablo J Sánchez; T Michael O'Shea; Ronald N Goldberg; Krisa P Van Meurs; Roger G Faix; Dale L Phelps; Ivan D Frantz; Kristi L Watterberg; Shampa Saha; Abhik Das; Rosemary D Higgins Journal: Pediatrics Date: 2010-08-23 Impact factor: 7.124
Authors: M L Tataranno; J L Oei; S Perrone; I M Wright; J P Smyth; K Lui; W O Tarnow-Mordi; M Longini; F Proietti; S Negro; O D Saugstad; G Buonocore Journal: Acta Paediatr Date: 2015-06-19 Impact factor: 2.299
Authors: Myra H Wyckoff; Jonathan Wyllie; Khalid Aziz; Maria Fernanda de Almeida; Jorge Fabres; Joe Fawke; Ruth Guinsburg; Shigeharu Hosono; Tetsuya Isayama; Vishal S Kapadia; Han-Suk Kim; Helen G Liley; Christopher J D McKinlay; Lindsay Mildenhall; Jeffrey M Perlman; Yacov Rabi; Charles C Roehr; Georg M Schmölzer; Edgardo Szyld; Daniele Trevisanuto; Sithembiso Velaphi; Gary M Weiner Journal: Circulation Date: 2020-10-21 Impact factor: 29.690
Authors: Valerie Thamrin; Ola D Saugstad; William Tarnow-Mordi; Yueping Alex Wang; Kei Lui; Ian M Wright; Koert De Waal; Javeed Travadi; John P Smyth; Paul Craven; Rowena McMullan; Elisabeth Coates; Meredith Ward; Parag Mishra; Kwee Ching See; Irene G S Cheah; Chin Theam Lim; Yao Mun Choo; Azanna Ahmad Kamar; Fook Choe Cheah; Ahmed Masoud; Ju Lee Oei Journal: J Pediatr Date: 2018-07-06 Impact factor: 4.406