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Maternal Health, Neonatology and Perinatology

, 3:9

First Online: 30 May 2017Received: 05 December 2016Accepted: 18 May 2017DOI: 10.1186-s40748-017-0048-y

Cite this article as: Ballot, D.E., Agaba, F., Cooper, P.A. et al. matern health, neonatol and perinatol 2017 3: 9. doi:10.1186-s40748-017-0048-y

Abstract

BackgroundAdvanced levels of delivery room resuscitation in very low birth weight infants are reported to be associated with death and complications of prematurity. In resource limited settings, the need for delivery room resuscitation is often used as a reason to limit care in these infants.

MethodsThis was a review of delivery room resuscitation in very low birth weight infants born in a tertiary hospital in South Africa between 01 January 2013 and 30 June 2016. Outcomes included death and serious complications of prematurity. Advanced delivery room resuscitation was defined as the need for intubation, chest compressions or the administration of adrenaline.

ResultsA total of 1511 very low birth weight infants were included in the study. The majority 1332-1511 88.2% required oxygen in the delivery room. Face mask ventilation was needed in 45.2% 683-1511. Advanced delivery room resuscitation was only required in 10.6% 160-1511. More than half the infants who required advanced delivery room resuscitation died 89-160; 55.6%. Advanced delivery room resuscitation was required in significantly more infants <1000 grams at birth than those infants >1000 grams 83-539 15.4% vs 77-972 7.9% p < 0.001. Advanced delivery room resuscitation was significantly associated with a 5 minute Apgar score < 6 OR 13.8 95%CI 8.6–22.0, supplemental oxygen at day 28 OR 2.2 95% CI 1.4–3.9, metabolic acidosis OR 2.3 95% CI 1.1–4.8 and death OR 1.9 95% CI 1.1–3.3. Other serious complications of prematurity were not associated with advanced delivery room resuscitation. Mortality was increased in infants with a low admission temperature 35.1 °C SD 0.92 vs 36.1 °C SD 1.4 p < 0.001.

ConclusionThere was a high mortality rate associated with advanced delivery room resuscitation; however complications of prematurity were not increased in survivors

The need for advanced delivery room resuscitation alone should not be used as a predictor of poor outcome in very low birth weight infants. Survivors of advanced delivery room resuscitation should be afforded ventilatory support if required. Special care must be taken to avoid hypothermia in very low birth weight infants requiring resuscitation at birth.

KeywordsNeonate Resuscitation Mortality Delivery room AbbreviationsADRRAdvanced delivery room resuscitation

BPDBronchopulmonary dysplasia

CAPCaffeine and apnoea of prematurity

CMJAHCharlotte Maxeke Johannesburg Academic Hospital

CSCaesarean section

DRRDelivery room resuscitation

ELBWIExtremely low birthweight infants

EOSEarly onset sepsis

IVHIntraventricular haemorrhage

LOSLate onset sepsis

NCPAPNasal continuous positive airways pressure

NECNecrotising enterocolitis

NICUNeonatal intensive care unit

PDAPatent ductus arteriosus

PVLPeriventricular leukomalacia

RDSRespiratory distress syndrome

REDCAPResearch electronic data capture

ROPRetinopathy of prematurity

SRTSurfactant replacement therapy

VLBWIVery low birthweight infants





Autor: Daynia E. Ballot - Faustine Agaba - Peter A. Cooper - Victor A. Davies - Tanusha Ramdin - Lea Chirwa - David Rakotsoane

Fuente: https://link.springer.com/







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