Impact of delivery room resuscitation on outcomes up to 18 months in very low birth weight infants

The impact of differing levels of delivery room respiratory and cardiac support on long-term survival and neurodevelopment of very preterm infants is uncertain. Until the early 1990s, delivery room resuscitation was not considered a suitable therapy for preterm infants because rates of survival were low, and rates of disability in survivors were high. Since then, some results have suggested that delivery room cardiopulmonary resuscitation may be compatible with survival and even with normal neurodevelopment. However, information on long-term outcomes is still scant.
On this basis, the investigators of the Caffeine for Apnea of Prematurity (CAP) trial have evaluated the relationships between the intensity of delivery room resuscitation and outcomes at a corrected age of 18 months in the cohort of very low birth weight (VLBW) infants who were enrolled in this study. In addition, the relationships between delivery room resuscitation and short-term outcomes were assessed. The CAP Trial enrolled 2006 infants with birth weights 500-1250 g who were eligible for caffeine therapy. Delivery room resuscitation data were available for all infants, and adequate information for the primary outcome were available for 1869 infants (93.2%). Infants were divided in 4 groups of increasing intensity of resuscitation: minimal (n=343), bag-mask ventilation (n=372), endotracheal intubation (n=1205), and cardiopulmonary resuscitation (chest compressions/epinephrine; n=86).
The observed rates of death or disability, death, cerebral palsy, cognitive deficit, and hearing loss at 18 months increased with higher levels of resuscitation (P value for trend <0.001). Risk of bronchopulmonary dysplasia (BPD), severe retinopathy of prematurity (ROP), and brain injury also increased with higher levels of resuscitation (P value for trend <0.05). However, the adjustment for prognostically important baseline characteristics reduced the differences between the groups for most outcomes. Only the adjusted rates of BPD and severe ROP remained significantly higher after more intense resuscitation. This large analysis suggests that the observed rates of many adverse short- and long-term outcomes increased with more intense levels of delivery room resuscitation. However, adjustment for prognostic variables reduced the differences between the groups of infants who received varying levels of resuscitation. Therefore, although intensive resuscitation may confer some additional risk, it does not guarantee a poor long-term outcome. In infants who survive delivery room resuscitation and achieve stability in the first days of life, the level of delivery room resuscitation appears one of many factors contributing to the long-term neurodevelopmental outcome.

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