Outcome of very-low-birth-weight infants who received epinephrine in the delivery room.

BACKGROUND: In recent years, there has been an increase in the number of very low birth weight (VLBW) infants and an improvement in their survival. However, there are no specific recommendations regarding the use of resuscitative efforts for VLBW infants, and there is scant data in the literature on morbidity and mortality in relation to epinephrine administration. Due to the vulnerability of VLBW infants, studies that examine the effects and consequences of cardiovascular resuscitation and epinephrine administration are needed.

STUDY AIM: The objective of this study is to determine the outcome of VLBW infants, who received epinephrine in the delivery room.

METHODS: Medical records of VLBW infants admitted to neonatal intensive care unit (NICU) from 1999 to 2007 were reviewed, and infants who received epinephrine in the delivery room were identified and included in the study.

RESULTS: Infants who received epinephrine are smaller in terms of gestational age and birth weight and have decreased survival. After adjusting for gestational age and birth weight, infants who received epinephrine presented lower 1 and 5 min APGAR (Appearance, Pulse, Grimace, Activity, Respiration) scores, more respiratory distress syndrome, lower survival (26% vs. 43%, p<0.01) and lower survival without severe brain injury (17% vs. 32%, p<0.01).

CONCLUSIONS: VLBW infants, who require epinephrine in the delivery room, are smaller in terms of gestational age and birth weight. The requirement of epinephrine in the delivery room during resuscitation may be associated to worst outcomes and decreased survival without severe brain injury. These findings lead to more questions on how aggressive resuscitation efforts should be for these infants.