Cardiopulmonary resuscitation in very low birthweight infants

Of 191 patients with birthweight less than 1500 gm admitted to our neonatal intensive care unit in a 2-year period, 41 underwent cardiopulmonary resuscitation (CPR). Eleven of 41 very low birthweight (VLBW) (27%) survived to be discharged. None of the infants who received CPR after 72 hours of life survived. Also, all infants who underwent CPR, both in the delivery room and neonatal intensive care unit (NICU), died. The most significant factor distinguishing survivors from nonsurvivors was the demonstration of vasopressor unresponsive hypotension 20 hours prior to CPR in the latter group. This study confirmed the very poor survival rate after CPR in VLBW infants. We conclude that performance of CPR in patients with vasopressor unresponsive hypotension or previous delivery room resuscitation should be considered a rescue or experimental treatment and parents should be given the option of no resuscitation. Future research efforts should be directed to better the understanding and treatment of cardiovascular dysfunction prior to cardiac arrest.