Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Perinatal Research

Background:

• Outcomes of preterm infants receiving extensive cardiopulmonary resuscitation (CPR) at birth or in neonatal intensive care units (NICUs) are varied.
• Very low birth weight (VLBW) and extremely low birth weight (ELBW) infants are a vulnerable population requiring specialized care.
• Limited data exists on the long-term effects of extensive resuscitation in these infants.

Purpose of the Study:

• To systematically review the outcomes of VLBW and ELBW infants who received extensive CPR.
• To analyze the association between extensive CPR (delivery room and NICU) and neonatal/long-term outcomes.
• To synthesize existing evidence on mortality and neurological injury following extensive resuscitation.

Main Methods:

• Systematic review of studies from MEDLINE, EMBASE, and CINAHL databases.
• Inclusion of studies reporting neonatal or long-term outcomes for infants receiving extensive CPR.
• Analysis of data from 20 eligible studies, including delivery room CPR (DR-CPR) and NICU CPR (NICU-CPR).

Main Results:

• DR-CPR was associated with increased mortality (OR 2.83) and severe neurological injury (OR 2.27) compared to no extensive CPR.
• NICU-CPR showed a significant increase in mortality (OR 55), though with wide confidence intervals.
• Long-term outcomes for survivors were reported in a limited number of studies.

Conclusions:

• Extensive CPR in VLBW/ELBW infants, whether at birth or in the NICU, is associated with a higher risk of mortality.
• Severe neurological injury is also a concern following DR-CPR.
• More research is needed to fully understand the long-term consequences for survivors of extensive resuscitation.