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The Perinatal Asphyxiated Lamb Model: A Model for Newborn Resuscitation
Published on: August 15, 2018
Impact of neonatal resuscitation changes on outcomes of very-low-birth-weight infants
So Jin Yoon1, Joohee Lim1, Jung Ho Han1
1Department of Pediatrics, Yonsei University College of Medicine, 211 Eonjuro Gangnamgu, Seoul, 06273, Republic of Korea.
Insights
Delivery room resuscitation practices changed significantly for very-low-birth-weight infants. Updated guidelines and increased positive pressure ventilation (PPV) use correlated with reduced mortality and morbidities, highlighting the need for meticulous care in extreme prematurity.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Critical Care
Background:
- Delivery room care significantly impacts neonatal outcomes, particularly for very-low-birth-weight (VLBW) infants.
- The 2015 International Consensus guidelines aimed to improve neonatal resuscitation practices.
Purpose of the Study:
- To investigate trends in neonatal resuscitation practices from 2014 to 2017.
- To analyze the association between resuscitation methods and neonatal outcomes in VLBW infants.
Main Methods:
- Retrospective analysis of 8142 VLBW infants from the Korean Neonatal Network (2014-2017).
- Examined trends in intubation and positive pressure ventilation (PPV) rates.
- Assessed the association of resuscitation levels with mortality and major morbidities.
Main Results:
- A significant decrease in intubation rates and a marked increase in PPV were observed.
- Higher levels of resuscitation were associated with increased risks of mortality, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and periventricular leukomalacia (PVL).
- PPV and intubation showed reduced risks of mortality and morbidities compared to epinephrine use.
Conclusions:
- Changes in resuscitation practices, aligned with updated guidelines, are associated with reduced mortality and morbidities in VLBW infants.
- Increased use of PPV and appropriate intubation strategies are crucial.
- Meticulous attention to delivery room resuscitation, especially for extremely premature infants, is essential for improving outcomes.
Abstract:
The improvement of delivery room care, according to the 2015 International Consensus, may affect neonatal outcome, especially in very-low-birth-weight infants. We aimed to investigate the current practice of neonatal resuscitation by year and analyze the association with neonatal outcomes. A total of 8142 very-low-birth-weight infants, registered in the Korean Neonatal Network between 2014 and 2017 were included. A significant decreasing trend of intubation (64.5% vs 55.1%, P < 0.0001) and markedly increasing trend of positive pressure ventilation (PPV) (11.5% vs 22.9%, P < 0.0001) were noted. The annual PPV rate differed significantly by gestation (P < 0.0001). The highest level of resuscitation was also shown as an independent risk factor for mortality within 7 days and for bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and periventricular leukomalacia. PPV and intubation were associated with significantly decreased risk of mortality and morbidities compared to epinephrine use. When considering association, the incidence of mortality within 7 days, IVH, PVL, and BPD or mortality showed significant differences by combination of year, gestational age, and level of resuscitation. According to updated guidelines, changes in the highest level of resuscitation significantly associated with reducing mortality and morbidities. More meticulous delivery room resuscitation focusing on extreme prematurity is needed.
