Cardiopulmonary resuscitation in the newborn intensive care unit

To determine the outcome for cardiopulmonary resuscitation (CPR) following cardiac arrest, and the predictors of response to CPR, in newborn infants with a diverse range of medical, surgical and cardiological problems cared for in a tertiary level newborn intensive care unit (NICU).

Infants who had suffered a cardiac arrest and received CPR were identified by retrospective review of the NICU medical records.

Thirty-five (1%) of 3624 infants admitted to the NICU during a six-year period received CPR because of a cardiac arrest. Twenty (57%) of the infants did not respond to CPR and died within 2.5 h (non-responders), eight (23%) responded to CPR but died before discharge from hospital (short-term responders), and seven (20%) responded to CPR and were discharged from hospital (long-term responders). The arterial pH was significantly lower in non-responders to CPR compared with responders. Non-responders to CPR were not significantly different from responders with regard to gestational age, birth weight, age at arrest, systolic blood pressure, blood gases, severity of respiratory failure, or renal function. In 24 infants (68%), the precipitating cause for the cardiac arrest was either irreversible (20), or not known (4) and all died prior to discharge from hospital. In 11 infants (32%), the cardiac arrest was considered to have been precipitated by an acute and reversible event, and seven (64%) survived to discharge from hospital. All six infants with septicaemic shock were non-responders to CPR. Three of 15 infants with complex congenital heart disease were long-term responders to CPR but none survived without a major physical and psychomotor disability.

The present study offers support for the recommendation that CPR may be withheld in infants who do not have a reversible cause for their cardiac arrest but are dying or will die soon from the inexorable progress of their illness.