Outcomes of delivery room resuscitation of bradycardic preterm infants: A retrospective cohort study of randomised trials of high vs low initial oxygen concentration and an individual patient data analysis. (October 2021)

• Record Type: Journal Article
• Authors: Kapadia, Vishal; Oei, Ju Lee; Finer, Neil; Rich, Wade; Rabi, Yacov; Wright, Ian M.; Rook, Denise; Vermeulen, Marijn J.; Tarnow-Mordi, William O.; Smyth, John P.; Lui, Kei; Brown, Steven; Saugstad, Ola D.; Vento, Maximo
• Is Part Of: Resuscitation. Volume 167(2021)
• Page Start: 209
• Page End: 217
• Publication Date: 2021-10
• Subjects: Bradycardia -- Neonatal resuscitation -- Death -- Mortality -- Oxygen saturation -- Heart rate -- Newborn -- Systematic review -- Neonatal Resuscitation Program -- International Liaison Committee on Resuscitation -- Oxygen -- Bronchopulmonary dysplasia -- Intraventricular hemorrhage; BPD Bronchopulmonary Dysplasia -- DR Delivery Room -- DR-CPR Chest compressions and/or epinephrine use in the DR -- FiO2 Fraction of inspired oxygen -- GA Gestational age -- GRADE Grading of Recommendations Assessment, Development and Evaluation -- HR Heart rate -- ILCOR International Liaison Committee on Resuscitation -- IVH Intraventricular Hemorrhage -- NB No bradycardia -- NEC Necrotizing enterocolitis -- NICU Neonatal intensive care unit -- O2 Oxygen -- PB Prolonged bradycardia -- PRISMA Preferred Reporting Items for Systematic Reviews and Meta-analyses -- RCT Randomized controlled trial -- RoB Risk of bias -- ROP Retinopathy of prematurity -- SpO2 Oxygen saturation -- TB Transient bradycardia; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2021.08.023
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Objective: To determine whether hospital mortality (primary outcome) is associated with duration of bradycardia without chest compressions during delivery room (DR) resuscitation in a retrospective cohort study of randomized controlled trials (RCTs) in preterm infants assigned low versus high initial oxygen concentration. Methods: Medline and EMBASE were searched from 01/01/1990 to 12/01/2020. RCTs of low vs high initial oxygen concentration which recorded serial heart rate (HR) and oxygen saturation (SpO2 ) during resuscitation of infants <32 weeks gestational age were eligible. Individual patient level data were requested from the authors. Newborns receiving chest compressions in the DR and those with no recorded HR in the first 2 min after birth were excluded. Prolonged bradycardia (PB) was defined as HR < 100 bpm for ≥2 min. Individual patient data analysis and pooled data analysis were conducted. Results: Data were collected from 720 infants in 8 RCTs. Neonates with PB had higher odds of hospital death before [OR 3.8 (95% CI 1.5, 9.3)] and after [OR 1.7 (1.2, 2.5)] adjusting for potential confounders. Bradycardia occurred in 58% infants, while 38% had PB. Infants with bradycardia were more premature and had lower birth weights. The incidence of bradycardia in infants resuscitated with low (≤30%) and high (≥60%) oxygen was similar. Neonates with both, PB and SpO2 < 80% at 5 min after birth had higher odds of hospital mortality. [OR 18.6 (4.3, 79.7)]. Conclusion: In preterm infants who did not receive chest compressions in the DR, prolonged bradycardia is associated with hospital mortality.