• Resuscitation · Oct 2021

    Randomized Controlled Trial

    aOutcomes 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.

    • Vishal Kapadia, Ju Lee Oei, Neil Finer, Wade Rich, Yacov Rabi, Ian M Wright, Denise Rook, Marijn J Vermeulen, William O Tarnow-Mordi, John P Smyth, Kei Lui, Steven Brown, Ola D Saugstad, and Maximo Vento.
    • Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center at Dallas, TX, USA. Electronic address: Vishal.kapadia@utsouthwestern.edu.
    • Resuscitation. 2021 Oct 1; 167: 209217209-217.

    ObjectiveTo 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.MethodsMedline 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.ResultsData 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)].ConclusionIn preterm infants who did not receive chest compressions in the DR, prolonged bradycardia is associated with hospital mortality.Copyright © 2021 Elsevier B.V. All rights reserved.

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