Mortality and neurodevelopmental outcome for infants receiving adrenaline in neonatal resuscitation

Objective: To document the outcome, in terms of mortality and morbidity, fo r all infants requiring adrenaline as part of initial neonatal resuscitatio n, and to identify the differences between term and preterm infants. Methods: All infants in a five-year period who received adrenaline during d elivery room resuscitation were retrospectively identified. Data from the p erinatal period were ascertained by chart review. Details of survivors at 1 year or later were reviewed. Results: Seventy-eight infants were identified representing 0.2% of all del iveries. Over half of all infants survived, with the proportion increasing with advancing gestational age from 30% below 29 weeks to 67% at term. Seve nty-three per cent of survivors were normal at follow-up to at least 1 year , with more preterm infants being normal than term infants (79% vs 64%). Ov er half of survivors below 29 weeks' gestation were normal, but overall 78% of this group either died or showed evidence of neurodevelopmental disabil ity. Asystolic infants did not differ from the bradycardic infants in terms of survival or rates of disability. Adrenaline may be contraindicated in a systolic very preterm infants. Conclusions: Adrenaline retains a role in term and mature preterm infants w here there is an acute cause for depression at delivery. In very preterm in fants its use is associated with a high rate of death and disability. Failu re to stabilise with adequate ventilatory support should be seen as a poor prognostic sign in this group.