Intact survival in extremely low birth weight infants after delivery room resuscitation

Objective. None of the 20 previously reported infants weighing <750 g at bi rth who received cardiopulmonary resuscitation (CPR) in the delivery room ( DR) survived. To clarify whether such resuscitation is futile in our center , we evaluated our experience with DR-CPR over a 4-year period. Study Design. We retrospectively reviewed the outcomes of all inborn infant s with birth weights <1000 g at University of California, San Diego Medical Center from January 1993 to December 1996. Surviving infants and matched c ontrol infants were followed for less than or equal to 40 months' adjusted age using standardized neurodevelopmental assessments. Results. Of the infants with birth weight <1000 g born during this period, 29% (51/177) died, including 44% of those <750 g and 16% of those greater t han or equal to 750 g. Overall, 19 infants received DR-CPR, of whom 12 were <750 g. Of the infants who received DR-CPR, 79% (15/19) survived, includin g 10 of 13 infants <750 g and 5 of 6 infants greater than or equal to 750 g . Of the 15 survivors, 10 were followed beyond 10 months' adjusted age (med ian: 28 months). At last examination, 70% were both neurologically and deve lopmentally normal. Two infants had cerebral palsy with mild cognitive and severe motor developmental delay. Of 7 infants with birth weight <750 g, 6 had normal neurodevelopmental outcomes. The mean composite mental and motor scores of DR-CPR survivors were 93 +/- 10 and 89 +/- 25, respectively. No differences were found in neurologic or developmental outcome between DR-CP R survivors and control infants matched for gestational age, sex, and year of birth. Conclusions. Our results indicate that intact survival is possible for infa nts weighing <750 g at birth after DR-CPR.