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

Objective. None of the 20 previously reported infants weighing <750 g at birth 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 infants with birth weights <1000 g at University of California, San Diego Medical Center from January 1993 to December 1996. Surviving infants and matched control 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 than 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, including 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 (median: 28 months). At last examination, 70% were both neurologically and developmentally 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-CPR survivors and control infants matched for gestational age, sex, and year of birth. Conclusions. Our results indicate that intact survival is possible for infants weighing <750 g at birth after DR-CPR.