Mortality and neurodevelopmental outcome for infants receiving adrenaline in neonatal resuscitation

Objective: To document the outcome, in terms of mortality and morbidity, for all infants requiring adrenaline as part of initial neonatal resuscitation, and to identify the differences between term and preterm infants. Methods: All infants in a five-year period who received adrenaline during delivery room resuscitation were retrospectively identified. Data from the perinatal 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 deliveries. Over half of all infants survived, with the proportion increasing with advancing gestational age from 30% below 29 weeks to 67% at term. Seventy-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%). Over half of survivors below 29 weeks' gestation were normal, but overall 78% of this group either died or showed evidence of neurodevelopmental disability. Asystolic infants did not differ from the bradycardic infants in terms of survival or rates of disability. Adrenaline may be contraindicated in asystolic very preterm infants. Conclusions: Adrenaline retains a role in term and mature preterm infants where there is an acute cause for depression at delivery. In very preterm infants its use is associated with a high rate of death and disability. Failure to stabilise with adequate ventilatory support should be seen as a poor prognostic sign in this group.