Duration of Resuscitation at Birth, Mortality, and Neurodevelopment: A Systematic Review

Author:

Foglia Elizabeth E.1,Weiner Gary2,de Almeida Maria Fernanda B.3,Wyllie Jonathan4,Wyckoff Myra H.5,Rabi Yacov6,Guinsburg Ruth3,

Affiliation:

1. Division of Neonatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;

2. Division of Neonatal-Perinatal Medicine, C.S. Mott Children’s Hospital and University of Michigan, Ann Arbor, Michigan;

3. Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil;

4. Departments of Paediatrics and Neonatology, The James Cook University Hospital, South Tees Hospitals National Health Services Foundation Trust, Middlesbrough, United Kingdom;

5. Division of Neonatal–Perinatal Medicine, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas; and

6. Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada

Abstract

CONTEXT: The International Liaison Committee on Resuscitation Neonatal Life Support Task Force reviewed evidence for the duration of cardiopulmonary resuscitation (CPR) for newborns immediately after birth. OBJECTIVE: To summarize evidence for ongoing CPR on the outcomes of survival, neurodevelopment, and the composite of survival without moderate or severe neurodevelopmental impairment (NDI). DATA SOURCES: Medline, Embase, Evidence-Based Medicine Reviews, Cumulative Index to Nursing and Allied Health Literature, and Scientific Electronic Library Online were searched between inception and February 29, 2020. STUDY SELECTION: Two independent reviewers selected studies of newborns with at least 10 minutes of asystole, bradycardia, or pulseless electrical activity for which CPR is indicated. DATA EXTRACTION: Two independent reviewers extracted data and appraised the risk of bias. RESULTS: In 16 eligible studies, researchers reported outcomes of 579 newborns born between 1982 and 2017. Within individual studies, 2% to 100% of infants survived to last follow-up (hospital discharge through 12 years). Summarized across studies, 237 of 579 (40.9%) newborns survived to last follow-up. In 13 studies, researchers reported neurodevelopmental outcomes of 277 newborns. Of these, 30 of 277 (10.8%) survived without moderate or severe impairment, and 240 of 277 (87%) met the composite outcome of death or NDI (191 died and 49 survived with moderate or severe impairment). LIMITATIONS: There was very low certainty of evidence because of risk of bias and inconsistency. CONCLUSIONS: Infants with ongoing CPR at 10 minutes after birth are at high risk for mortality and neurodisability, but survival without moderate or severe NDI is possible. One specified duration of CPR is unlikely to uniformly predict survival or survival without neuroimpairment.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference37 articles.

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3. Monitoring heart rate in the delivery room;Dawson;Semin Fetal Neonatal Med,2018

4. It’s time to reevaluate the Apgar Score;Rüdiger;JAMA Pediatr,2020

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