Cardiopulmonary resuscitation and epinephrine infusion in extremely low birth weight infants in the neonatal intensive care unit.

BACKGROUND

Survival of extremely low birth weight (ELBW) infants has improved significantly; however, the aggressiveness of treatment in these infants remains controversial. Critical appraisal of the benefits of cardiopulmonary resuscitation (CPR) and intravenous epinephrine infusion (IV EPI) has not been studied in this population.

OBJECTIVE

To determine if either CPR or continuous IV EPI in NICU is of benefit for surviving in a selected population of infants weighing </=750 g birthweight.

METHODS

Case records of infants </=750 g birthweight were reviewed retrospectively to document episodes of CPR and the use of IV EPI for inotropic support. Demographic data were collected for each infant and severity of illness scores were calculated using the clinical risk index for babies (CRIB).

RESULTS

In all, 91 infants </=750 g birth weight were identified, the overall survival rate was 35/91 (38%). A total of 15 infants received CPR, none of these infants survived to discharge. A total of 47 infants received continuous IV EPI of which 10/47 survived in comparison to 25/44 infants who did not receive this treatment (p<0.001). Increasing dosage of IV EPI was associated with decreased survival. All infants who received epinephrine at a dose >1.0 mcg/kg/hour intravenously died.

CONCLUSIONS

In view of the poor survival after either CPR or high-dose IV EPI in infants </=750 g, extreme caution should be applied to the use of these therapies in this high-risk population of ELBW infants.