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NEONATAL SOCIETY ABSTRACTS

Outcome of babies requiring adrenaline during resuscitation at birth

Presented at the Neonatal Society 2004 Autumn Meeting (programme).

Gupta S, Shyam R, Wyllie JP

The James Cook University Hospital, Middlesbrough, UK

Introduction: The use of adrenaline during cardiopulmonary resuscitation (CPR) at birth is uncommon. There is a paucity of outcome data on such babies (1,2).

Aim: To determine the outcome in terms of mortality and morbidity for babies who required use of adrenaline during CPR at birth.

Material and Methods: A ten-year (1992 -2002) retrospective case note study was performed at a level 3 Neonatal Intensive Care Unit (NICU) in north of England. The cases were identified from the medical record database. Details of resuscitation were noted including the appropriateness of use of adrenaline according to the 1992 resuscitation guidelines. Follow-up data on survivors was obtained from clinic letters and correspondence from Neonatologists, Consultant Paediatricians and General Practitioners involved in later care of these babies.

Results: Out of 43,191 live births during the study period, 44 (0.1%) babies were given adrenaline during resuscitation. In 4 babies, it was clear from the notes that junior medical staff attending delivery used adrenaline without appropriately managing the airway and we excluded these babies from further analyses. Of the remaining 40 babies where adrenaline was used appropriately, resuscitation was unsuccessful in 19 (48%) babies. Following admission to NICU, intensive care was subsequently withdrawn in a further 11 (28%) babies, due to severe cardio-respiratory compromise. 10 (25%) babies were discharged alive from NNU but 2 of these died within 1 year secondary to aspiration pneumonia. Out of the 8 (20%) surviving babies, 3 were severely disabled with 4-limb cerebral palsy and 1 had mild motor and language delay. 4 (10%) babies out of the study population had normal development at 18-month follow-up. There were no survivors among the 13 babies born at < 29 weeks gestation.

Discussion: The chance of survival is poor for babies requiring adrenaline as a part of CPR at birth, especially those born below 29 weeks of gestation. Below 29 weeks gestation use of adrenaline in resuscitation at birth should be questioned.

References
1. Scott H. Arch Dis Child. 1976 Sep;51(9):712-6. 2. Sims DG, Heal CA, Bartl SM. Arch Dis Child Fetal Neonatal Ed. 1994 Jan;70(1):F3-9

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