Delivery Room Resuscitation and Short-Term Outcomes of Extremely Preterm and Extremely Low Birth Weight Infants: A Multicenter Survey in North China
Extremely preterm infants (EPI, gestational age [GA] <28 weeks) and extremely low birth weight infants (ELBWI, birth weight [BW] <1000 g) represent a significant challenge in neonatal care due to their high risk of complications, mortality, and long-term neurodevelopmental impairments. Despite advancements in neonatal medicine, these infants continue to face substantial health challenges. This study aimed to evaluate the delivery room resuscitation practices and short-term outcomes of EPI and ELBWI in North China, focusing on survival rates, bronchopulmonary dysplasia (BPD), and associated risk factors.
The study was conducted across 33 neonatal intensive care units (NICUs) in North China, including 30 tertiary hospitals and three secondary hospitals, between January 2017 and December 2018. The clinical data of 952 preterm infants with a GA <28 weeks or BW <1000 g, admitted within 72 hours of birth, were analyzed. Infants with lethal congenital anomalies or inborn metabolic diseases were excluded. The primary outcomes assessed were delivery room resuscitation practices, particularly delivery room intubation (DRI), and the secondary outcomes included survival rates, incidence of BPD, and associated risk factors.
The cohort of 952 infants included 498 males (52.3%) and had a mean GA of 27.7 weeks and a mean BW of 938 g. Infants were categorized into three groups based on GA and BW: <28 weeks and <1000 g (n=380), <28 weeks and ≥1000 g (n=273), and ≥28 weeks and <1000 g (n=299). The study revealed that 55.9% of infants underwent DRI, 12.5% required chest compressions, and 7.0% received epinephrine during resuscitation. The incidence of DRI was significantly higher in infants with GA <28 weeks and BW <1000 g (69.5%) compared to those with BW ≥1000 g or GA ≥28 weeks. Multivariate analysis identified GA <28 weeks, BW <1000 g, antepartum infection, and forceps delivery as significant risk factors for DRI.
The overall survival rate of the cohort was 65.9%, with 627 infants discharged according to medical advice, 241 infants (25.3%) dying during hospitalization, and 84 infants (8.8%) discharged against medical advice. The survival rate was dependent on GA, with infants born at <28 weeks having lower survival rates compared to those born at ≥28 weeks. The mean duration of hospitalization for infants discharged according to medical advice was 69.6 days, while the median age at death was 3.0 days. Infants who died had higher rates of DRI, mechanical ventilation (MV), severe respiratory distress syndrome (RDS), and pulmonary hemorrhage, indicating that early mortality was associated with severe respiratory complications and vigorous resuscitation.
The incidence of BPD among the infants discharged according to medical advice was 29.3%. Univariate analysis showed that infants with BPD had smaller GA and BW, higher rates of DRI, RDS, and pulmonary hemorrhage, and were more likely to be male and require prolonged MV. Multivariate logistic regression analysis identified male gender, DRI, RDS requiring ≥2 doses of pulmonary surfactant (PS) therapy, and MV duration ≥7 days as significant risk factors for BPD. Conversely, larger BW, antenatal steroid (ANS) exposure, and PS use in the delivery room were protective factors against BPD.
The study highlighted the importance of delivery room resuscitation in the management of EPI and ELBWI. The high incidence of DRI and associated complications such as BPD underscore the need for improved resuscitation strategies that minimize lung injury. The use of non-invasive ventilation (NIV) and PS therapy in the delivery room was associated with reduced risks of BPD, suggesting that these interventions should be optimized to improve outcomes. Additionally, the study emphasized the critical role of perinatal care, including ANS exposure and management of maternal infections, in reducing the need for DRI and improving infant survival.
The findings of this study provide valuable insights into the management and outcomes of EPI and ELBWI in North China. The high survival rate of 65.9% and the incidence of BPD of 29.3% are comparable to previous studies, but the study also identified areas for improvement, particularly in reducing the need for DRI and managing respiratory complications. The study’s large sample size and multicenter design enhance the generalizability of the findings, providing a comprehensive overview of the current practices and outcomes in North China.
In conclusion, this study underscores the importance of optimizing delivery room resuscitation and perinatal care to improve the outcomes of EPI and ELBWI. The findings highlight the need for tailored interventions that address the specific risks and challenges faced by these high-risk infants, with the ultimate goal of reducing mortality and long-term morbidity. Future research should focus on developing and implementing strategies that further enhance the quality of care for EPI and ELBWI, particularly in resource-limited settings.
doi.org/10.1097/CM9.0000000000001499
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