UPR School of Medicine, Department of Pediatrics, Neonatology Section, P.O. Box 365067, San Juan 00936-5067, Puerto Rico.
Resuscitation. 2011 Apr;82(4):427-30. doi: 10.1016/j.resuscitation.2010.11.020. Epub 2011 Jan 26.
In recent years, there has been an increase in the number of very low birth weight (VLBW) infants and an improvement in their survival. However, there are no specific recommendations regarding the use of resuscitative efforts for VLBW infants, and there is scant data in the literature on morbidity and mortality in relation to epinephrine administration. Due to the vulnerability of VLBW infants, studies that examine the effects and consequences of cardiovascular resuscitation and epinephrine administration are needed.
The objective of this study is to determine the outcome of VLBW infants, who received epinephrine in the delivery room.
Medical records of VLBW infants admitted to neonatal intensive care unit (NICU) from 1999 to 2007 were reviewed, and infants who received epinephrine in the delivery room were identified and included in the study.
Infants who received epinephrine are smaller in terms of gestational age and birth weight and have decreased survival. After adjusting for gestational age and birth weight, infants who received epinephrine presented lower 1 and 5 min APGAR (Appearance, Pulse, Grimace, Activity, Respiration) scores, more respiratory distress syndrome, lower survival (26% vs. 43%, p<0.01) and lower survival without severe brain injury (17% vs. 32%, p<0.01).
VLBW infants, who require epinephrine in the delivery room, are smaller in terms of gestational age and birth weight. The requirement of epinephrine in the delivery room during resuscitation may be associated to worst outcomes and decreased survival without severe brain injury. These findings lead to more questions on how aggressive resuscitation efforts should be for these infants.
近年来，极低出生体重儿（VLBW）的数量有所增加，其存活率也有所提高。然而，对于 VLBW 婴儿的复苏努力，目前尚无具体建议，文献中关于肾上腺素给药与发病率和死亡率的相关数据也很少。由于 VLBW 婴儿的脆弱性，需要研究检查心血管复苏和肾上腺素给药的影响和后果。
本研究旨在确定在产房接受肾上腺素治疗的 VLBW 婴儿的结局。
回顾了 1999 年至 2007 年入住新生儿重症监护病房（NICU）的 VLBW 婴儿的病历，并确定了在产房接受肾上腺素治疗的婴儿，并将其纳入研究。
接受肾上腺素治疗的婴儿在胎龄和出生体重方面较小，存活率降低。在校正胎龄和出生体重后，接受肾上腺素治疗的婴儿的 1 分钟和 5 分钟 APGAR（外观、脉搏、面部表情、活动、呼吸）评分较低，呼吸窘迫综合征更多，存活率较低（26%对 43%，p<0.01），无严重脑损伤的存活率较低（17%对 32%，p<0.01）。
在产房需要肾上腺素治疗的 VLBW 婴儿，胎龄和出生体重较小。在复苏期间产房需要肾上腺素可能与更差的结局和无严重脑损伤的存活率降低有关。这些发现引发了更多关于这些婴儿应该进行多大程度的积极复苏努力的问题。
