Cardiopulmonary resuscitation in the delivery room. Associated clinical events

J. M. Perlman and R. Risser
Department of Pediatrics, University of Texas Southerwestern Medical Center, Dallas.

OBJECTIVES: To determine (1) what percentage of infants require chest compressions and medications as part of resuscitation in the delivery room, (2) the associated clinical events contributing to neonatal depression, and (3) the neonatal outcome of such children. DESIGN: Observational study. SETTING: Urban county hospital. RESULTS: For 2 years, 39 (0.12%) of 30,839 infants were administered chest compressions and/or epinephrine as part of cardiopulmonary resuscitation in the delivery room. Fifteen were term infants and 24 were premature. Five term infants had evidence of severe fetal acidemia (FA) (umbilical cord arterial pH < 7.00 and/or base deficit > or = -14 mEq/L); two died secondary to severe brain injury, and the neurologic examinations showed abnormalities in the three survivors. The 10 infants without severe FA exhibited an uncomplicated neonatal course. Five infants had evidence of severe FA; the neurologic examination showed abnormalities in four. Of the remaining 19 infants without severe FA, four died and five additional infants have moderate to severe brain injury. Abnormal outcome was more likely to occur with severe FA (P < .002). The presumed clinical events contributing to the neonatal depression were severe FA (n = 10), malpositioning of the endotracheal tube (n = 5), and ineffective or improper initial ventilatory support (n = 24). CONCLUSIONS: Cardiopulmonary resuscitation in the delivery room, resulting in administration of chest compressions and medications, is a rare event. Approximately one third of the infants had evidence of severe FA; in the remaining two thirds, ineffective or improper initial ventilatory support was the presumed mechanism for the continued neonatal depression. The appropriate therapeutic response to continuing neonatal depression should be to optimize ventilatory support before administering chest compressions or medications.

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