Abstract
Objective
To evaluate outcomes of preterm infants <26 weeks gestational age (GA) following postdelivery extensive cardiopulmonary resuscitation (ECPR) compared with airway and breathing support (ABS).
Study design
Retrospective review of Canadian Neonatal Network data during January 2010 to December 2016. The primary outcome was death or severe morbidity (intraventricular hemorrhage ≥grade 3 or periventricular leucomalacia, retinopathy of prematurity ≥stage 3, bronchopulmonary dysplasia, or necrotizing enterocolitis).
Result
Among 3633 infants analyzed, 433 (11.9%) received ECPR. In multivariable analysis, death or severe morbidity was higher in the ECPR versus ABS group [adjusted odds ratio 2.26 (95% confidence interval 1.49, 3.43)]. The majority of the difference was due to increased mortality, which occurred mostly during the first week of life.
Conclusion
These data from a recent cohort of infants near the limits of viability may be useful for prognostication for health care providers and counseling of parents.
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Acknowledgements
The authors gratefully acknowledge all site investigators and abstractors of the CNN. We also thank the staff at the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital, Toronto, ON, for organizational support of the CNN, CNFUN, and this project. In addition, we thank Sarah Hutchinson, PhD, and Iris Kulbatski, PhD, from MiCare for editorial assistance in the preparation of this manuscript. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CIHR) (CTP 87518), the Ontario Ministry of Health, and support from participating hospitals.
Funding
Although no specific funding has been received for this study, organizational support for the CNN was provided by the MiCare Research Centre at Mount Sinai Hospital in Toronto, ON, Canada. MiCare is supported by a CIHR Team Grant (CTP 87518), the Ontario Ministry of Health and individual participating centers. Dr Shah holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the CIHR (APR-126340). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Site Investigators of the Canadian Neonatal Network
Jaideep Kanungo5, Joseph Ting6, Zenon Cieslak7, Rebecca Sherlock8, Ayman Abou Mehrem9, Jennifer Toye10, Carlos Fajardo11, Zarin Kalapesi12, and Jaya Bodani12, Koravangattu Sankaran13, and Sibasis Daspal13, Mary Seshia14, Ruben Alvaro15, Amit Mukerji16, Orlando Da Silva17, Chuks Nwaesei18, Kyong-Soon Lee19, Michael Dunn20, Brigitte Lemyre21, Faiza Khurshid22, Ermelinda Pelausa23, Keith Barrington24, and Anie Lapointe24, Christine Drolet25, and Bruno Piedboeuf25, Martine Claveau26, and Marc Beltempo26, Valerie Bertelle27, and Edith Masse27, Roderick Canning28, Hala Makary29, Cecil Ojah30, and Luis Monterrosa30, Julie Emberley31, Jehier Afifi32, Andrzej Kajetanowicz33
Author contributions
VS conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. OE conceptualized and designed the study, and reviewed and revised the manuscript. PSS conceptualized and designed the study, and contributed to the analysis, and substantially reviewed and revised the manuscript. JY conducted the analysis and reviewed the manuscript for important intellectual content. K-SL conceptualized and designed the study, coordinated and supervised the analysis, and substantially reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Members of the Canadian Neonatal Network Investigators are listed below Acknowledgements.
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Shukla, V., Elkhateeb, O., Shah, P.S. et al. Outcomes of neonates born at <26 weeks gestational age who receive extensive cardiopulmonary resuscitation compared with airway and breathing support. J Perinatol 40, 481–487 (2020). https://doi.org/10.1038/s41372-019-0570-z
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DOI: https://doi.org/10.1038/s41372-019-0570-z