Resuscitation of extremely low birth weight infants

As medical care has advanced, the ability to resuscitate infants with gestational ages of 23-30 weeks and birth weight 400-1000 g has improved. However, outcomes for infants in this category are quite variable. In this issue of The Journal, Wyckoff et al seek to determine whether cardiopulmonary resuscitation (CPR) in the delivery room is associated with morbidity or mortality in extremely low birth weight infants. They found that infants who received CPR had greater overall morbidity and greater mortality by 12 hours and by 120 days of life. Of the infants who survived, those who received CPR had greater neurocognitive impairment. It should be clear that these associations are not causal but represent the fact that it is the sickest newborn infants who require CPR. Nevertheless, this information could be useful in clinical decision-making (only 14% of extremely low birth weight infants who received CPR in the delivery room and had a 5-minute Apgar score <2 survived without neurocognitive impairment), counseling parents, and forming guidelines for follow-up neurocognitive testing.