Article

Use and Efficacy of Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room

Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA.
PEDIATRICS (Impact Factor: 5.47). 09/2006; 118(3):1028-34. DOI: 10.1542/peds.2006-0416
Source: PubMed

ABSTRACT

Given the paucity of information regarding endotracheal epinephrine for newborn resuscitation, the objectives of this study were: (1) to determine the frequency of endotracheal epinephrine use in newborns in the delivery room, and (2) to determine whether the previously recommended dose of 0.01 to 0.03 mg/kg of endotracheal epinephrine is effective in establishing a return of spontaneous circulation.
A retrospective review was conducted for all neonates who received > or = 1 dose of epinephrine in the delivery room between January 1999 and December 2004. Infants who received > or = 1 dose of endotracheal epinephrine in the delivery room during resuscitation were included in the study population whether or not they survived to be admitted to the NICU. Exclusion criteria included lethal congenital anomalies, delivery outside the hospital, and missing medical charts.
Of 93,656 infants, 52 neonates (0.06%) received epinephrine in the delivery room, 5 of whom met exclusion criteria. Of the remaining 47 infants, 44 (94%) received the first dose via the endotracheal tube. Only 14 (32%) of 44 achieved return of spontaneous circulation after endotracheal tube administration of epinephrine. Of the 30 remaining infants, 23 (77%) had return of spontaneous circulation with intravenous epinephrine after initially failing endotracheal tube epinephrine. There were no differences in clinical characteristics between newborns who responded to endotracheal tube versus intravenous epinephrine except for a lower blood glucose on NICU admission (52 vs 113 mg%).
Endotracheal epinephrine is frequently used when intensive resuscitation is required in the delivery room. The previously recommended endotracheal epinephrine dose of 0.01 to 0.03 mg/kg is often ineffective. Higher endotracheal doses will likely be needed to improve efficacy. A prospective study is needed to determine the best endotracheal epinephrine dosing regimen. Until such information is available, intravenous administration should be the preferred route of delivery.

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Available from: Myra Wyckoff, Nov 09, 2014
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    • "Our findings are comparable to other studies in which chest compression was needed for resuscitation in 0.1–0.12% of live births and epinephrine was given in 0.08-0.1% ofresuscitation in 0.1–0.12% of live births and epinephrine was given in 0.08-0.1% of neonates[1, 2, 7–9]. In a study by Wyckoff et al it was shown that 0.47% of 37972 neonates were resuscitated at birth, with 0.39% needing bag and mask ventilation and only 0.08 requiring endotracheal intubation[10]. "
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    ABSTRACT: Objective Timely identification and prompt resuscitation of newborns in the delivery room may cause a decline in neonatal morbidity and mortality. We try to identify risk factors in mother and fetus that result in birth of newborns needing resuscitation at birth. Methods Case notes of all deliveries and neonates born from April 2010 to March 2011 in Mahdieh Medical Center (Tehran, Iran), a Level III Neonatal Intensive Care Unit, were reviewed; relevant maternal, fetal and perinatal data was extracted and analyzed. Findings During the study period, 4692 neonates were delivered; 4522 (97.7%) did not require respiratory assistance. One-hundred seven (2.3%) newborns needed resuscitation with bag and mask ventilation in the delivery unit, of whom 77 (1.6%) babies responded to bag and mask ventilation while 30 (0.65%) neonates needed endotracheal intubation and 15 (0.3%) were given chest compressions. Epinephrine/volume expander was administered to 10 (0.2%) newborns. In 17 patients resuscitation was continued for >10 mins. There was a positive correlation between the need for resuscitation and following risk factors: low birth weight, preterm labor, chorioamnionitis, pre-eclampsia, prolonged rupture of membranes, abruptio placentae, prolonged labor, meconium staining of amniotic fluid, multiple pregnancy and fetal distress. On multiple regression; low birth weight, meconium stained liquor and chorioamnionitis revealed as independent risk factors that made endotracheal intubation necessary. Conclusion Accurate identification of risk factors and anticipation at the birth of a high-risk neonate would result in adequate preparation and prompt resuscitation of neonates who need some level of intervention and thus, reducing neonatal morbidity and mortality.
    Full-text · Article · Dec 2013 · Iranian Journal of Pediatrics
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    • "Although chest compressions are a fairly infrequent intervention during delivery room resuscitation, occurring in 1 in 1000 term deliveries, they are, however, more common in preterm infant resuscitation (occurring in roughly 1 in 50 to 1 in 10 deliveries) [11] [12]. Optimizing CC performance during neonatal resuscitation could therefore be critical to improving survival outcomes because current protocols often achieve only a fraction of the native cardiovascular perfusion even under optimal conditions [13] [14]. Moreover, resuscitation of acutely ill newborns is a key competency skill of physicians and many interventions used in acute life-threatening situations are unproven and frequently unsuccessful. "
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    ABSTRACT: Optimizing chest compression (CC) performance during neonatal cardiopulmonary resuscitation (CPR) is critical to improving survival outcomes since current clinical protocols often achieve only a fraction of the native cardiovascular perfusion. This study presents the development of a diagnostic tool to unobtrusively measure the CC depth and force during neonatal CPR using sensors mounted on a glove platform. The performance of the glove was evaluated by infant manikin tests using the two-thumb (TT) and two-finger (TF) methods of CC during simulated, unventilated neonatal CPR. The TT method yielded maximum CC depths and forces of as much as 25.7 ± 3.2 mm and 35.9 ± 2.2 N while the TF method produced CC depths and forces of as much as 21.6 ± 2.2 mm and 23.7 ± 2.9 N. These results are consistent with clinical findings which suggest that TT compression is more effective than TF compression since it produces greater CC depths and forces.
    Full-text · Dataset · Jul 2013
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    • "Although chest compressions are a fairly infrequent intervention during delivery room resuscitation, occurring in 1 in 1000 term deliveries, they are, however, more common in preterm infant resuscitation (occurring in roughly 1 in 50 to 1 in 10 deliveries) [11] [12]. Optimizing CC performance during neonatal resuscitation could therefore be critical to improving survival outcomes because current protocols often achieve only a fraction of the native cardiovascular perfusion even under optimal conditions [13] [14]. Moreover, resuscitation of acutely ill newborns is a key competency skill of physicians and many interventions used in acute life-threatening situations are unproven and frequently unsuccessful. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Optimizing chest compression (CC) performance during neonatal cardiopulmonary resuscitation (CPR) is critical to improving survival outcomes since current clinical protocols often achieve only a fraction of the native cardiovascular perfusion. This study presents the development of a diagnostic tool to unobtrusively measure the CC depth and force during neonatal CPR using sensors mounted on a glove platform. The performance of the glove was evaluated by infant manikin tests using the two-thumb (TT) and two-finger (TF) methods of CC during simulated, unventilated neonatal CPR. The TT method yielded maximum CC depths and forces of as much as 25.7 ± 3.2 mm and 35.9 ± 2.2 N while the TF method produced CC depths and forces of as much as 21.6 ± 2.2 mm and 23.7 ± 2.9 N. These results are consistent with clinical findings which suggest that TT compression is more effective than TF compression since it produces greater CC depths and forces.
    Full-text · Article · Jul 2013 · Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference
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