Abstract 12791: Heart Rate at One Minute Impact Neonatal Resuscitation & Clinical Outcomes in Infants
Introduction: Fetal hypoxia from intrapartum events can lead to absent heart rate (HR) or bradycardia (BC) at birth requiring neonatal resuscitation. Neonatal resuscitation guidelines do not differentiate infants with BC (HR<100/min) from absent HR at birth;
Hypothesis: As HR is the primary determinant of resuscitation, we hypothesize that infants with no HR at 1min [determined by Apgar score (AS) of 0 @ 1min] would require more extensive resuscitation with worse clinical outcomes compared to infants with BC at 1min (determined by AS=1 @ 1 min).
Methods: A retrospective analysis was done on infants born from 1/1/00 - 12/31/15 with AS of 0 (ASZ grp) or AS of 1 (ASN grp) at 1min. Patient demographics, resuscitation characteristics & clinical outcomes were analyzed in both the groups. Descriptive statistics & logistic procedure was performed (SAS System, Cary, NC).
Results: Table.1 summarizes the resuscitation characteristics analyzed. AS were different between the groups over time (Fig.1). Death was higher in ASZ grp compared to ASN grp [0.37 (0.18-0.77)] & at lower gestational ages (GA) [0.82 (0.76-0.89)]. Infants who died had lower AS at 5 min [0.67 (0.55-0.82)]. Infants < 32 wks GA had higher incidence of PDA & severe IVH in the ASZ grp.
Conclusions: Infants with no HR at 1min did worse than infants with BC. Death & low AS may reflect the severity of illness at birth, particularly in premature infants with no HR. Current guidelines do not address management of infants with HR of zero at birth. NRP need to include an algorithm for a subset of infants with absent HR at birth, as prompt resuscitation may decrease mortality & improve clinical outcomes of these infants.
Author Disclosures: V.H. Kumar: None. A. Skrobacz: None. C. Ma: None.
- © 2016 by American Heart Association, Inc.