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A 24-week gestation infant is born with no respiratory effort, no detectable heart beat and absent tone. Despite intubation, surfactant and ventilatory support, the heart beat remains undetectable. The infant receives chest compressions and a dose of epinephrine after which a heart beat is detected. The heart rate increases and the baby is admitted to the neonatal unit. The attending neonatal registrar would like to know what effect cardiopulmonary resuscitation (CPR) at birth has on survival and risk of disability in infants born extremely prematurely.
Structured clinical question
In extremely preterm infants [population], what is the effect of cardiopulmonary resuscitation at delivery [intervention] on survival and neurodevelopmental outcome [outcome]?
Search strategy and outcome
Under “disorders related to short gestation”, the ICD-10/WHO defines “extreme immaturity” as “less than 28 completed weeks of gestation”.1 The Nuffield Council on Bioethics defines “extremely premature” as “birth before 27 weeks gestation” and states “the approximate equivalent of extreme prematurity is a birth weight of less than 1000 g”.2 The British Association of Perinatal Medicine framework for practice on the management of babies born extremely preterm discusses care for babies born at less than 26 weeks gestation.3
As there was no MeSH term for ‘extremely preterm infant’, ‘premature infant’ was applied in searching. To enable inclusion of results from studies indexed by birth weight, ‘low birthweight’ was also applied. Studies retrieved have gestational ages and outcomes according to birth weight stipulated to enable interpretation of results.
A search of the Cochrane Library using ‘premature or low birthweight infant’ and ‘CPR’ yielded one relevant …