Background The use of drugs during resuscitation of extremely preterm infants remains contentious, and while there may be short term gain, long term survival is thought to be poor. We set out to determine the survival and developmental outcome of infants who had received Epinephrine during delivery room resuscitation or at any time during their stay on the neonatal intensive care unit.

Method We conducted a retrospective case note audit on infants who were equal or less than 26 weeks gestation who received Epinephrine during resuscitation. The study period was from 1 January 2004 to 31 December 2008. Infants were excluded if they were outborn or had significant congenital anomalies.

Results During the 5 year period 361 infants ≤26 weeks were admitted to the regional neonatal unit, of which 156 were inborn. 25 of these infants received epinephrine during resuscitation and were therefore included in our analysis. Mean gestational age was 25 weeks and mean birth weight was 667 g. Mortality in patients who received epinephrine during resuscitation was 80% as 20 infants eventually died. Of the five infants who survived to 1 year, one had significant neurodevelopmental delay (visual impairment and delayed speech), one had hearing impairment, two infants had no delay noted at age 1 year and one patient was lost to follow-up.

Conclusion Survival in extremely preterm infants who require epinephrine during resuscitation is poor. The role of epinephrine in cardiopulmonary resuscitation of these infants may not be appropriate and therefore requires careful consideration.