Length of Resuscitation for Severely Depressed Newborns

Abstract

Objective Current guidelines for neonatal resuscitation suggest it may be reasonable to stop resuscitation after 10 minutes in infants born with no detectable heartbeat. This study describes the length of resuscitation provided in a cohort of profoundly compromised newborn infants. Study Design Chart review of a regional hospital system database of newborn infants from 2010 to 2017 with a documented 10-minute Apgar score of 0 or 1. Results From a total birth population of 49,876 infants, 172 newborns were identified. Of these, 133 infants did not receive resuscitation and died while receiving comfort care. In the 39 resuscitated infants, 15 (38%) achieved return of spontaneous circulation (ROSC) at an average of 20 minutes; 32 of these 39 newborns (82%) died within 24 hours. Average time to ROSC for survivors was 17.8 minutes. Death or severe neurologic disability at 15 to 24 months of age was present in 92% (36/39) of resuscitated infants. Conclusion Prolonged resuscitation of newborns is rare. In this cohort, 92% died or had severe neurodevelopmental disability. Infants with ROSC received 20 minutes of resuscitation. Infants with ROSC typically did not survive beyond 24 hours unless they survived to discharge. To increase the number of infants with ROSC, continuing resuscitation beyond 10 minutes may be reasonable.

Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

“…There was important heterogeneity [ 1 1 2 8 _ T D $ D I F F ] across studies (and in some cases, within studies) about the timing and tools used to assess neurodevelopmental outcomes that precluded calculation of confidence intervals. Casalaz, 1998 104 Harrington, 2007 103 Jain, 1991 106 Sproat, 2017 111 Zhang, 2019 117 131 13% (17/131) 88% (15/17) 60% (9/15) 7% (9/131)…”

“…Ayerapetyan, 2019 116 Kasdorf, 2015 107 Natarajan, 2013 108 Sarkar, 2010 109 Shah, 2015 110 Shibasaki, 2020 112 Sproat, 2017 111 Zhang, 2019 117 Zhong 116 Casalaz, 1998 104 Harrington, 2007 103 Kasdorf, 2015 107 Natarajan, 2013 108 Patel, 2004 114 Sarkar, 2010 109 Shah, 2015 110 Shibasaki, 2020 112 Sproat, 2017 111 Zhang, 2019 117 Zhong 104 Harrington, 2007 103 Shah, 2015 110 Sproat, 2017 111 Zhang, 2019 117 Zhong, 2019 113 Note: Neurodevelopmental outcomes in postdischarge follow-up were reported in 13 studies using structured exams. 103,104,106À 112,114 À 117 In 11 studies, these assessments used validated developmental assessment tools.…”

Duration of Resuscitation at Birth, Mortality, and Neurodevelopment: A Systematic Review

“…Sixteen eligible studies enrolling 579 newborns were included in this review. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] All studies were conducted in wellresourced settings, representing Australia, Canada, Japan, the United Kingdom, and the United States (Table 1). There was important clinical and methodologic heterogeneity among studies.…”

2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 8. Neonatal resuscitation

“…In previous studies about the prognosis of newborns who underwent CPR for ≥ 10 minutes after delivery, the proportion of those admitted to the neonatal intensive care unit and the proportion of surviving newborns were significantly different depending on the studies. [209][210][211][212][213][214][215][216][217][218][219][220][221][222] Newborns who underwent CPR for ≥ 10-20 minutes immediately after birth and did not show recovery of spontaneous circulation had a high risk of mortality and moderate-to-severe neurological impairment even if they survived. However, there is currently no evidence that a specific CPR duration is associated with death or neurological sequelae.…”