Haines, Morgan, Wright, Ian M., Bajuk, Barbara, Abdel-Latif, Mohamed E., Hilder, Lisa, Challis, Daniel, Guaran, Robert, and Oei, Ju Lee (2016) Population-based study shows that resuscitating apparently stillborn extremely preterm babies is associated with poor outcomes. Acta Paediatrica, International Journal of Paediatrics, 105 (11). pp. 1305-1311.

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Abstract

Aim: This population-based study determined the delivery room management and outcomes of extremely preterm infants born with Apgar scores of 0.

Methods: We linked birth, neonatal intensive care unit (NICU) and death records for babies who were born between 22 + 0 and 27 + 6 weeks of gestation with a one-minute Apgar score of 0, in New South Wales, Australia, between 1998 and 2011.

Results: We classified 2173/2262 (96%) of infants with a one-minute Apgar score of 0 as stillborn. Resuscitation was provided for 48/89 (54%) live births and 40/2173 (2%) stillbirths. Cardiac massage was given to 44 infants, including three 22-week stillborn babies. Of the 13 live births admitted to an NICU, 11 survived to hospital discharge. Most (98%) of the 2212 deaths occurred on the first day of life. One baby who was classified as stillborn lived for 51 days. Resuscitation increased the mean (95% confidence interval) duration of survival from 1 (0–2) to 45 (0–104) hours (p < 0.001). No infant with a five-minute Apgar score of 0 survived.

Conclusion: Clinicians resuscitated extremely preterm infants without a detectable heartbeat, even at 22 weeks of gestation. No infant survived without resuscitation or if their heartbeat was not regained by five minutes.

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