Legal Briefs: Extremely Preterm Infant, Pronounced Dead, Comes to Life, But Outcome Is Compromised

Abstract

A 233/7 weeks’, 592-g female infant was born to a 19-year-old-mother with a benign prenatal course until the development of preterm labor. When contractions began, the mother was hospitalized and received tocolysis and a full course of antenatal corticosteroids. After 3 days of hospitalization, the membranes spontaneously ruptured, labor progressed, and her footling breech fetus was delivered by emergency cesarean section. The neonatologist discussed medical intervention, comfort care, and data on mortality and morbidity in infants of similar gestation with the parents before delivery. The parents wanted resuscitation and full medical intervention after birth if the estimated gestational age and birth weight before birth were validated after delivery and if no unforeseen findings that would alter the outcome appeared. The fetal heart rate (HR) pattern was unremarkable, with the fetal HR being 145 beats per minute immediately before birth. At delivery, the infant had a similar HR, palpable pulses, and respiratory effort. At 30 seconds after birth, a 2.5-mm endotracheal tube (ETT) was inserted through which positive pressure ventilation was started because the respiratory effort was weak. The HR decreased to 58 beats per minute at 1 minute at which point chest compressions were initiated. Two rounds of endotracheal epinephrine via ETT were given because of a HR that continued to decrease. At 11 …