Neonatal resuscitation with no detectable heartbeat.

Abstract

Shah et al.1 recently published a study on the long term outcomes for infants with Apgar scores of 0 at 10 minutes and concluded that long-term outcomes for survivors may not be universally poor as suggested by previous studies.2 The decision to stop resuscitation can be very challenging even for experienced paediatricians. The major clinical question is what proportion of these infants survive without major neurological sequelae if resuscitation proceeds beyond the 10 minutes advised by the Australian Resuscitation Council.3 Therapeutic hypothermia treatment for neonatal hypoxic ischaemic encephalopathy (HIE) reduces mortality without increasing major disability in survivors.4 The authors argued that the current resuscitation guidelines are based on old observational data before therapeutic hypothermia became standard treatment for HIE. Thirteen infants were included in the study. Four out of the five surviving infants (30.7% of all the infants in the study) had normal formal infant developmental scores on follow up although one of them was treated with hearing aids for sensorineural deafness. Only one out of the five survivors had severe neurological sequelae in the form of spastic quadriplegia. Eight infants did not survive to discharge. Despite the small number of infants included in this study, it generates fresh debate on the need for more and larger studies to answer the question of long-term neurological outcomes of infants with undetectable heart rates at 10 minutes and raises the question of whether we need to review current resuscitation guidelines on when to stop resuscitation given the wide usage of therapeutic hypothermia.