Twelve‐year review of neonatal deaths in the delivery room in a perinatal tertiary centre

Abstract

To describe decisions made for babies who died in the delivery room as a result of clinical practice of non-resuscitation or unsuccessful resuscitation. A retrospective study was conducted of neonatal deaths (NNDs) ≥ 400 g and/or ≥20 weeks' gestation born at Mater Mothers' Hospitals 1998-2009 who were not admitted to a neonatal nursery. Deaths were divided into not resuscitated and unsuccessful resuscitation and subdivided by cause of death as extremely preterm, congenital abnormality or 'other'. Of all 539 NNDs, 217 (40.3%) were not admitted to a neonatal nursery, comprising 174 (80.2%) not resuscitated and 41 (18.9%) unsuccessful resuscitation, while in a further two newborn infants resuscitation was not required. Only 13 of 123 (10.6%) extremely preterm infants who died in the delivery room had resuscitation attempted. Of 77 infants who died from congenital abnormalities in the delivery room 18 (23.3%) had resuscitation attempted. Fifteen babies with other diagnoses died in the delivery room; five with severe intrapartum asphyxia without resuscitation and a further 10 (8 preterm) with Apgar scores of 0-1 at 1 min and ≤3 at 5 min who did not respond to extensive resuscitation. A large proportion of NNDs occurred outside the neonatal nurseries involving end-of-life decision-making. Review of the circumstances of these NNDs in the subcategories of extreme prematurity, congenital abnormalities and 'other' raises different management dilemmas with the potential for clinical practice improvement in compassionate care and transparency in decision-making.