Resuscitation beyond 10 minutes of term babies born without signs of life

To obtain population-based data on babies who were admitted to a neonatal intensive care unit despite having Apgar scores of 0 up to and including 10 min, and to document their outcomes. We aimed also to review other studies where outcomes following a 10-min Apgar score of 0 were described, and to combine them with own results. Current recommendations regarding the discontinuation of resuscitation will be reconsidered in light of these results.

In order to obtain population-based data for babies born in New South Wales (NSW), a request was made to the NSW Neonatal Intensive Care Unit Study (NICUS) directors to allow identification of babies in the NICUS database with Apgar scores of 0 at both 1 and 5 minutes. Individual directors were then asked to determine from their hospital records, which of these babies had a 10-minute Apgar of 0, and to provide the results of follow-up assessments of any survivors in this subgroup.

Twenty-nine full-term newborns with a 10-minute Apgar score of 0 were identified. Twenty of the 29 babies died before leaving hospital. Of the 9 who were discharged alive, eight had severe disability and one had moderate disability. Thus death or severe disability occurred in 28/29 (97%), and death or any disability in 100%. Combining with other published studies, death or severe disability occurred in 63/64 (98%).

The above findings strongly support the discontinuation of resuscitation if a baby remains asystolic at 10 minutes.