Resuscitation and beyond

[Sutirtha Roy]

Dear Stefan,

How are you?
Even after extensive search we could not find any evidence based answer for the scenario mentioned below.

[except "Discontinuation of Neonatal Resuscitation In Term > Babies",Rollo D Clifford, Fetal Neonatal Ed. Online, 22 May 2007].

I would like to know if is there Standard Guideline/Protocol/ Recommendation/Recent Study regarding the ongoing management of Term/ Post Term Neonates* having persisting HR more than 120/m but with no Spontaneous Respiration even after 20 minutes after the initiation of Resuscitation?
*Newborn with Severe Perinatal Asphyxia but no maternal narcotic history.

In a Set up where no Basic Mechanical Ventilatory Support is available what should be the line of further management?

What should be the ethical,moral, medico-legal [irrespective of country of origin,religious,colour,class,cast and creed] point of view?

Looking for your kind Reply.

My Best Regards, Dr .Sutirtha Roy.

[Stefan Johansson]

Dear Sutirtha Roy,
this is really an interesting issue. I think one could try to stretch the scientific question on outcomes on such cases using observational methodology (using national registers, for example)
And, one need to consensus within the medical/scientific community upon a pragmatic strategy.

Our current Swedish (national) guidelines include the following recommendations:
1. if there are no heart activity after 15 minutes of full neonatal resuscitation (incl intubation , adrenalin etc) - resuscitation is stopped.
2. if there are only heart activity but not spontaneous breathing after 30 min of full neonatal resuscitation, no further resuscitation is recommended.


Let's hope more people share their views upon this difficult topic.

Best wishes, Stefan

PS. I think you refer to this letter in ADC. I could not read it full-text from home though:
http://fn.bmj.com/cgi/content/extract/93/1/F78

[Lama]

This has been addressed by WHO.WHO recommendations:
If no spontaneous breathing after 20min of adequate ventilation, continue for 30min while preparing for transfer to NICU OR Discontinue if no NICU care available.
See WHO web site on neonatal resuscitation guidelines.