The ethics of delivery-room resuscitation

Clinical Assessment of Extremely Premature Infants in the Delivery Room Is a Poor Predictor of Survival

“…12 In Singh's study, 3 Apgar scores and heart rate at 1 and 5 minutes were shown to be poor predictors of neonatal outcome. A previous study using videos of newborn infants at our institution concluded that there is wide variation between clinicians in the assessment of an infant's color (when the infant becomes 'pink') in the minutes after birth.…”

“…A previous study using videos of newborn infants at our institution concluded that there is wide variation between clinicians in the assessment of an infant's color (when the infant becomes 'pink') in the minutes after birth. 13 Although there are data suggesting antenatal estimation of GA is imperfect, 12 what the caregiver felt intuitively was likely to happen to the infant) and serial illness severity scores in predicting the outcomes of death in the NICU in a cohort of premature infants with a median GA of 26 weeks. They found no statistical difference between scores in survivors and nonsurvivors, and concluded that serial intuition scores failed to identify prospective nonsurviving infants.…”

Outcomes of infants born at borderline viability (23–25 weeks gestation) who received cardiopulmonary resuscitation at birth

“…There is wide variation in the rates of DR‐CPR in ELBW infants and there is no consensus on whether to offer advanced resuscitative measures to infants born at borderline viability as many clinicians perceive this as futile . This decision is clinically and ethically challenging to both health‐care providers and parents.…”

“…However, there is a grey zone in regards to what is considered standard of care in the context of providing advanced resuscitative measures to infants born at borderline viability . The 2009 British Association of Perinatal Medicine framework for practice on the management of infants born at borderline viability states: ‘There is no evidence to support the use of epinephrine by any route, or chest compressions, during resuscitation at gestational age < 26 weeks’ .…”