Population-based study shows that resuscitating apparently stillborn extremely preterm babies is associated with poor outcomes

Morgan Haines; Ian M Wright; Barbara Bajuk; Mohamed E Abdel-Latif; Lisa Hilder; Daniel Challis; Robert Guaran; Ju Lee Oei

doi:10.1111/apa.13503

Population-based study shows that resuscitating apparently stillborn extremely preterm babies is associated with poor outcomes

Acta Paediatr. 2016 Nov;105(11):1305-1311. doi: 10.1111/apa.13503. Epub 2016 Jul 14.

Authors

Morgan Haines¹, Ian M Wright^{2

3}, Barbara Bajuk⁴, Mohamed E Abdel-Latif^{5

6}, Lisa Hilder¹, Daniel Challis⁴, Robert Guaran⁴, Ju Lee Oei^{7

8}

Affiliations

¹ School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
² Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, Australia.
³ Department of Paediatrics, The Wollongong Hospital, Wollongong, NSW, Australia.
⁴ New South Wales Pregnancy and Newborn Services Network, Westmead, NSW, Australia.
⁵ Department of Neonatology, The Canberra Hospital, Garran, ACT, Australia.
⁶ Faculty of Medicine, The Australian National University, Deakin, ACT, Australia.
⁷ School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia. J.oei@unsw.edu.au.
⁸ Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia. J.oei@unsw.edu.au.

PMID: 27334852
DOI: 10.1111/apa.13503

Abstract

Aim: This population-based study determined the delivery room management and outcomes of extremely preterm infants born with Apgar scores of 0.

Methods: We linked birth, neonatal intensive care unit (NICU) and death records for babies who were born between 22 + 0 and 27 + 6 weeks of gestation with a one-minute Apgar score of 0, in New South Wales, Australia, between 1998 and 2011.

Results: We classified 2173/2262 (96%) of infants with a one-minute Apgar score of 0 as stillborn. Resuscitation was provided for 48/89 (54%) live births and 40/2173 (2%) stillbirths. Cardiac massage was given to 44 infants, including three 22-week stillborn babies. Of the 13 live births admitted to an NICU, 11 survived to hospital discharge. Most (98%) of the 2212 deaths occurred on the first day of life. One baby who was classified as stillborn lived for 51 days. Resuscitation increased the mean (95% confidence interval) duration of survival from 1 (0-2) to 45 (0-104) hours (p < 0.001). No infant with a five-minute Apgar score of 0 survived.

Conclusion: Clinicians resuscitated extremely preterm infants without a detectable heartbeat, even at 22 weeks of gestation. No infant survived without resuscitation or if their heartbeat was not regained by five minutes.

Keywords: Extremely preterm; Mortality; Outcomes; Resuscitation; Stillbirth.

MeSH terms

Apgar Score*
Female
Gestational Age
Hospitals / classification
Hospitals / statistics & numerical data
Humans
Infant
Infant, Extremely Premature*
Infant, Newborn
Intensive Care Units, Neonatal
Male
Maternal Age
New South Wales / epidemiology
Outcome Assessment, Health Care / statistics & numerical data*
Perinatal Mortality*
Pregnancy
Pregnancy Complications, Cardiovascular
Prenatal Care / statistics & numerical data
Resuscitation / methods
Resuscitation / statistics & numerical data*
Smoking / adverse effects
Smoking / epidemiology
Stillbirth*