How Long Is Too Long To Resuscitate?

Fewer than one in every 1,000 deliveries is stillborn but, of those that are, little is known about survival and neurologic outcome. Currently, the International Liaison Committee is considering a proposal to stop resuscitative efforts after 10 minutes on stillborn babies, even though most respond to resuscitative treatment beyond that time.

In their presentation here today, How Long is Too Long? Cardiopulmonary Resuscitation (CPR) of Apparently Stillborn Infants, Drs. J.M. Anderson, J.M. Perlman, and M.H. Wyckoff reviewed the findings of their retrospective review of databases from the Parkland Memorial Hospital Neonatal Resuscitative and Neonatal Intensive Care Unit (NICU). They determined that the failure of stillborn infants to respond after 10 minutes suggests that "there are no antenatal or perinatal factors which reliably predict survival or neurologic outcome at discharge."

Criteria for a birth to be included in the study was gestational age at least 38 weeks and no major congenital anomalies. All births took place at the Parkland Memorial Hospital between January 1991 and November 2004. Apgar scores were 0 at 1, 5, and 10 minutes, with resuscitation performed by a team comprising a nurse, respiratory therapist, senior pediatric resident, neonatal nurse practitioner, neonatal fellow, and, often, a neonatal attending physician. The study concluded that, contrary to earlier reports, "54% of near-term and term infants with a 10-minute Apgar score of 0 survived and 29% exhibited a normal neurologic discharge examination."

Differences in outcomes were explained as reflecting "an exclusively inborn population, an experienced and dedicated resuscitation team, or a difference in parental decisions regarding redirection of care in this study population." The researchers also proposed that stillborn infants should still be considered capable of being resuscitated until 15 minutes after birth, in accordance with current recommendations.