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Are there circumstances when resuscitation of the newly born infant may not be the appropriate action?
Because all ED deliveries are considered “unexpected” and there is no previous relationship with the delivering mother, conversations about withholding resuscitation are difficult at best. Antenatal information can be incomplete or inaccurate. In the ED, it may not be possible to gather this information quickly with precision and reliability. Guidelines should be developed after discussion with local resources, review of the most recent literature, and discussion with parents. Review the guidelines regularly and modify them on the basis of changes in resuscitation and neonatal intensive care practices. If gestational age, birth weight, or congenital anomalies are associated with almost certain death or high morbidity, resuscitation is not indicated. Examples include extreme prematurity (< 23 weeks’ gestation or birth weight < 400 g), anencephaly, and major chromosomal abnormalities incompatible with life.
Sources
Kattwinkel J, Perlman JM, Aziz K, et al: Part 15: Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 Suppl 3):S909-S919.
