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I read with interest the editorial by D Wilkinson and B Stenson
commenting on a series of papers which suggest that current outcomes of
neonates with APGAR scores of zero at 10 minutes are not universally poor.
Given that stopping at 10 minutes in all cases will then lead to a number
of unnecessary death they rightly ask what stopping time is appropriate.
I wonder if this is the right question. A baby who has fa...
I wonder if this is the right question. A baby who has failed to
respond to expert and prompt resuscitation by 10 or 12 minutes is likely
to have a different prognosis to a baby who has had delayed or sub optimal
resuscitation with possibly intubation first occurring at 10 minutes or
more. We know from clinical experience that babies who requiring
resuscitation due to hypovolaemia rather than prolonged fetal hypoxia
often do better than their APGARs would suggest. Time from birth alone
would seem to be too simplistic to predict the inevitability of death or
severe disability in a very disparate group of infants.
We need a paradigm shift possibly towards response to treatment as a
predictor. Research is needed to identify a predictor that is both
specific and easily clinically applicable in the first 20 minutes of life.
The question is not "what is the right time" but "what is the right