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Shah and colleagues from Western Australia present the latest in a series of papers, suggesting that outcomes for infants who have received prolonged resuscitation in the delivery room are more favourable than before.1 They report 13 near-term infants who had an Apgar score of 0 at 10 min and were admitted to intensive care. Five of the 13 infants survived and 4 of the 5 appeared to have normal development at 1–2 years of age (one of the infants had hearing impairment). One of the five survivors developed severe spastic quadriplegia.1
Similar findings were reported recently in this journal by Kasdorf et al.2 They reported nine infants managed in a New York hospital, and combined their results with data from three of the therapeutic hypothermia trials and one other previously published report.3 In total, Kasdorf et al2 analysed a cohort of 90 infants with an Apgar score of 0 at 10 min who were admitted to intensive care. Fifty per cent of the infants survived to discharge from hospital, and 49% of the survivors were developmentally normal at follow-up at 1–2 years.2 Longer-term developmental outcome data are available for a subgroup of these infants who were enrolled in the US NICHD cooling trial.4 Twenty four infants in that trial had an Apgar score of 0 at 10 min. Eleven (46%) survived to age 6–7 years, and 5/11 (46%) had mild or no disability at follow-up.4
Considered together, these results are in striking contrast to earlier studies and should cause us to question current recommendations in consensus resuscitation guidelines. A systematic review in 2007 identified 94 infants from eight reports.5 Seventy eight infants (83%) died, while 10/13 (76%) of survivors with available long-term follow-up were severely impaired. The authors concluded that the outcome for infants with an …
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Contributors DW and BS conceived and planned this article. DW wrote the first draft and edited the manuscript. BS reviewed and edited the manuscript.
Funding DW was supported by a grant from the Wellcome Trust (086041/Z/08/Z) during the preparation of this manuscript.
Competing interests BS has been a member of the ILCOR neonatal group and is editor of the Fetal and Neonatal edition of Archives of Disease in Childhood. DW has contributed to recent RCPCH guidelines on decisions around life-sustaining treatment and is an associate editor of the Journal of Medical Ethics. The views expressed in this article are solely those of the authors and do not represent the views of any other organisation.
Provenance and peer review Commissioned; internally peer reviewed.
Data sharing statement DW had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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