From the Guidelines
Neonatal Resuscitation Guidelines: Resuscitation would be attempted on a neonate at a gestational age of 22 weeks or more, as these infants are considered potentially viable 1.
Key Considerations
- The decision to initiate resuscitation should be individualized and based on the specific circumstances of the birth, including the infant's overall condition and the presence of any major congenital anomalies.
- Assessment for resuscitation is recommended for neonates born at 22 weeks of gestation or more, with the approach to care depending on parental preferences regarding resuscitation 1.
- Positive pressure ventilation with room air should be initiated if the heart rate is less than 60 beats per minute, and epinephrine (0.01 to 0.03 mg/kg) may be administered intravenously or intraosseously if the heart rate remains less than 60 beats per minute despite effective ventilation.
Important Factors
- Gestational age: The gestational age at which resuscitation is attempted may vary depending on the specific circumstances of the birth and the potential for viability 1.
- Parental preferences: The approach to care should be informed by parental preferences regarding resuscitation, with a focus on either optimizing survival or minimizing suffering 1.
- Clinical condition: The decision to initiate resuscitation should be based on the infant's overall clinical condition, including the presence of any major congenital anomalies 1.
From the Research
Gestational Age for Neonatal Resuscitation
The gestational age at which neonatal resuscitation is attempted varies, but most studies suggest that it is typically considered for infants born at 22 weeks gestation or later.
- At 22 weeks gestation, the likelihood of survival is very low, and resuscitation is often not attempted 2.
- At 23 weeks gestation, some studies suggest that resuscitation may be attempted if the infant shows signs of vitality, but the outcome is still often poor 3, 4.
- At 24 weeks gestation, resuscitation is more likely to be attempted, but the risk of morbidity and mortality is still high 5, 6.
- At 25 weeks gestation or later, resuscitation is generally attempted, and the prognosis for survival and outcomes is better 6, 4.
Factors Influencing Resuscitation Decisions
The decision to attempt resuscitation is influenced by several factors, including:
- Birth weight: Infants with higher birth weights are more likely to be resuscitated 2.
- Presence of a neonatologist: Infants born in the presence of a neonatologist are more likely to be resuscitated 2.
- Parental preference: Parents' wishes regarding resuscitation are taken into account, but may be overridden if the medical team believes that resuscitation is not in the best interests of the infant 6, 2.
- Infant's condition at birth: Infants who show signs of vitality, such as detectable vital signs, are more likely to be resuscitated 4.