title: Population-based study shows that resuscitating apparently stillborn extremely preterm babies is associated with poor outcomes.
abstract: OBJECTIVE
  This population-based study determined the delivery room management and outcomes of extremely preterm infants born with Apgar scores of 0.
  
  
  METHODS
  We linked birth, neonatal intensive care unit (NICU) and death records for babies who were born between 22 + 0 and 27 + 6 weeks of gestation with a one-minute Apgar score of 0, in New South Wales, Australia, between 1998 and 2011.
  
  
  RESULTS
  We classified 2173/2262 (96%) of infants with a one-minute Apgar score of 0 as stillborn. Resuscitation was provided for 48/89 (54%) live births and 40/2173 (2%) stillbirths. Cardiac massage was given to 44 infants, including three 22-week stillborn babies. Of the 13 live births admitted to an NICU, 11 survived to hospital discharge. Most (98%) of the 2212 deaths occurred on the first day of life. One baby who was classified as stillborn lived for 51 days. Resuscitation increased the mean (95% confidence interval) duration of survival from 1 (0-2) to 45 (0-104) hours (p < 0.001). No infant with a five-minute Apgar score of 0 survived.
  
  
  CONCLUSIONS
  Clinicians resuscitated extremely preterm infants without a detectable heartbeat, even at 22 weeks of gestation. No infant survived without resuscitation or if their heartbeat was not regained by five minutes.
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
authors.forename: Morgan
authors.initials: M
authors.lastname: Haines
authors.affiliation: Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, Australia.|Department of Paediatrics, The Wollongong Hospital, Wollongong, NSW, Australia.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Wright
authors.affiliation: New South Wales Pregnancy and Newborn Services Network, Westmead, NSW, Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bajuk
authors.affiliation: Department of Neonatology, The Canberra Hospital, Garran, ACT, Australia.|Faculty of Medicine, The Australian National University, Deakin, ACT, Australia.
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Abdel-Latif
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hilder
authors.affiliation: New South Wales Pregnancy and Newborn Services Network, Westmead, NSW, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Challis
authors.affiliation: New South Wales Pregnancy and Newborn Services Network, Westmead, NSW, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Guaran
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia. J.oei@unsw.edu.au.|Department of Newborn Care, Royal Hospital for Women, Randwick, NSW, Australia. J.oei@unsw.edu.au.
authors.forename: Ju Lee
authors.initials: JL
authors.lastname: Oei
mesh_terms: D001034:Apgar Score; D005260:Female; D005865:Gestational Age; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008423:Maternal Age; D009517:New South Wales / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D054238:Perinatal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011295:Prenatal Care / Q000706:statistics & numerical data; D012151:Resuscitation / Q000379:methods / Q000706:statistics & numerical data*; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D050497:Stillbirth
keywords: Extremely preterm; Mortality; Outcomes; Resuscitation; Stillbirth