557 - Outcomes at two years of age for term infants with no heart rate detected at 10 minutes in the UK and Ireland: a prospective national cohort study

Publication Number: 3538.557

Katie Mckinnon, University of Edinburgh, London, England, United Kingdom; Katherine Roberts, Children's Hospital, Edinburgh, Scotland, United Kingdom; Ewen D.. Johnston, NHS Lothian, Edinburgh, Scotland, United Kingdom; Julie-Clare Becher, University of Edinburgh, Edinburgh, Scotland, United Kingdom; Colm P.F.. O'Donnell, National Maternity Hospital; University College Dublin, Dublin, Dublin, Ireland; Benjamin J. Stenson, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom; Gemma Sullivan, University of Edinburgh, Edinburgh, Scotland, United Kingdom

Background: The International Liaison Committee on Resuscitation recommends considering stopping neonatal resuscitation efforts if there is no response by 20 minutes of age. However, this is based on limited data from historical retrospective studies.

Objective: To describe the incidence, clinical features and outcomes for term infants born in the UK and Ireland who did not have a heart rate (HR) detected at 10 minutes after birth.

Design/Methods: We conducted a prospective study using the British Paediatric Surveillance Unit reporting system (Dec 2020-Dec 2022). Eligible infants were: ≥37 weeks’ gestational age (GA), resuscitated after birth, and did not have a HR detected at 10 minutes. We describe demography, labour and delivery, resuscitation, brain MRI, survival, and neurodevelopmental outcome at two years. Ethical approval: South-East Scotland REC (17/SS/0009), HRA CAG (19/CAG/0002), HSC-PBPP (1819-0054).

Results: We received 171 notifications, and 92 cases were identified after removal of duplicates. Incidence was 6 per 100,000 live births. Infants were 52% female, with mean birth GA 39.4 weeks. Mean lowest cord/neonatal pH was 6.78 (SD 0.20) and mean highest lactate was 19.1 (SD 6.4). Mean time to first HR was 20.5 (SD 7.6) minutes.
Seventy-eight (85%) infants were admitted to a neonatal unit. Therapeutic hypothermia was initiated for 73/78. Thirty-six infants had brain MRI: 11/36 were normal, 23/36 showed hypoxic-ischaemic injury, 2/36 showed ischaemic stroke. Twenty-nine (32%) infants survived to discharge.

At two years, 26/29 are known to be alive (12 female, 14 male); the status of the remaining three children is unknown. 8/26 children have severe neurodevelopmental impairment (CP with GMFCS score of IV or V, blindness, deafness cognitive/language scores ≥ 3 SD below the mean). Six of these children also have a seizure disorder. 4/26 children have moderate impairment (CP with GMFCS score of II or III, correctable hearing/visual impairment or cognitive/language scores 2-3 SD below the mean). 6/26 children have mild impairment (CP with GMFCS score of I, mild hearing/visual impairment or cognitive/language scores 1-2 SD below the mean). 8/26 children have normal neurodevelopment.

Conclusion(s): Among term infants, not detecting a HR at 10 minutes is a rare event. Nearly one third of infants survived to two years of age. Less than one third of survivors had severe neurodevelopmental impairment. These data suggest that good outcomes are possible beyond the current recommendations. The time to first heart rate by auscultation should not be used in isolation to guide the decision to stop resuscitation efforts.