Selection criteria for resuscitation and survivability rates for neonates at the limit of viability

Salama, H.*, Al Rifai, H., Mahmoud, N., Al Qubasi, M., Al Obaidly, S., Sabry, I., Ben Hadj Khalifa, O., Mousa, A., Sabouni, A. | JNPM 2020;


AIM: To evaluate outcomes of a cohort of infants born at 23 weeks’ gestational age after introducing a new selection score for resuscitation in the delivery room (DR).

METHODS: This was a retrospective charts review study using data from the maternal and newborn registry funded by the Qatar National Research Fund. Parents were consulted prenatally and their wishes were honored. The plan of resuscitation was based on the new selection score. The seven components of the score were four antenatal and three immediate postnatal in the DR. Each component received a score of zero, one, or two according to its presence, uncertainty or absence, respectively. Only a score of≥7 would receive active resuscitation unless specified otherwise during prenatal consultation.

RESULTS: The study reviewed 60 infants that were delivered over a two year period. The DR death rate was 23 of 60 (38%). Thirty-seven infants (61%) were admitted to the NICU. The score was applied only on 37 infants where all score criteria were reported in their files. Twenty infants had score <7; of them 13 (65%) died in the DR and 7 were admitted to NICU of whom two (29%) survived to discharge. Seventeen babies with scores≥7 admitted to NICU of whom nine (51%) survived to discharge. The survival rate to discharge was 13 of 37(35%). A satisfaction survey included 33 neonatal physicians; 32 neonatologists stated the score was easy to comprehend, 26 voted for easy to implement, and 30 voted for ethical relief and moral comfort.

CONCLUSIONS: Using a resuscitation score of seven was associated with improved survival until the discharge of those infants resuscitated. NICU physicians described the score as functional and convenient.

*Corresponding Author: 

Husam Salama, Division of Neonatal and Perinatal Medicine, Hamad Medical Corporation, Doha, P.O. Box: 3050. Qatar. Tel.: +974 55262159; E-mail: