End of Life Decision: We are not Playing God?
A 23-year-old primigravida was admitted in labour
at 40 weeks and 2 days gestation. The labour was
complicated by Type 1 deceleration and fetal
bradycardia on cardiotocogram at the second stage. A
baby girl was born shortly with tight loops of umbilical
cord around her neck. The baby had no breathing
effort, and heart beat thus was vigorously resuscitated
by the paediatric team.
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Get Help Now!After intubation and administration of Adrenaline via
the endotracheal tube, the heart beat was audible at
5 minutes of life, although it was still weak. Further
resuscitation with normal saline bolus and sodium
bicarbonate was required. The Apgar score was 0 at
1 minute, 0 at 5 minutes, 0 at 10 minutes, 2 at 13
minutes, 3 at 15 minute and 4 at 20 minutes. The cord
blood gas done showed a severe metabolic acidosis.
In the neonatal intensive care unit, the baby was
supported by the mechanical ventilation. The vital
signs were near normal with blood pressure of 79/48,
heart rate 167/min, oxygen saturation 99% and
temperature 35.8 C. Physical examination revealed the
absence of spontaneous respiration and movement.
There was no eye opening with constricted, unreactive
pupils. At 1 hour, the baby developed intractable
seizure, which required multiple loading with
intravenous phenobarbitone and phenytoin.
Initial investigations showed persistent metabolic
acidosis and elevated cardiac enzymes; troponin T
was 0.09 ng/dl and CKMB was 12.5umol/dl. Renal and
liver functions were impaired. Ultrasound of the brain
showed cerebral oedema, and the chest X-ray revealed
a right pneumothorax. The baby was given a dose of IV
Mannitol 10% and chest tube was inserted to drain the
pneumothorax.
The baby also needed some ionotropic support and
antibiotics for suspected sepsis on the following days.
Despite improvement in clinical parameters and
biochemical changes thereafter, the neurological
impairment remained. Apart from spontaneous
irregular breathing the
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