What Would You Do? (2)

What would you do in the following clinical scenario?

Delivery: Twin pregnancy. 37 weeks. Twin 1 SVD. Twin 2 high up therefore not delivered immediately. FHR ~120. 20 minutes later they could not detect a fetal heart – mother noted to be tachycardic. Baby born by breech vaginal delivery 5 minutes later. Neonatal team present at delivery. 

At birth: white, floppy, no heart rate, no respiratory effort. 

Resuscitation: Full resuscitation including inflation breaths, cardiac massage, intubation and UVC insertion. 2* adrenaline, bicarbonate and 10% dextrose given. Heart rate detected at 12 minutes. Cord pH 6.70 BE-26. 

On admission to NICU: remained flaccid with no spontaneous movement. No reflexes could be elicited. Pupils fixed and dilated.

  1. What is the diagnosis?

  2. How long should you resuscitate a baby?

  3. Does the baby fit the criteria for cooling?

  4. The baby is very sick – is it appropriate to cool and transfer the baby? Would CFM monitoring help? Would ultrasound or MRI help?