If a baby has no confirmed heart rate 20 minutes after birth despite all appropriate resuscitation efforts, the team should consider ending the resuscitation. The decision should, of course, encompass all relevant patient and contextual factors. 

When resuscitative measures are withheld or aborted, palliative care becomes the focus of care for the baby, and healthcare providers shift to providing comfort to the baby and family. The attending physician can offer to bring the baby to the parents. There are some important considerations and changes in routine measures that should be implemented before and during this challenging time.

All alarms and monitors can be turned off. Unnecessary tubes, tapes, leads, and equipment can be disconnected if no further medical examiner investigation is needed. The baby should be clean and wrapped in a fresh, warm blanket. Narcotics can be administered orally, intranasally, or intravenously to remove any pain. 

Before presenting the dying baby to the parents, the physician should first inform them about what to expect—the baby’s appearance and present condition, agonal gasps, color, persistent heartbeat, and continuous movements. It may help to point out the baby’s memorable features. 

The parents should be given some private time with their baby with a healthcare provider nearby. The provider should intermittently auscultate for a full 60 seconds for a heartbeat. The physician should discuss the option for an autopsy. An autopsy may address the parent’s concerns or give them closure regarding what caused their baby’s death. It may provide information for future pregnancy planning.

The hospital and its staff must be mindful of the cultural aspects of care surrounding a newborn’s death and respect the traditions of parents and family members. Hospitals should accommodate and support family traditions whenever possible. 

The hospital should have protocols in place to connect the parents with support after leaving the hospital. They can be referred to a bereavement professional or a support group. The parents should also be provided with contact information for the attending physician, primary care doctor, and obstetrician to ask questions that come up for them over time about why and how their baby died.