Life-threatening situations for the newborn require difficult decisions about whether to initiate resuscitation. There are recommendations and practice guidelines, but the clinician must treat each birth as unique, with individualized decisions.

After obtaining all of the newborn’s vital information, the attending physician may confirm that the infant has no chance of survival and should not undergo resuscitation. Discussion and inclusion of the family are essential when making this determination.

At birth, palliative care is provided to keep the baby as comfortable as possible. A baby born at < 22 weeks gestation or with severe chromosomal abnormalities is a patient for which withholding resuscitation may be the best option.

If there is a high risk of mortality and resuscitation might significantly burden a baby, the team should consider withholding resuscitative efforts. The attending physician should discuss the risks and benefits of resuscitation with the parents. If it is agreed that further resuscitative efforts are not in the baby’s best interest and may pose a significant burden to the baby and that the chances for long-term survival are close to none, then palliative measures should commence. Palliative care focuses on ensuring that the baby is as comfortable as possible. 

Withholding resuscitation and life-support measures is ethical if the attending physician and the parents have concluded that the treatment is no longer in the baby’s best interest. If the parents are not ready to make a determination, it is better to perform resuscitation pending further discussion.