What is a reasonable time frame after birth for considering cessation of resuscitation efforts when there is an absence of heart rate?

In the context of neonatal resuscitation, guidelines recommend that if there is no evidence of heart rate restoration after effective resuscitation efforts, practitioners can consider cessation of resuscitation efforts around 20 minutes after birth. This time frame is informed by clinical evidence regarding the outcomes of newborns who have not shown a return of heart rate despite intensive resuscitative measures.

The rationale behind this guideline is based on the understanding that the probability of achieving a favorable outcome diminishes significantly after this duration without restoration of a viable heart rate. After approximately 20 minutes, the likelihood of reversible causes being identified and corrected decreases, and the risks associated with prolonged resuscitation efforts may outweigh the potential benefits, particularly in the absence of clear signs of viability.

In practice, decisions about the continuation or cessation of resuscitation efforts are complex and may also take into account other clinical signs, the context of the birth, gestational age, and protocols established in specific healthcare settings. However, the 20-minute benchmark serves as a guideline that supports a balance between providing sufficient time for potential recovery while also recognizing the limits of resuscitation efficacy.