Neonates may occasionally present in cardiorespiratory arrest. Although SIDS should be considered, catastrophic deterioration is more likely to be due to infectious causes (e.g., septicemia or meningitis), trauma (e.g., intracranial bleeding or child abuse), and inborn errors of metabolism (e.g., medium-chain acyl dehydrogenase deficiency).
In most cases, cardiopulmonary resuscitation is unsuccessful, since the myocardium has suffered severe hypoxic ischemic damage. The physician's role in such cases is to provide supportive care for the family. In most cases, this entails reassurance that all appropriate efforts were made to save their child's life and that the infant has been treated with dignity. Other personnel (e.g., chaplain, social worker, or family physician) may also be required to provide support.
When the cause of death is not known, physicians should obtain appropriate samples (blood, urine, skin biopsy, etc.) and obtain permission for an autopsy. Such postmortem studies are very important because of the genetic implications of metabolic disease. A postmortem protocol for sudden neonatal deaths should be available in all emergency departments.6364
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