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Resuscitation References Update: New Concept InNeonatal Resuscitation

February 27, 2012

There have been major changes in the way that newly born infants are managed in the

delivery room. Colour is no longer recommended as a useful indicator of oxygenation or

effectiveness of resuscitation. Pulse oximetry provides rapid, continuous and accurate

information on both oxygenation and heart rate. Resuscitation of term infants should

begin with air, with the provision of blended oxygen to maintain oxygen saturations

similar to those of term infants requiring no resuscitation. Positive end-expiratory

pressure during initial ventilation aids lung aeration and establishment of functional

residual capacity. Respiratory function monitoring allows operators to identify factors

adversely affecting ventilation, including leak around the face mask and airway

obstruction. Clamping of the umbilical cord should be delayed for at least 1 min forinfants not requiring resuscitation. The use of intensive care techniques in the deliveryroom is promising but requires further evaluation. Monitoring techniques and

interventions need to be adapted for use in developing countries.

Point Update in Neonatal resuscitation: Progression to the next step following an initial evaluation is now defined by

simultaneous evaluation of HR and respirations. Pulse oximetry should be used for evaluation of oxygenation because colour

assessment is unreliable.

Room air resuscitation should be started for all term and preterm infants (theinitial gas concentration for very preterm infants is unclear). Administration of supplementary oxygen should be regulated by blending air

and oxygen, and should be guided by oximetry. Available evidence does not support or refute routine endotracheal suctioning

of infants born through MSAF, even when depressed. Until further informationis available, endotracheal suctioning of nonvigorous babies should beperformed.

The chest compression-ventilation ratio remains at 3:1. A higher ratio mightbe considered if an arrest is of cardiac etiology.

Therapeutic hypothermia should be considered within 6 h for infants born atterm or late preterm gestation with evolving moderate-severe hypoxicischemic encephalopathy (with protocol and follow-up through a regionalperinatal system).

It is appropriate to consider discontinuing resuscitative efforts after there hasbeen no detectable heart rate for 10 min.

Cord clamping should be delayed for at least 1 min in babies not requiringresuscitation. There is insufficient evidence to recommend a time for clampingin babies who require resuscitation.

Simulation should be used as a teaching methodology in resuscitationeducation, but the most effective methods of teaching and evaluation remain

to be defined. It is reasonable to recommend the use of briefings and debriefings during

learning activities both in simulation and in clinical activities.

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