Part 7: Neonatal resuscitation
Section snippets
Supplementary oxygen versus room airW202A, W202B
There is growing evidence from both animal and human studies that air is as effective as 100% oxygen for the resuscitation of most infants at birth. There are concerns about potential adverse effects of 100% oxygen on breathing physiology, cerebral circulation, and potential tissue damage from oxygen free radicals.
Medications
The primary considerations about medications focused on which drugs should be used and the route by which they should be given. Medications are rarely needed in neonatal resuscitation. Those that may be used include adrenaline and fluids. Very rarely, a narcotic antagonist, sodium bicarbonate,W200 or vasopressors may be useful after resuscitation.
Consensus on science
Numerous observational studies showed an association between hypothermia and increased mortality in premature newborns. Premature infants continue to be at risk for hypothermia when treated according to current recommendations (dry the infant, remove wet linens, place the infant on a radiant warmer) (LOE 5).80 Two randomised controlled trials (LOE 2)81, 82 and three observational studies (LOE 483, 84; LOE 585) confirm the efficacy of plastic bags or plastic wrapping (food-grade, heat-resistant
Consensus on science
Babies born to febrile mothers (temperature >38 °C) have an increased risk of death, perinatal respiratory depression, neonatal seizures, and cerebral palsy (LOE 4).88, 89 During the first 24 h after adult stroke, fever is associated with a marked increase in neurological morbidity and mortality (LOE 7).90, 91 Adult animal studies indicate that hyperthermia during or after ischaemia is associated with a progression of cerebral injury (LOE 6).92, 93
Treatment recommendation
The goal is to achieve normothermia and to avoid
Consensus on science
Mortality and morbidity for newborns varies according to region and availability of resources (LOE 5).113 Social science studies indicate that parents would like a greater role in decisions to start resuscitation and continue life support of severely compromised newborns. Opinions among neonatal providers vary widely regarding the benefits and disadvantages of aggressive therapies in such newborns (LOE 5).114, 115
Some data are available to help identify conditions associated with high mortality
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