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NEONATAL RESUSCITATION GUIDELINES
Category: Child Health
Abstract : Neonatal resuscitation Neonatal resuscitation skills are essential for all
health care providers who are involved in the delivery of newborns. The
transition from fetus to newborn requires intervention by a skilled individual
or team in approximately 10% of all deliveries. This figure is concerning
because 81% of all babies in the United States are born in nonteaching
nonaffiliated le
Neonatal resuscitation
Neonatal resuscitation skills are essential for all
health care providers who are involved in the delivery of newborns. The
transition from fetus to newborn requires intervention by a skilled individual
or team in approximately 10% of all deliveries. This figure is concerning
because 81% of all babies in the United States are born in nonteaching
nonaffiliated level I or II hospitals.
In such hospitals, the volume of delivery
service may not be perceived to economically justify the continuous in-hospital
presence of personnel with high-risk delivery room experience as recommended by
the American Academy of Pediatrics (AAP) and the American College of
Obstetricians and Gynecologists (ACOG) in Guidelines for Perinatal
Care.
Perinatal asphyxia and extreme prematurity are the 2 complications
of pregnancy that most frequently require a complex resuscitation by skilled
personnel. However, only 60% of asphyxiated newborns can be predicted
antepartum. The remaining newborns are not identified until the time of birth.
Additionally, approximately 80% of low birth weight infants require
resuscitation and stabilization at delivery. Nearly one half of newborn deaths
(many of which are extremely premature infants) occur during the first 24 hours
following birth. A number of these early deaths also have a component of
asphyxia and/or respiratory depression as an etiology. For the surviving
infants, effective management of asphyxia in the first few minutes of life may
influence long-term outcome.
Even though prenatal care is able to
identify many potential fetal difficulties antepartum, allowing maternal
transfer of care to the referral center, many women who experience preterm labor
are not identified prospectively, therefore not allowing the appropriate
maternal transfer to a tertiary perinatal center. Consequently, many deliveries
of extremely premature infants occur in smaller hospitals. For this reason, all
personnel involved in delivery room care of the newborn should be trained
adequately in all aspects of neonatal resuscitation.
This chapter reviews
the adaptation to extrauterine life and the steps necessary to optimally
resuscitate neonates. Along with the necessary skills, the practitioner should
approach any resuscitation with a good comprehension of transitional physiology
and adaptation, as well as an understanding of the infant's response to
resuscitation. Resuscitation involves knowing much more than an ordered list of
skills and having a resuscitation team; it requires excellent assessment skills
and a grounded understanding of physiology.
To decrease neonatal
morbidity and mortality, the practitioner must be able to rapidly identify
infants whose transition from an intrauterine to extrauterine physiology is
delayed. Neonatal transition requires spontaneous breathing and successful
cardiopulmonary changes, as well as other changes to independent organ system
functions. A thorough understanding of normal transitional physiology leads to a
better understanding of the needs of the infant who is experiencing difficulties
and, therefore, should result in a more effective resuscitative effort.
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