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Leading article
Advances in neonatal resuscitation: supporting transition
  1. Colin J Morley,
  2. Peter G Davis
  1. Neonatal Services, Royal Women’s Hospital, Carlton, Victoria 3053, Australia
  1. C Morley, Neonatal Services, Royal Women’s Hospital, Carlton, Victoria 3053, Australia; colin.morley{at}rwh.org.au

https://doi.org/10.1136/adc.2007.128827

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    NEONATAL TRANSITION

    Although neonatologists use the term resuscitation we rarely practise resuscitation as the adult doctors understand it. An adult who collapses lifeless needs very urgent chest compressions, cardioversion and ventilation. Such an episode is very uncommon in neonates. Wyckoff et al suggests that it probably occurs in less than 1:2000 deliveries.1 Newborn infants who do not breathe sufficiently need gentle assistance to make the transition from placental to pulmonary gas exchange.

    LUNG AERATION AND OXYGENATION

    Apnoea and bradycardia after birth are caused by relative hypoxia of the brain stem and myocardium. At birth the lungs are not aerated and filled with lung liquid. If infants do not breathe adequately they need assistance aerating their lungs and forming a functional residual capacity (FRC). Oxygenation of the myocardium then improves and the heart rate and blood pressure rapidly increase. Shortly thereafter the brain stem recovers and breathing starts. Most apnoeic newborn infants respond well to effective aeration of the lungs. If the heart rate does not increase quickly then the ventilation technique is probably unsatisfactory. Cardiac massage is rarely needed if the ventilation is adequate.

    100% OXYGEN OR AIR

    Treating newborn infants at birth with 100% oxygen is traditional.2–5 However, 100% oxygen may cause injury and should be used cautiously.6 7 Free radical damage to the newborn and in particular the preterm infant is well recognised.8 9 A meta-analysis of randomised controlled trials suggests that using 100% oxygen is associated with an increased mortality compared with air.10

    PULSE OXIMETRY

    Observing whether a newborn infant is cyanosed is part of the traditional assessment. However, it is subjective and cannot be reliably used to decide on the appropriate fraction of inspired oxygen (FiO2).11 Recent studies show that it is possible to obtain accurate oximetry readings of heart rate and oxygen saturation, from the right hand …

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    Footnotes

    • Funding:PD is supported by an NHMRC practitioner fellowship. The authors’ research is supported by NHMRC programme grant no. 384100.

    • Competing interests: None.