Special ReportResuscitation of the newly born infant: an advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation☆,☆☆
Section snippets
Purpose
The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to provide a forum for liaison between the following principal resuscitation organizations in the developed world: the American Heart Association (AHA), European Resuscitation Council (ERC), Heart and Stroke Foundation of Canada (HSFC), Australian Resuscitation Council (ARC), Resuscitation Council of Southern Africa (RCSA), and Council of Latin America for Resuscitation (CLAR). Since 1992, international consensus
Need for BLS and ALS guidelines for the newly born
Resuscitation of the newly born infant presents a different set of challenges than resuscitation of the adult or even the older infant or child. The transition from dependence on placental gas exchange in a liquid-filled intrauterine environment to spontaneous breathing of air presents dramatic physiological challenges to the infant within the first minutes to hours after birth. Approximately 5–10% of the newly born population require some degree of active resuscitation at birth (e.g.
Personnel
Personnel trained in the basic skills of resuscitation at birth should be in attendance at every delivery. Ideally, at least one person should be responsible solely for the care of the infant. A person trained in ALS techniques for the newly born should be available for normal low-risk deliveries and in attendance for all deliveries considered at high risk for neonatal resuscitation. Appendix A lists the maternal, fetal, and intrapartum circumstances that place the newly born infant at risk.
Techniques of resuscitation
The techniques of ALS resuscitation are discussed below and are outlined in the Fig. 1, which shows the universal template for ALS of the newly born.
Special resuscitation circumstances
Several circumstances have unique implications for resuscitation of the newly born infant. Birth attendants are sometimes aware of these special circumstances through prenatal diagnostic information. While the implications of these circumstances for resuscitation are described below, full consideration and discussion of these entities are beyond the scope of this advisory statement.
Continuing care of the newly born infant after resuscitation
After resuscitation with ALS, ongoing supportive care, monitoring, and appropriate diagnostic evaluation must be provided. Once adequate ventilation and circulation have been established, the infant who has required resuscitation is still at risk and should be maintained in or transferred to an environment in which close monitoring and anticipatory care can be provided. This should include oxygen saturation and heart rate monitoring with blood gas measurement as indicated. Blood pressure should
Initiation of resuscitation
The delivery of extremely immature infants and those with severe congenital anomalies raises questions about initiation of resuscitation [77], [78], [79], [80], [81]. In such cases, initiation of resuscitation at delivery does not mandate continued support. Non-initiation of support and later withdrawal of support are generally considered to be ethically equivalent; however, the latter approach allows time to gather more complete clinical information and to provide counseling to the family.
Documentation of resuscitation
It is essential for good clinical care, for communication, and for medicolegal concerns that the findings at each assessment and the actions taken in resuscitation are fully documented. The Apgar scores quantify and summarize the response of the newly born infant to the extrauterine environment and to resuscitation [84], [85]. An Apgar score is used to assess and record breathing, heart rate, muscle tone, reflex irritability, and color at 1 and 5 min after birth and then sequentially every 5
Areas of controversy and need for additional research
The ILCOR Pediatric Working Group recognizes the difficulty in creating advisory statements for universal application. After careful review of the rationale for current guideline recommendations from among the constituent resuscitation councils (Table 2), the working group identified the following areas of controversy regarding resuscitation of the newly born infant. The group believes that additional research is required in these areas before more specific, evidence-based universal ALS
Summary
Scientific justification of each component of current resuscitation council guidelines is difficult because of the paucity of outcome data specifically addressing interventions in the newly born. Rapid transitions from intrauterine to extrauterine physiology further complicate the interpretation of findings and make education of trained birth attendants more complex. Assessment, stimulation, and provision of the first breaths of life are simultaneous critical steps in initial resuscitation of
Pediatric and neonatal ILCOR participants and expert reviewers
Walter Kloeck, MD; Efraim Kramer, MD; Jelka Zupan, MD; Amelia Reis, MD; David Burchfield, MD; David Boyle, MD; Waldemar Carlo, MD; Linda McCollum, RN; Susan E. Denson, MD; Martha Mullett, MD; Alfonso Solimano, MD; Michael Speer, MD; Jeffrey Perlman, MD; Robert Berg, MD; Robert Hickey, MD; Amy Davis, RN; Jay Deshpande, MD; Thomas Terndrup, MD; Lisa Carlson, RN; Mary E. Fallat, MD; Dianne Atkins, MD; Sally Reynolds, MD; Charles Schleien, MD; Tres Scherer, MD; Pip Mason; Petter Steen, MD; Richard
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‘Resuscitation of the Newly Born Infant’ is being copublished in Circulation, Pediatrics, Resuscitation and European Journal of Pediatrics.
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