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As authors of the 2015 guidelines we read with interest the “UK neonatal resuscitation survey” . Comparison with 2012 shows a rewarding positive effect of successive guidelines on newborn resuscitation practice.
However, we wanted to address this statement: “…updated guidelines have been criticised for failing to consider data from the Targeted Oxygen in the Resuscitation of Preterm Infants [To2rpido]”. To2rpido , published 2017, was unavailable for inclusion in 2015 ILCOR reviews of evidence. . The analysis referred to was post-hoc and unprespecified. Clinicians were not blinded and recruitment was problematic. Enrolling only 5% of eligible infants, To2rpido was terminated after reaching 15% of targeted sample size due to loss of equipoise: ironically, clinicians were concerned about using high oxygen concentrations.
Nonetheless, To2rpido generated such interest that it led to the first neonatal review in ILCOR’s continuous evidence evaluation strategy.  Utilising GRADE methodology to rate quality of evidence and strength of recommendations, To2rpido’s impact was downgraded because of high risk of bias. This review  continues to recommend “starting with a lower oxygen concentration (21–30%) compared to higher oxygen concentration (60–100%)” whilst highlighting many gaps in our current knowledge.
The use of end-tidal CO2 (ETCO2) detection was not recommended because the guidelines, and Newborn Life Support (NLS) course, focus on airwa...
The use of end-tidal CO2 (ETCO2) detection was not recommended because the guidelines, and Newborn Life Support (NLS) course, focus on airway management without need for intubation. Both explain how, and when, ETCO2 might be used highlighting limitations to its use. The European guidelines, on which UK guidelines are based, state “detection of exhaled carbon dioxide in addition to clinical assessment is recommended as the most reliable method to confirm tracheal placement in neonates with spontaneous circulation”.  Given this, considered and careful use of ETCO2 detection best sits within the Advanced Resuscitation of the Newborn Infant (ARNI) course which teaches care, including intubation, beyond Newborn Life Support.
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