Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations☆,☆☆

The first steps in resuscitation include stimulating the infant, maintaining a normal body temperature through management of heat gain and loss, and assessment of breathing and heart rate. About 5% of babies will require resuscitation beyond drying and stimulation. These percentages may seem small, but these numbers add up to about 190,000 babies in the United States and 6.8 million worldwide each year who require resuscitative measures beyond the initial basic steps. Birth attendants with neonatal resuscitation training can decrease neonatal mortality.

To maximize the chances of survival during neonatal resuscitation, rapid assessment of HR is crucial to evaluate neonatal status and guide resuscitation interventions. Underestimating neonatal HR leads to unnecessary life-saving interventions, while overestimating neonatal HR may delay life-saving interventions. Using the most reliable and accurate method of measuring HR is crucial in guiding resuscitation actions during the first minutes of life. The purpose of this manuscript is to provide a review of the current options for HR measurement during neonatal resuscitation, and to highlight strengths and limitations of each method. Well-established methods to assess neonatal HR within the first minutes of life include auscultation, palpation, PO, and ECG. Accuracy of these routine methods varies, with ECG considered as the most reliable and accurate method. Additional technologies that hold promise for the future are also reviewed.

The transition of a fetus to a newborn involves a sequence of well-orchestrated physiological events. Most neonates go through this transition without assistance but 5–10% may require varying degrees of resuscitative interventions at birth. The most crucial event during this transition is lung inflation with optimal concentrations of oxygen. Rarely, extensive resuscitation including chest compressions and medication may be required. In the past few decades, significant strides have been made in our understanding of the cardiorespiratory transition at birth from a fetus to a newborn and the subsequent resuscitation. This article reviews the physiology behind neonatal transition at birth and various interventions during neonatal resuscitation.

The study aims to assess the effect of sensory stimulation on apnoea among premature newborns.

Thirty preterm newborns that were diagnosed with apnoea of prematurity, had a gestational age between 32 and 34 weeks, had low birth weight, and were appropriate for gestational age from 1200 to 2000 g were included in this prospective randomized study. Subjects were divided into two equivalent groups: a control group that received the standard care including nasal oxygen (one litre per minute) and caffeine citrate, and a study group that received the same care plus sensory stimulation (tactile, proprioceptive, and kinaesthetic). Participants’ heart rate, oxygen saturation, and apnoea frequency were measured by the neonatal intensive care unit team using a pulse-oximeter. The sensory stimulation sessions were 10 min, 3 times per day, totalling 30 min over a 7 day period.

There was a significant decrease in heart rate within both groups after receiving treatment from before treatment (p < 0.05), with no significant differences between the two groups. Furthermore, there was no significant difference in oxygen saturation within the groups after treatment compared with the levels before treatment, with no significant differences between the two groups (p > 0.05). Before treatment, there was a non-significant difference in the apnoea rate between both groups (p = 0.464), whereas there was a significant decrease in the apnoea rate of the study group after treatment compared with the control group (p = 0.031).

Sensory stimulation applied with standard respiratory care can decrease the frequency of apnoea of prematurity.

The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.

The digital revolution of noncontact physiological signal monitoring in clinical and home health care is underway, and deep learning techniques are incredibly popular. Camera-based physiological signal monitoring for adults has made considerable progress in recent years. However, most of existing methods and datasets are developed for adult subjects, and until now, there has been no neonatal public database that is collected for developing deep learning method. Thus, in this paper, we introduce a large-scale newborn baby database, named NBHR (newborn baby heart rate estimation database), to fill the abovementioned knowledge gap. A total of 9.6 h of clinical videos (1130 videos totaling 921 GB) and reference vital signs are recorded from 257 infants at 0–6 days old. The facial videos and corresponding synchronized physiological signals, including photoplethysmograph information, heart rate, and oxygen saturation level, are recorded in our database. This large-scale database could be used to develop deep learning methods to estimate heart rate or oxygen saturation levels. Furthermore, a multitask deep learning method, called NBHRnet, is proposed to estimate heart rate based on the NBHR database, and the model is succinct that it can be deployed on a computer without GPUs. The experimental results indicate that NBHRnet yields competitive performance in predicting infant heart rate, with a mean absolute error of 3.97 bpm and a mean absolute percentage error of 3.28%; additionally, it can estimate heart rate almost instantaneously (2 s/60 frames). Our datasets are freely publicly available by request.