Recent Recommendations in Neonatal Resuscitation 2019 UPDATE

Sometimes we need a reminder and update on the basics… Your Welcome..

Recent Recommendations and Emerging Science in Neonatal Resuscitation. Pediatr Clin N Am 66 (2019) 309–320. https://doi.org/10.1016/j.pcl.2018.12.002

TIMING OF UMBILICAL CORD CLAMPING 
– The 2017 NRP guidelines recommend a 30- to 60-second delay in clamping in all term and preterm infants not requiring resuscitation.

– If the placental circulation is disrupted (e.g., placental abruption), the cord should be clamped immediately. Investigators found that delayed clamping reduced mortality before discharge.

– Another option is to clamp and cut a long segment of the cord immediately after birth and then milk the cord. The major advantage of either method of cord milking is that the newborn can be passed to the awaiting resuscitation team without delay while preserving the receipt of the placental transfusion.
ROOM TEMPERATURE
– Delivery room temperatures should be at 23 C to 25 C (74 F–77 F).

AIRWAY MANAGEMENT in  MECONIUM-STAINED AMNTIOTIC FLUID
– Suctioning of newborns should be performed only if the airway is obstructed or if PPV is needed.
– In nonvigorous infants born through meconium-stained amniotic fluid (MSAF), current recommendations include only intubation and endotracheal suctioning for those who need it for ventilation or airway obstruction.

OXYGENATION ASSESSMENT AND ADMINISTRATION 
– It is recommended that room air (21% O2 at sea level) be used at the initiation of resuscitation in infants born at 35 weeks gestation.

– Failing to reach SpO2 of 80% at 5 minutes was associated with adverse outcomes including intraventricular hemorrhage, and risk of death was significantly increased with time to reach SpO2 80%.
ENDOTRACHEAL INTUBATION AND LMA 
– Endotracheal intubation is indicated for ineffective or prolonged positive pressure ventilation (PPV) or for special circumstances such as an abnormal airway anatomy.
CHEST COMPRESSIONS

– Chest compressions are indicated when heart rate remains less than 60 beats/min after at least 30 seconds of PPV. When chest compressions begin, supplemental O2 may be increased until the heart rate recovers and weaned rapidly afterward.
– Epinephrine is indicated when the heart rate is <60 beats/min after 60 seconds of chest compressions coordinated with PPV using 100% O2